Punctures Case Viii

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

This case illustrates the mode of treatment by the lunar caustic, of

those terrible effects of punctured wounds which have been neglected

in the beginning.



B. Unwin, aged 40, washerwoman, applied to me on July the 10th, 1820,

with severe inflammation and ulceration of the middle finger, arising

from a puncture by a pin or needle some time before; there was much

painful tumefaction, and the integuments had burst along nearly half

of the length of the finger, on the ulnar side, and over the middle

joint on the radial side; the probe did not however pass to the bone

or into the joint. I applied the lunar caustic deep in every part, and

over the whole surface, and enveloped the finger in a cold poultice

covered with cold water.



On the 11th she reported that she had slept well for the first time

during the last fortnight; to-day there is scarcely any pain, but she

complains of soreness; the swelling has greatly subsided. The caustic

was again applied and the poultice and lotion continued.



On the 12th there were still swelling and pain; there was considerable

bleeding from the wound, so that I could not apply the caustic well.



On the 13th the swelling and pain were nearly gone. I repeated the

caustic which induced bleeding from the fungous flesh.



On the 14th the swelling had nearly subsided; the cuticle was

separating all over the finger. The lunar caustic was applied

extensively over the wound and abraded parts and induced little

bleeding or pain.



On the 15th the fungous was nearly removed; the wound presented an

appearance of slough over its surface.--The caustic was applied to the

remaining fungous.



On the 17th the wound was much smaller and the slough separating. The

caustic and cataplasm were applied as before.--A similar report was

made on the succeeding day.



On the 20th the slough was separating. The caustic and cataplasm were

applied.--A similar report was made on the 22d.



On the 24th the slough having separated the integuments over it were

flabby and loose; the caustic was applied to them.



By a continuation of this plan the wound gradually contracted, and, at

length, when there was no further use for the cataplasm, the eschar

became adherent and the sore healed underneath. It appeared highly

probable to me that, under ordinary treatment, the finger, in this

case, would have been lost.



* * * * *



I shall in this place, introduce a few observations on wounds received

during dissection.



It is not in my power to give any cases in illustration of the

treatment of the severer accidents resulting from these wounds; for

since I began the free use of the lunar caustic all the terrible

effects of such wounds have been invariably prevented.



I may here mention that in the years 1813 and 1819, respectively, I

was myself exposed to great danger from inoculation during the

examination of dead bodies. Since the latter period I have repeatedly

been exposed to the same danger from inoculation, but in every

instance, the danger has been completely averted by the prompt and

free application of the lunar caustic.



The following is the exact mode of treatment which I would adopt in

such cases.



In recent punctures the caustic should be applied in the manner

already described in cases of simple punctured wounds.



When the case has been neglected, a small tumour is usually formed

underneath the skin with smart stinging pain; this tumour should be

removed entirely by the lancet, and the caustic should be applied,

both to the surface of the wound and over the surrounding skin, to

form an adherent eschar.



When the case has been still longer neglected, and inflammation of the

absorbents has supervened, a free crucial incision is to be made, the

caustic is to be very freely applied, and afterwards a cold poultice

and lotion, the usual constitutional remedies being actively enforced.



* * * * *



In connexion with punctured wounds I here subjoin several cases of the

bites of animals.