Part 4 (2/2)

Five days after this period, I again observed a disposition to excoriate. I applied the caustic.

In two days more, the eschars were adherent, and there was no further appearance of excoriation.

In ten more days, the eschars had separated and all the ulcers and excoriations were completely healed.

This case occurred several years ago, and there has been no return of the affliction whatever.

CASE XXIII.

Mr. Marshall, aged 60, had a troublesome ulcer under the outer ankle, of an oblong form and of the size of sixpence. He has been long subject to ulcers of the legs, and he had a similar ulcer to the present one in the same situation, some years ago, which proved extremely difficult to heal under usual remedies. The veins are varicose.--From the small size of the ulcer, I applied the lunar caustic and protected the eschar by the gold-beater's skin.

On the following day, I found the eschar complete but unadherent by the effusion of a little fluid; this I evacuated daily in the manner already described, for about a fortnight, when the eschar became adherent.

During the progress of the cure a little excoriation formed round the eschar. I touched the parts with the caustic, and the eschar thus formed served to support that formerly made, and so to do good. The whole adhered until the sore was very nearly healed; but as it was situated in a part greatly exposed, it was removed by accident. The caustic was again applied; fluid formed underneath the eschar as before and required evacuating thrice; but at length the eschar adhered, and in due time separated leaving the ulcer quite healed.

The same patient has since been affected by similar ulcers at different times in different parts of the leg. He applied early and they were each time easily cured by one application of the caustic. He has also twice had injuries upon the s.h.i.+n, which were readily cured in the same manner.

CASE XXIV.

The following case must not be regarded as altogether trifling. For such sores are very apt to spread and to remain long very troublesome.

An old gentleman came to me with an oblong ulcer on the s.h.i.+n about an inch in length; it was very painful and inflamed. I applied the lunar caustic to form an eschar and requested him to call on the following morning. He did not come, however, but on seeing him the next day it was requisite to evacuate a little fluid; this was repeated on they third day, after which period the eschar remained adherent, and the part totally free from pain.

The eschar separated in about three weeks leaving the part healed.

CASE XXV.

The following case ill.u.s.trates 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 s.h.i.+lling upon the back of the leg just above the tendo achillis, the other rather less, on the outside of the leg; they were caused 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 sh.o.r.e 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 days.

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.

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