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Punctures Case Xiii





Category: ON THE APPLICATION OF THESE MODES OF TREATMENT TO PARTICULAR CASES.
Source: Application Of The Lunar Caustic In The Cure Of Certain Wounds And Ulcers

Am old man applied leeches to the instep for inflammation occasioned
by a bruise. Several very irritable sores were produced with some
swelling. I applied the lunar caustic to form an eschar.

On the following day, the eschars were adherent, the swelling had
subsided, and he had slept well for the first time of several nights.

I do not, however, think the lunar caustic would succeed in such cases
if attended by great inflammation, without the previous application of
a cold poultice with rest for a day or two.


TTTILE ON BRUISES.

It has been already observed, p. 9, that the caustic is an invaluable
remedy in cases of bruised wounds of the shin. In these, as in all
other cases, the value of this remedy is greatly enhanced by an early
application. In bruises on the shin I have not had a single instance
in which I was not enabled to effect a cure by the adherent eschar, if
application was made to me early. The difficulty of forming an
adherent eschar is always increased by delay; but in these bruises
along the shin there is an additional reason for this increased
difficulty, arising out of the tendency observed in them, to the
formation of a slough.

In this place I have, indeed, to make an observation of particular
interest, both in a pathological and curative point of view; it is,
that the formation of this slough has always been prevented by an
early application of the caustic, in the cases which have hitherto
fallen under my care. This fact may probably admit of explanation in
the following manner; the bruise partially destroys the organization
of the part, and the subsequent inflammation completing what the
injury had partially effected, a loss of vitality takes place, and
the slough is formed. The early application of the caustic has
already been shown to have the remarkable effect of preventing the
inflammation consequent upon certain wounds, and thus the part is
suffered to recover from the injury done to its organization, and its
vitality is preserved.

Whether this mode of explaining the fact be correct or no, the fact
itself is extremely important, for the formation of a slough, which
the early application of the caustic can alone prevent, renders it
quite impossible to effect the formation of an adherent eschar.

When the patient applies too late after the accident to prevent the
formation of a slough we must still treat the case by the caustic. It
is to be applied over the bruised and inflamed part. The eschar
remains adherent round the part occupied by the slough and prevents or
moderates the inflammation, and when the slough separates an eschar is
to be formed over the exposed sore.

In the neglected and severer cases of bruise attended by much
inflammation, it will be found best to treat the part for a day or two
by a cold poultice to give time for the inflammation to subside;
otherwise the caustic might induce vesication of the skin, as I have
mentioned already, p. 5, and the eschar could not be adherent.





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