On the third day the swelling remained as before, and there was a little sense of heat. On the fourth day the swelling and heat had subsided, and the eschar remained adherent. On the succeeding day the eschar had been removed by washing the hand, and the puncture was unhealed but free from pain and irritation. The caustic was reapplied.
From this time the eschar remained adherent, and at length gradually separated leaving the part perfectly well.
It is quite certain that under any other mode of treatment this severe puncture would have greatly inflamed and have proved very painful and troublesome; and it is not improbable but that suppuration and much suffering might have ensued. All this is effectually and almost certainly prevented if the caustic be applied promptly, as in this case. When time has been lost, the case is very different as will appear hereafter; but even in these cases, the caustic proves an invaluable application.
Case II.
Mrs. Middleton, aged 40, wounded her wrist, on the ulnar side, by the hook of a door post; there was a considerable flow of blood at first, but this ceased suddenly and the arm immediately became affected with great pain and swelling. The lunar caustic was applied in half an hour after the accident.
On the following day the eschar was observed to be adherent, and the patient reported that she had suffered scarcely any pain, after the smarting of the caustic had ceased. There was a slight swelling round the puncture but that of the arm had totally subsided. The caustic was applied over and beyond the swelling. On the third day all tumefaction had subsided and there was no complaint whatever.
I hoped that this case would have required no further attention or remedy. But my patient contrived unfortunately to rub off the eschar about a week after its formation, and so to expose the subjacent wound unhealed; she suffered however no pain or inconvenience from it; and it was again shielded by means of a fresh eschar, which remained adherent until removed by the healing process underneath.
This puncture was so severe that the arm was in a state of ecchymosis for six or eight inches upwards, and I doubt not that without the caustic, there would have been severe and long continued suffering, and perhaps painful suppurations.
Case III.
A female servant punctured the end of the finger by a pin; there succeeded much pain and swelling, and it appeared that the nail would separate, and the cuticle all round the finger was raised by the effusion of fluid. This fluid was evacuated and a poultice applied.