The pain from the caustic was severe for several hours. An eschar had formed round the edges, but in the middle part it was quite wanting; the inflammation surrounding the ulcer had abated, and the green hue of its surface had disappeared. I reapplied the caustic in the central part.
On the following day the eschar appeared tolerably complete in the centre but had separated at one part of the circumference. I again applied the caustic to the defective part.
On the following day the eschar was defective in several parts, but the inflammation was quite removed, there was no pain, and there had been less smarting after each successive application of the caustic. I again applied the caustic.
On the succeeding day, I learnt that my patient had been intoxicated, and I found the ulcer attended by inflammation. The eschar was by no means complete; some part of it was in a detached state. I removed the loose portions and repeated the application of the caustic.
This sort of treatment was continued for a fortnight without my being able to effect the formation of a complete eschar. I therefore relinquished the idea of healing the ulcer by the adherent eschar; I eventually succeeded in doing so by applying the caustic every third day and the poultice continually, and I had hopes that the cure might be permanent, but he made application to me in two years afterwards with a similar ulcer on the same part.
In another similar case, I removed the elevated hard edges of the ulcer by the lancet, and then tried the caustic, without better success.
Case XXXVI.
The last case I have to give is one of great interest, as it clearly shows the influence of the lunar caustic in subduing the inflammation surrounding ulcerations, and in promoting the healing process, even in cases of phagedenic ulcer. In such cases its influence eminently deserves a still further trial.
Mrs. H. aged 56, has had very extensive phagedenic ulcerations on the legs and thighs during three years, which began in little red spots and then spread rapidly, destroying the integuments. One of these ulcers, on the thigh, was twelve inches in length and five in breadth, and exhibited the appearance of a deep corroding furrow; it was surrounded by a fiery redness and was attended by extreme pain. There were many other ulcers of the same kind, several nearly of the same magnitude; and the poor patient was compelled to take large doses of laudanum several times in the day. She had formerly been treated for syphilis, and had afterwards taken the sarsaparilla freely; amongst a great variety of local applications, the white bread poultice had afforded most relief.
I applied the lunar caustic to two of the smaller ulcers.