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Ulcers Case Xxviii





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

Mrs. U. aged 60, has been subject to ulcerated legs for several years.
She has one ulcer on the outer ankle of the size of a shilling, and
another behind it of the size of a horse-bean; they have been
extremely troublesome and under surgical treatment for the last year,
but during the last few weeks she has tried cerate, poultice, and the
cold lotion. The leg is much swollen and inflamed, the redness
extending several inches round the wound and over the instep; the
oedema increases towards night. She has been in the habit of taking
saline purgatives frequently.

I directed my patient to continue the cold poultice and lotion, and to
rest completely for several days. At this period, the inflammation
having somewhat abated, I applied the lunar caustic to form eschars
and protected the parts with gold-beater's skin.

On the following day there was a slight increase of redness round the
eschars. Upon making an incision into their centre some fluid was
evacuated. The same report was made on each of the two following
days.

On the seventh day, the eschars having been neglected, fluid had
escaped from beneath the eschars at their edges, and my patient
complained of more pain. A little more fluid escaped in the same
manner on the following day on making a little pressure upon the
eschars. I applied the caustic to make up the breach.

Subsequently to this day there was an increase of inflammation. From
this circumstance, and from the neglect of the eschars for two or
three days already mentioned, I suspected the formation of a scab
under them. It was impossible to pierce the eschars by the penknife
without breaking them, as they had become too hard and thick by delay
and the addition of the scab.

I again directed the cold poultice for four or five days. On examining
the wounds on the separation of the eschars, I found the healing
process going on. I reapplied the lunar caustic to form eschars, and I
evacuated a little fluid from their centre for three successive days.

At this time the patient took cold and a smart attack of fever came
on, and the part round the eschars became much inflamed. I prescribed
an emetic and purge, and a cold poultice and lotion.

In the space of a week I again attempted to form an eschar over the
larger wound, for the smaller one had quite healed.

The next day I discharged a little fluid from the centre, and again on
the eight or nine succeeding days, giving saline purgatives.

After this time the eschar remained adherent, and no further remedy
was required.

This case is particularly interesting and important, as it illustrates
the plans to be adopted in two circumstances of no unfrequent
occurrence; 1. when there is an attack of fever and increased
inflammation, and 2. when a scab forms underneath the eschar. In both
cases we must relinquish our attempt to form an adherent eschar for a
time,--apply the poultice,--and recur to the caustic in the course of
a few days.

In the beginning of my trials of the treatment of the ulcers by the
caustic, I was repeatedly betrayed by the smooth appearance of the
eschar, to think that all was going on well, when in fact a scab was
all along forming underneath. In these cases inflammation soon
followed, and it was only by carefully and daily evacuating the fluid
effused under the eschar that I at length succeeded in effecting an
adherent eschar free from surrounding inflammation. This remark cannot
be too often repeated.





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