Part 1 (1/2)

An Essay on the Application of the Lunar Caustic in the Cure of Certain Wounds and Ulcers.

by John Higginbottom.

PREFACE.

The following pages are presented to the medical public with very humble pretensions. It is chiefly with the minor accidents or diseases that they have to do; but I shall not consider that I have laboured in vain, if I am enabled to mitigate even these little evils of human life.

In these prefatory observations, however, I would suggest the question whether the caustic may not be employed with benefit even in some of the severer diseases to which the human frame is liable. Indeed I consider the investigation as only just begun, and many other uses of the lunar caustic, besides those detailed in the following pages, have suggested themselves to me.

May not the caustic, for instance, be of greater efficacy, because of greater power and of quicker operation, than ordinary blisters, in some internal diseases?

It is repeatedly stated hereafter, that the application of the lunar caustic is a means, in certain circ.u.mstances, of subduing external inflammation. Might it not, on this principle, be of service in the treatment of some of the internal phlegmasiae?

It may be observed, that the lunar caustic may be regarded, almost without further trial, as an effectual preventive of those cases of irritative fever which arise from local injuries, and probably of the effects of poisoned wounds in general. I would not, however, in the latter cases, fail to render ”sure doubly sure” by free excision.

Might not an adherent eschar be easily formed in those cases of compound fracture in which the external wound is of moderate size, so as effectually to exclude the external air and prevent cutaneous inflammation, and in more respects than one, to reduce the case to the state of a simple fracture? This object, if attained, would be important indeed, and I hope the suggestion will be submitted to the most a.s.siduous and cautious trial.

I can have no doubt that the use of the lunar caustic admits of being still further extended; and, as I intend to pursue the inquiry, I hope at some future period to publish something more worthy of the attention of the medical public. In the mean time, the plans hereafter suggested must not be adopted without that degree of care, attention, and perseverance, which are obviously necessary to render them successful.

CHAPTER I.

ON HEALING BY ESCHAR.

Having been led, by several circ.u.mstances, to try the effects of the Lunar Caustic in the treatment of Wounds and Ulcers, and having great reason, from these trials, to think that this remedy may be used with much advantage far more extensively than has. .h.i.therto been done, I lay the results of my experience before my medical brethren.

A very natural mode of healing certain wounds and ulcers, is by scabbing; but this mode of treatment is attended by many disadvantages, as will be pointed out shortly; yet it may be supposed to have suggested to me some of those trials of the treatment by eschar, which I am about to detail.

I. ON THE ADHERENT ESCHAR.

It appears scarcely necessary to describe the immediate and well known effects of the application of the lunar caustic to the surface of a wound or ulcer. It may, however, be shortly observed that the contact of the caustic induces, at first, a white film or eschar which, when exposed to the air, a.s.sumes in a few hours a darker colour, and at a later period, becomes black; as the eschar undergoes these changes of colour it gradually becomes harder and resembles a bit of sticking plaster; in the course of a few days, according to the size and state of the wound, the eschar becomes corrugated and begins to separate at its edges, and at length peels off altogether, leaving the surface of the sore underneath, in a healed state.

In the formation of this eschar several things require particular attention. The application of the caustic should be made over the whole surface of the sore; and indeed no part requires so much attention as the edges; to make a firmer eschar the caustic should even be applied beyond the edge of the wound, upon the surrounding skin, for the eschar in drying is apt to contract a little, and in this manner may leave a s.p.a.ce between its edges and that of the adjacent healthy skin.

At the same time, much attention must be paid to the degree in which the caustic is applied. In cases of recent wounds unattended by inflammation, it may be applied freely; but when inflammation has come on, too severe an application of the caustic induces vesication of the surrounding skin, and the edges of the eschar may in this manner also be loosened and removed. If every part is touched, a slight application of the caustic is generally sufficient.

The importance of avoiding all causes which might detach the edges of the eschar will be apprehended by the following interesting observation, which I have been enabled to deduce from very extensive trials of the caustic; it is, that, in every instance in which the eschar remains adherent from the first application, the wound or ulcer over which it is formed, invariably heals.

Not only the cause just mentioned, but every other by which the eschar might be disturbed, must, therefore, be carefully avoided; and especially, as the eschar begins to separate from the healed edges of the sore, it should be carefully removed by a pair of scissors.

To the surface of the wound the eschar supplies a complete protection and defence, and allows the healing process to go on underneath uninterruptedly and undisturbed. It renders all applications, such as plasters, totally unnecessary, as well as the repeated dressings to which recourse is usually had in such cases; and it at once removes the soreness necessarily attendant on an ulcerated surface being exposed to the open air. In many cases too, in which the patients are usually rendered incapable of following their wonted avocations, this mode of treatment saves them from an inconvenience, which is, to some, of no trifling nature.

It has already been stated how important it is that the eschar should be preserved adherent. To secure this still more effectually, I have found it of great utility to protect it by a portion of gold-beater's skin. The skin surrounding the wound is simply moistened with a drop of water, and the gold-beater's skin is then to be applied over it and over the eschar, to which it soon adheres firmly, but from which it may be removed at any time, by again moistening it for a moment with water; the same bit of gold-beater's skin admits of being again and again reapplied in the same manner.

The other circ.u.mstances which render the eschar unadherent will be mentioned hereafter. In the mean time the fact stated p. 6, will sufficiently establish the propriety of treating distinctly of the adherent eschar.