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On Ulcers

Sources: Application Of The Lunar Caustic In The Cure Of Certain Wounds And Ulcers

From the preceding observations it would naturally be concluded that

the lunar caustic would afford a remedy for the treatment of ulcers.

This conclusion is perfectly just. Yet there are many circumstances

which render the mode of treating ulcers by the caustic, efficacious

or the contrary.

In order that the treatment by eschar may be successful, there must be

the following conditions in regard to the ulc
r: first, the surface

occupied by the ulcer must not be too extensive; secondly, it must

not be exposed to much motion or friction; and thirdly, it must not be

attended by a profuse discharge; for all these circumstances have a

direct effect in, preventing the formation of an adherent eschar or of

removing it if formed.

I observe, therefore, that I have not found the mode of treatment by

eschar to succeed in large ulcers of the legs. But in small ulcers,

and especially in those irritable and painful little ulcers which are

so apt to form about the ankle and occasionally occur near, the tendo

achillis, and in which Mr. Baynton's plan is inadmissible, the caustic

is invaluable; in these cases the cold poultice and lotion should

precede the application of the caustic, for a few days, that the

irritability and inflammation of the sore and surrounding skin may be

first subdued; and after the eschar is formed, the part must be kept

exposed to the air and defended from external injury, by enjoining the

patient to wear trowsers and to be careful not to disturb the eschar.

The plan of curing ulcers is exactly what has been described in the

treatment by the unadherent eschar. For in these cases the eschar is

generally unadherent at first. It is necessary therefore in all cases,

except those of very small ulcers, to examine the eschar, making a

small puncture or rather smooth incision in its centre, so as to

evacuate the subjacent fluid if there be any, taking great care not to

break down or bruise the eschar so as to leave its inferior surface at

all ragged. This operation should be repeated daily until the eschar

proves to be quite adherent. And if the ulcer be rather large, rest

should be enjoined until the adherent eschar be fully and safely

formed, and a dose of saline purgative may be interposed. It must also

be particularly borne in mind, that the eschar must be constantly

defended by the gold-beater's skin, which must be removed and

reapplied at each examination.

I have here spoken of ulcers upon the legs. But the same observations

apply to ulcers on other parts of the body, and these are, in general,

far more manageable than the former, and do not require the same rest

during the unadherent state of the eschar.