On the third day the cuticle was removed, and the exposed surface was found to be ulcerated in several spots. The lunar caustic was passed slightly over the excoriated surface, which was then left exposed to dry.
On the succeeding day the eschar was adherent and the pain had almost subsided. On the next day, the eschar still remained adherent, and as there was neither pain nor soreness, the patient used her finger.
The eschar was at length removed by the healing process and was separated together with the nail, and the case was unattended by any further inconvenience or trouble either to the patient or myself.
It is scarcely necessary to contrast the advantage of this mode of treatment with that by plasters, poultices, &c. It is at once more speedy and secure, and less cumbersome to such patients as are obliged to continue domestic avocations.
Case IV.
The present case is somewhat more severe than those which have been already given, and what is of great importance, the caustic was not applied immediately after the accident.
William Chantry, aged 50, received a stab in the wrist with a hay-fork yesterday and applied a poultice; to-day there are great pain and swelling, and the wounded orifice is very small. I applied the lunar caustic within the puncture, and directly a cold poultice to be worn over it; the arm was kept in a sling.
The next day the swelling and pain were diminished, and a little lymph flowed from the wound. I again applied the caustic and continued the poultice.
Two days afterwards, the swelling and pain were nearly gone. The poultice was merely continued, the caustic not being requisite from the subsidence of the inflammation. The patient came to me again in four days more quite free from pain and swelling. The poultice was discontinued, and the caustic was then applied in order to form an adherent eschar, in which I was successful.
This case illustrates many important points; 1. it shows the efficacy of the caustic with the poultice as a remedy against inflammation; 2. it presents an instance of a labouring man returning to work on the sixth or seventh day after a severe accident, even when the application of the caustic had been unfortunately delayed; 3. it points out the proper treatment, when all hope of the treatment from the first by adherent eschar is lost from such delay,—for had this been attempted in this case, suppuration would doubtless have taken place from the closed state of the puncture by the swelling;—our objects must therefore be, to open the puncture and to subdue the inflammation, and these objects are admirably attained by means of the caustic.