Ulcers Case Xxviii


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

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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