Ulcers Case Xxv
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
The following case illustrates the superior efficacy of the lunar
caustic over the ordinary modes of treatment in some ulcers of the
legs, and will, I trust, be found particularly interesting.
Mr. G.B. aged 60, a very tall and stout person, had two ulcers, one of
the size of a shilling upon the back of the leg just above the tendo
achillis, the other rather less, on the outside of the leg; they were
by his scratching the parts severely three months before; and
he had used various remedies in the interval. There were some oedema
of the leg to which he is subject, and much pain and inflammation of
the ulcers. I directed the application of a cold poultice and lotion,
and prescribed the pil. hydrarg. every second night with an aperient
draught the following morning.
This plan of treatment was continued for a number of days without any
appearance of healing in the ulcers. As the inflammation had subsided
I proposed to adopt the mode of treatment recommended by Mr. Baynton,
fearing that any attempt to heal the ulcers by eschar would fail on
account of the oedema. This project was deferred, however, by the
patient's wish to try the effect of sea-bathing. After a month's
residence on the sea shore I was, on the return of my patient, again
requested to examine these ulcers, which I found very nearly in the
same state as before, only with the addition of some excoriations. I
recommended the cold poultice for a few days to allay inflammation,
and then tried Mr. Baynton's plan, dressing the leg myself daily; on
the fourth day, however, the sore above the tendo achillis became so
irritable that I was compelled to desist and to remove the plaster and
bandage, and I again directed the cold poultice with rest, for a few
When the inflammation had again subsided, I ventured, notwithstanding
the oedema, to apply the lunar caustic to form an eschar, enjoining
rest and the horizontal position.
On the following day complete but unadherent eschars were formed over
each sore. There, had been no pain after the smart of the caustic had
ceased. On carefully making an incision into the centre of each
eschar, a little fluid was evacuated.
On the second day, rather more fluid was evacuated in the same manner.
There was a little more inflammation round the eschar than yesterday.
On the third day the sores were exactly in the same state. On the
fourth, the patient having used his leg a little, rather more fluid
was evacuated from the centre, and there was rather more inflammation
round the edges, of the eschars. I enjoined the strictest rest.
On the fifth day, there were less inflammation and discharge.
From this day until the tenth the fluid required daily evacuation; the
eschar became adherent, and I allowed my patient to walk about.
In about six weeks the eschar was nearly separated and I removed it
by the scissors, leaving only a portion adherent of the size of a
pea. It had been prevented from being removed from the beginning, by
the gold-beater's skin. The smaller eschar had dropped off leaving the
ulcer quite healed. In a week more the last portion of eschar
separated from the larger sore, leaving it also quite well.