Part 3 (2/2)

It is also quite certain, I think, that there would have been an extensive slough, from the severity of the bruise. This was doubtless prevented by the application of the caustic.

CASE XVI.

J. Jennings, bricklayer, aged 26, fell through the roof of a house and bruised and lacerated his s.h.i.+n rather severely to the extent of an inch and half in one part and in several other places in a less degree. I applied the lunar caustic to the wound immediately.

On the following day the eschar was found to be adherent, and there was neither pain nor swelling.

The eschars separated in nine days leaving the wounds healed.

It is remarkable that the eschar remains a greater or less time over the wound according to the severity and exigency of the case. This case being less severe than the former one the eschar remained upon the wound during a much shorter period of time.

CASE XVII.

An old man, aged 60, received a bruise upon the occiput from a fall; the skin was lacerated and removed to the extent of half-a-crown. I applied the lunar caustic soon after the accident.

On the next day an adherent eschar was formed. There was neither pain nor swelling.--The eschar separated in a fortnight.

CASE XVIII.

Mrs. C. aged 40, was detained on a journey by a bruised wound on her knee, received a fortnight before, which was healing very slowly under the usual mode of treatment. The inflammation was subsiding but the sore was extremely irritable and painful, and she was prevented from moving. From the degree of inflammation still present, I applied the lunar caustic very slightly over the sore and not over the inflamed skin; I left the eschar to dry, but was very doubtful, from the same cause, whether it would be adherent or no.

On the succeeding day I found that the eschar did remain adherent and that the inflammation was diminished, and the soreness had entirely subsided after that induced by the caustic had ceased.

On the next day, the lameness was gone, and there was no sort of inconvenience from the wound. My patient continued her journey on the following day, so that I do not know when the eschar separated.

In regard to the inflammation attendant on these wounds, I would remark that slight inflammation is relieved by the application of the lunar caustic and does not prevent the formation of an adherent eschar; but very severe inflammation requires the application of the cold poultice and lotion over the wound, and it is necessary to watch for the period when an eschar may be attempted with the lunar caustic.

This a little experience will readily teach.

It is further to be particularly observed that the inflammation attendant on a recent wound is removed by the caustic, when the same degree of inflammation at a later period, and with suppuration, would be aggravated and require the cold poultice and lotion, and render the formation of an adherent eschar impossible. This fact, the result of much experience, is extremely interesting, and, I think, not easy to be explained. It is ill.u.s.trated by the following case.

CASE XIX.

Robert Hill, aged 16, received a blow yesterday from a bone which was thrown at him, upon the outer condyle of the humerus. He complains of extreme pain and there are much redness and swelling. I applied the lunar caustic and directed the part to be exposed to the cold air.

On the succeeding day, I found that the eschar was quite adherent, and that the pain, redness and swelling had much subsided, although there was some stiffness of the elbow.

On the third day there was still further amendment. From this time no remedy or attention was required.

CASE XX.

It frequently occurs to surgeons to receive slight wounds upon the hands which prove very troublesome. Of this kind is the following.

Mr. L.C. had an irritable and inflamed sore on the ulnar side of the third finger, occasioned by a bruise a fortnight ago. Many applications had been made during this fortnight but the sore had no disposition to heal. I applied the lunar caustic to form an adherent eschar.

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