20
E XIII.
Am old man applied leeches to the instep for inflammation occasioned by a bruise. Several very irritable sores were produced with some swelling. I applied the lunar caustic to form an eschar.
On the following day, the eschars were adherent, the swelling had subsided, and he had slept well for the first time of several nights.
I do not, however, think the lunar caustic would succeed in such cases if attended by great inflammation, without the previous application of a cold poultice with rest for a day or two.
II. ON BRUISES.
It has been already observed, p. 9, that the caustic is an invaluable remedy in cases of bruised wounds of the shin. In these, as in all other cases, the value of this remedy is greatly enhanced by an early application. In bruises on the shin I have not had a single instance in which I was not enabled to effect a cure by the adherent eschar, if application was made to me early. The difficulty of forming an adherent eschar is always increased by delay; but in these bruises along the shin there is an additional reason for this increased difficulty, arising out of the tendency observed in them, to the formation of a slough.
In this place I have, indeed, to make an observation of particular interest, both in a pathological and curative point of view; it is, that the formation of this slough has always been prevented by an early application of the caustic, in the cases which have hitherto fallen under my care. This fact may probably admit of explanation in the following manner; the bruise partially destroys the organization of the part, and the subsequent inflammation completing what the injury had partially effected, a loss of vitality takes place, and the slough is formed. The early application of the caustic has already been shown to have the remarkable effect of preventing the inflammation consequent upon certain wounds, and thus the part is suffered to recover from the injury done to its organization, and its vitality is preserved.
Wheth