Part 5 (1/2)

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.

CASE XXVI.

The following case occurred in the person of a lady with varicose veins and far advanced in pregnancy. Its speedy cure by the caustic was, therefore, the more remarkable, and saved her much trouble and suffering.

Mrs. C. aged 40, had two small irritable and inflamed ulcers, under the inner ankle. I applied the lunar caustic to form an eschar.

It was requisite to evacuate a little fluid from under the eschars for three successive days; they then remained adherent.

About the usual time the eschars separated, leaving a small point of the size of a pin's head, unhealed; this I again touched with the caustic. The case required no further attention.

This case leads me to caution my readers always to examine the parts carefully after the separation of the eschars, and if there be the slightest ulcer remaining to apply the caustic to it.

CASE XXVII.

Mrs. Wakefield, aged 36, had an extensive ulceration with excoriation on the upper part of the right breast, of two months continuance; it had been greatly aggravated by improper treatment. I applied the lunar caustic over the whole ulcerated and excoriated surface. It gave much pain.

On the following day I was concerned to find that part of the eschar had been separated by the patient's dress. I repeated the application of the caustic and again directed the part to be exposed and carefully protected from being disturbed. The breast required to be supported being full of milk.

On the succeeding day an adherent eschar existed over all the ulcerated parts, and the pain, redness, and irritation had nearly subsided.

On the fourth day there was still less pain and inflammation. On the eight the eschars had separated and the breast was quite well.

CASE XXVIII.

Mrs. U. aged 60, has been subject to ulcerated legs for several years.

She has one ulcer on the outer ankle of the size of a s.h.i.+lling, and another behind it of the size of a horse-bean; they have been extremely troublesome and under surgical treatment for the last year, but during the last few weeks she has tried cerate, poultice, and the cold lotion. The leg is much swollen and inflamed, the redness extending several inches round the wound and over the instep; the oedema increases towards night. She has been in the habit of taking saline purgatives frequently.

I directed my patient to continue the cold poultice and lotion, and to rest completely for several days. At this period, the inflammation having somewhat abated, I applied the lunar caustic to form eschars and protected the parts with gold-beater's skin.

On the following day there was a slight increase of redness round the eschars. Upon making an incision into their centre some fluid was evacuated. The same report was made on each of the two following days.

On the seventh day, the eschars having been neglected, fluid had escaped from beneath the eschars at their edges, and my patient complained of more pain. A little more fluid escaped in the same manner on the following day on making a little pressure upon the eschars. I applied the caustic to make up the breach.

Subsequently to this day there was an increase of inflammation. From this circ.u.mstance, and from the neglect of the eschars for two or three days already mentioned, I suspected the formation of a scab under them. It was impossible to pierce the eschars by the penknife without breaking them, as they had become too hard and thick by delay and the addition of the scab.

I again directed the cold poultice for four or five days. On examining the wounds on the separation of the eschars, I found the healing process going on. I reapplied the lunar caustic to form eschars, and I evacuated a little fluid from their centre for three successive days.

At this time the patient took cold and a smart attack of fever came on, and the part round the eschars became much inflamed. I prescribed an emetic and purge, and a cold poultice and lotion.

In the s.p.a.ce of a week I again attempted to form an eschar over the larger wound, for the smaller one had quite healed.

The next day I discharged a little fluid from the centre, and again on the eight or nine succeeding days, giving saline purgatives.

After this time the eschar remained adherent, and no further remedy was required.