Produced by Bryan Ness, Jeannie Howse and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
book was produced from scanned images of public domain
material from the Google Print project.)
* * * * *
+--------------------------------------------------------+
| Transcriber's Note: |
| |
| Inconsistent hyphenation and archaic spelling in |
| the original document has been preserved. |
| |
| Obvious typographical errors have been corrected. |
| For a complete list, please see the end of this |
| document. |
| |
+--------------------------------------------------------+
* * * * *
ON THE
LUNAR CAUSTIC.
AN
ESSAY
ON THE
APPLICATION
OF
THE LUNAR CAUSTIC,
IN THE
_CURE OF CERTAIN_
WOUNDS AND ULCERS.
BY
JOHN HIGGINBOTTOM,
_NOTTINGHAM_,
MEMBER OF THE ROYAL COLLEGE OF SURGEONS
OF LONDON.
LONDON:
PRINTED FOR
LONGMAN, REES, ORME, BROWN, AND GREEN,
_PATER-NOSTER ROW_.
1826.
T. WHEELHOUSE, PRINTER, NOTTINGHAM.
TO
MY BROTHER-IN-LAW,
MARSHALL HALL, M.D. F.R.S.E.
&c. &c.
THIS LITTLE WORK IS INSCRIBED
WITH
GREAT AFFECTION.
_Nottingham, Jan. 6, 1826._
PREFACE.
The following pages are presented to the medical public with very
humble pretensions. It is chiefly with the minor accidents or diseases
that they have to do; but I shall not consider that I have laboured in
vain, if I am enabled to mitigate even these little evils of human
life.
In these prefatory observations, however, I would suggest the question
whether the caustic may not be employed with benefit even in some of
the severer diseases to which the human frame is liable. Indeed I
consider the investigation as only just begun, and many other uses of
the lunar caustic, besides those detailed in the following pages, have
suggested themselves to me.
May not the caustic, for instance, be of greater efficacy, because of
greater power and of quicker operation, than ordinary blisters, in
some internal diseases?
It is repeatedly stated hereafter, that the application of the lunar
caustic is a means, in certain circumstances, of subduing external
inflammation. Might it not, on this principle, be of service in the
treatment of some of the internal phlegmasiae?
It may be observed, that the lunar caustic may be regarded, almost
without further trial, as an effectual preventive of those cases of
irritative fever which arise from local injuries, and probably of the
effects of poisoned wounds in general. I would not, however, in the
latter cases, fail to render "sure doubly sure" by free excision.
Might not an adherent eschar be easily formed in those cases of
compound fracture in which the external wound is of moderate size, so
as effectually to exclude the external air and prevent cutaneous
inflammation, and in more respects than one, to reduce the case to the
state of a simple fracture? This object, if attained, would be
important indeed, and I hope the suggestion will be submitted to the
most assiduous and cautious trial.
I can have no doubt that the use of the lunar caustic admits of being
still further extended; and, as I intend to pursue the inquiry, I hope
at some future period to publish something more worthy of the
attention of the medical public. In the mean time, the plans hereafter
suggested must not be adopted without that degree of care, attention,
and perseverance, which are obviously necessary to render them
successful.
CONTENTS.
CHAPTER I.
PAGE
ON HEALING BY ESCHAR 1
I. _Of the Adherent Eschar_ 3
II. _Of the Unadherent Eschar_ 14
III. _On the Treatment by Eschar and Poultice_ 21
CHAPTER II.
OF THE APPLICATION OF THESE MODES OF TREATMENT TO
DIFFERENT CASES 24
I. _Of Punctures, Bites, &c_ 24
II. _Of Bruised Wounds_ 64
III. _Of Ulcers_ 82
IV. _Of some Anomalous cases_ 120
CHAPTER III.
OF SOME CASES IN WHICH THE CAUSTIC IS INAPPLICABLE 130
CHAPTER I.
ON HEALING BY ESCHAR.
Having been led, by several circumstances, to try the effects of the
Lunar Caustic in the treatment of Wounds and Ulcers, and having great
reason, from these trials, to think that this remedy may be used with
much advantage far more extensively than has hitherto been done, I lay
the results of my experience before my medical brethren.
A very natural mode of healing certain wounds and ulcers, is by
scabbing; but this mode of treatment is attended by many
disadvantages, as will be pointed out shortly; yet it may be supposed
to have suggested to me some of those trials of the treatment by
eschar, which I am about to detail.
I. ON THE ADHERENT ESCHAR.
It appears scarcely necessary to describe the immediate and well known
effects of the application of the lunar caustic to the surface of a
wound or ulcer. It may, however, be shortly observed that the contact
of the caustic induces, at first, a white film or eschar which, when
exposed to the air, assumes in a few hours a darker colour, and at a
later period, becomes black; as the eschar undergoes these changes of
colour it gradually becomes harder and resembles a bit of sticking
plaster; in the course of a few days, according to the size and state
of the wound, the eschar becomes corrugated and begins to separate at
its edges, and at length peels off altogether, leaving the surface of
the sore underneath, in a healed state.
In the formation of this eschar several things require particular
attention. The application of the caustic should be made over the
whole surface of the sore; and indeed no part requires so much
attention as the edges; to make a firmer eschar the caustic should
even be applied beyond the edge of the wound, upon the surrounding
skin, for the eschar in drying is apt to contract a little, and in
this manner may leave a space between its edges and that of the
adjacent healthy skin.
At the same time, much attention must be paid to the degree in which
the caustic is applied. In cases of recent wounds unattended by
inflammation, it may be applied freely; but when inflammation has come
on, too severe an application of the caustic induces vesication of the
surrounding skin, and the edges of the eschar may in this manner also
be loosened and removed. If every part is touched, a slight
application of the caustic is generally sufficient.
The importance of avoiding all causes which might detach the edges of
the eschar will be apprehended by the following interesting
observation, which I have been enabled to deduce from very extensive
trials of the caustic; it is, that, in every instance in which the
eschar remains adherent from the first application, the wound or ulcer
over which it is formed, invariably heals.
Not only the cause just mentioned, but every other by which the eschar
might be disturbed, must, therefore, be carefully avoided; and
especially, as the eschar begins to separate from the healed edges of
the sore, it should be carefully removed by a pair of scissors.
To the surface of the wound the eschar supplies a complete protection
and defence, and allows the healing process to go on underneath
uninterruptedly and undisturbed. It renders all applications, such as
plasters, totally unnecessary, as well as the repeated dressings to
which recourse is usually had in such cases; and it at once removes
the soreness necessarily attendant on an ulcerated surface being
exposed to the open air. In many cases too, in which the patients are
usually rendered incapable of following their wonted avocations, this
mode of treatment saves them from an inconvenience, which is, to some,
of no trifling nature.
It has already been stated how important it is that the eschar should
be preserved adherent. To secure this still more effectually, I have
found it of great utility to protect it by a portion of gold-beater's
skin. The skin surrounding the wound is simply moistened with a drop
of water, and the gold-beater's skin is then to be applied over it and
over the eschar, to which it soon adheres firmly, but from which it
may be removed at any time, by again moistening it for a moment with
water; the same bit of gold-beater's skin admits of being again and
again reapplied in the same manner.
The other circumstances which render the eschar unadherent will be
mentioned hereafter. In the mean time the fact stated p. 6, will
sufficiently establish the propriety of treating distinctly of the
adherent eschar.
I now proceed to mention some other effects of the application of the
caustic. The first is that, in cases in which there would be much and
long continued irritability and pain, as in superficial wounds along
the shin, all this suffering, and its consequences in disabling the
patient, are completely avoided. A blush of inflammation forms around
the eschar, but this gradually subsides without any disagreeable
consequences, and the inflammation which would otherwise have been set
up is entirely prevented by the due formation of the eschar.
If inflammation be previously established, it is increased, at first,
by the application of the caustic. But if this inflammation be not
severe, and if the eschar remain adherent, all inflammation, both that
induced by the application of the caustic, and that existing
previously, entirely subsides. When the previous inflammation round
the ulcer is considerable, however, the application of the caustic
would induce vesication, and it should in such a case of course be
avoided, and another mode of treatment to be described hereafter must
be adopted.
I would introduce in this place some observations on the comparative
effects of healing by eschar and by scabbing. On the subject of
scabbing I must refer my reader to the well known work of Mr. John
Hunter. The advantage of healing by eschar over that by scabbing is
quite decided. By comparative trials, I have found that whilst the
scab is irritable and painful, and surrounded by a ring of
inflammation, the adherent eschar is totally free from pain and
inflammation; and that whilst the scab remains attended by
inflammation and unhealed, the eschar is gradually separating, leaving
the surface underneath completely healed. To these observations I may
add that the success of the plan of healing by eschar is infinitely
more certain as well as more speedy than that by scabbing.
I shall, in conclusion, briefly recapitulate the advantages of this
mode of treatment. In the first place, it will be found far more
efficacious and speedy than any other; secondly, it has the great
advantage of saving the patient much suffering and inconvenience; and
thirdly, it renders the repeated application of dressings and
ointments quite unnecessary. Its utility is extremely great,
therefore, where the time of the poor, the expense of an
establishment, and the labours of the medical officer, as well as the
sufferings of the patient, require to be considered; and it will I
imagine be found of no little advantage, in all these respects, in
many cases which are incident to the soldier and sailor.
II. ON THE UNADHERENT ESCHAR.
The eschar is generally adherent in cases of recent injuries, and in
small ulcers, when they are nearly even with the skin and attended by
little inflammation. In other cases the eschar is too apt to be
unadherent, and this arises from the formation of pus or of a scab
underneath.
If the eschar be unadherent by subjacent pus, it may be ascertained in
the space of from twelve to twenty-four hours; the centre is generally
observed to be raised and to yield to the pressure of a probe;
sometimes the subjacent fluid has partly escaped by an opening at the
side of the eschar.
When a scab forms underneath the eschar, which does not happen except
the fluid has been allowed to remain too long under the eschar without
being evacuated, there are pain and some inflammation, the eschar does
not separate, but remains long over the sore, and there is no
appearance of healing.
When it is ascertained that there is fluid underneath the eschar, a
slight puncture is to be made by the point of a penknife, the fluid is
to be gently pressed out, and the caustic is then to be applied to
the orifice thus made. The same plan is to be adopted if the fluid
ooze out at the edge of the eschar; it is to be fully evacuated by
pressure, and the orifice is to be touched with the caustic. The
healing process goes on best however when the orifice is in the centre
of the eschar. After this treatment the eschar occasionally remains
adherent, but more frequently the fluid requires to be evacuated
repeatedly, and this should be done every twelve hours, or once a day,
according to the quantity of fluid formed, taking care that the eschar
be not needlessly separated by allowing the fluid to accumulate
underneath. If, from accident, the eschar is separated before the sore
be healed I would reapply the caustic. At length the eschar becomes
adherent, and in due time begins to peel off, leaving the surface
healed.
In every case in which the eschar does not separate favourably, I
begin to suspect the formation of a scab underneath, in which case the
whole must be removed by the application of a cold poultice for two or
three days; this has not only the effect of removing the eschar but of
allaying any inflammation or irritation; afterwards the caustic must
be reapplied as before.
The gold-beater's skin is more useful as a protection to the
unadherent than to the adherent eschar, as the former would be more
liable to be torn off by accident than the latter. The gold-beater's
skin must be removed in the manner already described, whenever the
subjacent fluid is to be evacuated, and must be reapplied after
touching the orifice with caustic.
The pain experienced on the application of the caustic is greater or
less according to the sensibility and size of the wound. In small
wounds it is trifling, and of short duration; it is more severe in
recent wounds than in ulcers; it soon subsides in every case, and
then the patient enjoys greater ease than would be experienced under
any other mode of treatment. Little or no pain is caused on applying
the caustic after evacuating the subjacent fluid of an unadherent
eschar. Altogether the pain inflicted by the caustic is far less than
is generally imagined, and forms scarcely an obstacle to its
employment.
It may be proper, in this place, to notice such circumstances as
render the employment of the caustic improper or inefficient. It is
improper to employ the caustic when the ulcer is too large to admit of
the formation of a complete eschar; or when it is so situated as to
render it impossible that the eschar should remain undisturbed, as
between the toes, unless, indeed, the patient be confined to his
bed;--or in cases attended by much inflammation, or by much oedema.
I have found no kind of caustic so manageable as the lunar caustic;
and this is best applied in the solid form. I have thought too, that
the newly prepared lunar caustic is more apt to dissolve on being
applied than that which has been longer made and more exposed to the
air; the latter is therefore to be preferred.
III. ON THE TREATMENT BY ESCHAR AND POULTICE.
In many cases in which it is impossible to adopt either the mode of
treatment by the adherent or the unadherent eschar, it is of great
utility to apply the caustic first and then a cold poultice made
without lard or oil: this plan is particularly useful in cases of
punctured wounds attended by much pain and swelling, and in cases of
recently opened abscesses. By this application the pain and swelling
are much subdued and a free issue is secured for the secreted fluid;
and in no case have I seen the original inflammation increased by it.
It is generally necessary to repeat the application of the caustic
every second or third day, or every day if the inflammation and
swelling of the part be considerable, and the cold poultice may be
renewed about every eight hours. At length, however, the inflammation
having subsided, the attempt may be made to form an adherent eschar.
I have seen many cases, in which, by this mode of treatment, much
suffering and perhaps the loss of some of the smaller joints have been
prevented, particularly cases of deep seated inflammation of the
fingers, which, having been neglected, have issued in severe
inflammation, abscess, and terrible fungous growths. In these cases it
is not only necessary to apply the caustic to the surface of the sore,
but in every cavity or orifice which may be formed by the disease.