In cases of recent punctured wounds the orifice and surrounding skin should be moistened with a drop of water; the caustic should then be applied within the puncture until a little pain be felt, and then over the surrounding skin, and the eschar must be allowed to dry. In this manner it is astonishing how completely the terrible effects of a punctured wound are prevented; the eschar usually remains adherent, and the case requires no further attention.
At a later period after the accident, when the caustic has been neglected, some degree of inflammation is usually present, the orifice is nearly closed with the swelling, and a little pus or fluid is formed within. A slight pressure will evacuate this fluid, the caustic may then be applied within the puncture, and over the surrounding skin, beyond the inflammation, and must be allowed to dry. In this manner we frequently succeed in forming an adherent eschar, and all inflammation subsides. Any slight vesication which may be raised around punctured wounds is not of the same consequence as when an adherent eschar is wished to be formed over a sore or ulcer; one or more small punctures may be made to evacuate the fluid and the part may be allowed to dry.
If there is reason to think that an abscess has actually formed under the puncture to any extent, it must be opened freely by a lancet and treated with caustic and poultice, keeping the poultice moist and cold with water.
In cases of puncture where the orifice is healed and where an erysipelatous inflammation is spreading, attended with swelling, I have applied the caustic freely over and beyond the inflamed parts, and I have had the satisfaction to find that the inflammation has been arrested in its progress and has shortly subsided.
This mode of treatment is particularly useful in cases of punctured and lacerated wounds from various instruments, such as needles, nails, hooks, bayonets, saws, &c. and in the bites of animals, leech-bites, stings of insects, &c. In considerable lacerations the same objection would exist to this treatment as in large ulcers.
The dreadful effects of punctures from needles, scratches from bone, or other injuries received in dissection, are totally prevented by this treatment. I have for the last five years had frequent opportunities of trying it in these cases and have the most perfect confidence in its success.
The advantage of these modes of treating punctured wounds will however be best explained and established by a selection of cases, to which I can add particular remarks as they may be suggested by peculiarities in the cases themselves.
Case I.
A.B. received a severe punctured wound by a hook of the size of a crow-quill, which pierced into the flesh between the thumb and fore-finger on the outside of the hand; scarcely a drop of blood followed, but there was immediately severe pain and tumefaction. The lunar caustic was applied without loss of time, deep within the orifice and around the edge of the wound; and the eschar was left to dry. The smarting pain induced by the caustic was severe for a time but gradually subsided.
On the ensuing day, the eschar was adherent and there was little pain; but there was more swelling than usual after the prompt application of the caustic, owing to the mobility of the part.