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Punctures Case Xiii

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

Am old man applied leeches to the instep for inflammation occasioned

by a bruise. Several very irritable sores were produced with some

swelling. I applied the lunar caustic to form an eschar.

On the following day, the eschars were adherent, the swelling had

subsided, and he had slept well for the first time of several nights.

I do not, however, think the lunar caustic would succeed in such cases
/> if attended by great inflammation, without the previous application of

a cold poultice with rest for a day or two.


It has been already observed, p. 9, that the caustic is an invaluable

remedy in cases of bruised wounds of the shin. In these, as in all

other cases, the value of this remedy is greatly enhanced by an early

application. In bruises on the shin I have not had a single instance

in which I was not enabled to effect a cure by the adherent eschar, if

application was made to me early. The difficulty of forming an

adherent eschar is always increased by delay; but in these bruises

along the shin there is an additional reason for this increased

difficulty, arising out of the tendency observed in them, to the

formation of a slough.

In this place I have, indeed, to make an observation of particular

interest, both in a pathological and curative point of view; it is,

that the formation of this slough has always been prevented by an

early application of the caustic, in the cases which have hitherto

fallen under my care. This fact may probably admit of explanation in

the following manner; the bruise partially destroys the organization

of the part, and the subsequent inflammation completing what the

injury had partially effected, a loss of vitality takes place, and

the slough is formed. The early application of the caustic has

already been shown to have the remarkable effect of preventing the

inflammation consequent upon certain wounds, and thus the part is

suffered to recover from the injury done to its organization, and its

vitality is preserved.

Whether this mode of explaining the fact be correct or no, the fact

itself is extremely important, for the formation of a slough, which

the early application of the caustic can alone prevent, renders it

quite impossible to effect the formation of an adherent eschar.

When the patient applies too late after the accident to prevent the

formation of a slough we must still treat the case by the caustic. It

is to be applied over the bruised and inflamed part. The eschar

remains adherent round the part occupied by the slough and prevents or

moderates the inflammation, and when the slough separates an eschar is

to be formed over the exposed sore.

In the neglected and severer cases of bruise attended by much

inflammation, it will be found best to treat the part for a day or two

by a cold poultice to give time for the inflammation to subside;

otherwise the caustic might induce vesication of the skin, as I have

mentioned already, p. 5, and the eschar could not be adherent.