Ulcers Case Xxv


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

The following case illustrates the superior efficacy of the lunar

caustic over the ordinary modes of treatment in some ulcers of the

legs, and will, I trust, be found particularly interesting.



Mr. G.B. aged 60, a very tall and stout person, had two ulcers, one of

the size of a shilling upon the back of the leg just above the tendo

achillis, the other rather less, on the outside of the leg; they were

caused by his scratching the parts severely three months before; and

he had used various remedies in the interval. There were some oedema

of the leg to which he is subject, and much pain and inflammation of

the ulcers. I directed the application of a cold poultice and lotion,

and prescribed the pil. hydrarg. every second night with an aperient

draught the following morning.



This plan of treatment was continued for a number of days without any

appearance of healing in the ulcers. As the inflammation had subsided

I proposed to adopt the mode of treatment recommended by Mr. Baynton,

fearing that any attempt to heal the ulcers by eschar would fail on

account of the oedema. This project was deferred, however, by the

patient's wish to try the effect of sea-bathing. After a month's

residence on the sea shore I was, on the return of my patient, again

requested to examine these ulcers, which I found very nearly in the

same state as before, only with the addition of some excoriations. I

recommended the cold poultice for a few days to allay inflammation,

and then tried Mr. Baynton's plan, dressing the leg myself daily; on

the fourth day, however, the sore above the tendo achillis became so

irritable that I was compelled to desist and to remove the plaster and

bandage, and I again directed the cold poultice with rest, for a few

days.



When the inflammation had again subsided, I ventured, notwithstanding

the oedema, to apply the lunar caustic to form an eschar, enjoining

rest and the horizontal position.



On the following day complete but unadherent eschars were formed over

each sore. There, had been no pain after the smart of the caustic had

ceased. On carefully making an incision into the centre of each

eschar, a little fluid was evacuated.



On the second day, rather more fluid was evacuated in the same manner.

There was a little more inflammation round the eschar than yesterday.



On the third day the sores were exactly in the same state. On the

fourth, the patient having used his leg a little, rather more fluid

was evacuated from the centre, and there was rather more inflammation

round the edges, of the eschars. I enjoined the strictest rest.



On the fifth day, there were less inflammation and discharge.



From this day until the tenth the fluid required daily evacuation; the

eschar became adherent, and I allowed my patient to walk about.



In about six weeks the eschar was nearly separated and I removed it

by the scissors, leaving only a portion adherent of the size of a

pea. It had been prevented from being removed from the beginning, by

the gold-beater's skin. The smaller eschar had dropped off leaving the

ulcer quite healed. In a week more the last portion of eschar

separated from the larger sore, leaving it also quite well.





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