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are the best remedies I know, beginning with the strongest, and diluting them, or substituting one for the other as the ulcer heals, or, by becoming accustomed to the stimulus, may require a change.
I would recommend the surgeon, in dressing ulcers, wounds, &c. always to keep a scalpel in his hand, which he will find the most serviceable thing in cleaning the edges of the healing ulcer from the layers of coagulable lymph that is constantly thrown out by the young skin, to which ulcers treated by these stimulants are particularly liable, and which, by accumulation, is very often the cause of the callous edges seen in ulcers in other respects healthy. There is nothing so convenient in taking off the hairs, remains of discharge, &c. that cannot be well remov ed by washing without much pain to the patient.
This method, by which the ulcer is kept remarkably clean, besides being creditable to the surgeon, who too often thinks the cleaning of an ulcer beneath his notice, is of greater use, perhaps, in the healing of some kinds of ulcers, than the appli cation of any particular dressing.
. I need hardly mention, that the manner of making these applications is by using the spirits as a lotion, or applying lint, wet in it either once or twice a day, with the usual bandages; taking care, especially if the discharge be scanty, to keep the bandage moist with water, particularly near the time of dressing, in or der to render the removal easy.
I have frequently, where the spirits caused very great pain, applied the lint wet in water, and poured the spirits over it afterwards.
In wounds, the spirituous applications correct the fetor of the discharge, a great desideratum in a warm climate; diminish its quantity, and in an extraordinary manner facilitate the process of skinning.
In burns, they are only a continuation of Mr Kentish's stimulating plan of treatment. In accordance with his directions, the stimulus must at first be gradually diminished, or entirely left off, for some time, if the burnt surface be very extensive, as it is apt to augment the fever, and, by over-stimulation, may produce more watchfulness, and even the delirium attending very severe cases be thereby exasperated.
In slight cases, this is not necessary; only the spirits must be diluted when there is much inflammation. But when fever, &c. are not present, or have subsided, and the discharge is profuse and offensive, the spirituous lotion, either pure or diluted, applied with the usual dressings, has the greatest possible effect.
I have found, in the West Indies, the application of calamine
cerate, partly, I imagine, on account of its rancidity, irritate the surface, produce a great deal of pain, augment the discharge, and make it of a worse quality. I therefore mostly prefer, as a dressing, the ung. ceræ.
The second remedy is the use of charcoal internally in dysentery, diarrhoea, the debilitated state of the first passages, geE nerally left by the endemic fever of this climate, and other complaints of the stomach and bowels.
This may, like all new remedies, be spoken of at first more highly than it really deserves. At present, in the estimation of those practitioners who have had an extensive opportunity of giving it a trial, it ranks higher in these complaints than any other medicine whatever. Some of them, I hope, will shortly give their experience of its efficacy to the world, as it is a pity it should long be confined to any particular part of the world, or class of men, when likely to be so very beneficial to the whole.
In conversation lately with Dr Jackson, Inspector of Hospitals at Barbadoes, he related a very striking instance of its utility in dysentery. A soldier, who had a severe attack, after taking a dose of not perhaps more than half a drachm, felt himself quite relieved in a short time, and was conscious it was the effect of the medicine.
His griping, tormina, tenesmus, and purging, which had just before been excruciating, were entirely gone, and, as he expressed himself, he was as it were in heaven. By continuing the medicine two or three times a day, for a few days, he had no return of the complaint.
Perhaps the rationale of the action of charcoal in these complaints may have some similarity to that of its chemical relative, carbonic acid gas, when taken into the stomach in sufficient quantities, in allaying sickness and vomiting, and acting as a sudorific and tonic.
His Majesty's Ship Pique, West Indies, December 1814.
Case of very extensive Wound of the Abdomen, with complete Division of the Ileum, and Penetration of the Cavity of the Thorax. By THOMAS CALTON, Surgeon, Collingham.
WEDNESDAY, August 23d, 1815.--I was this day called upon
to visit a son of William Cooper, miller, of South Clifton, at a village about six or seven miles from hence, who had,
as I was informed by the messenger, his belly ripped open by a boar, and the bowels protruded through the wound. Having provided myself with proper requisites for such an accident, I proceeded to his father's residence, and arrived there about two hours after it had taken place.
HENRY COOPER, æt. seven years, the subject of this injury, about four o'clock this afternoon was at Newton, with his father and brother Edward, with flour, at a Mr Wilimot's. Mrs Wilimot gave the child two apricots, which he was eating in the yard, when he was attacked by the boar, in the presence of the abovenamed persons, who saw the transaction. The boy was imme diately placed in a cart and taken home, a distance of three miles.
I found him lying on his back in his clothes. These I now caused to be removed, when the horrible sight of nearly the whole of the abdominal viscera, the stomach, much of the intestinal canal, the mesentery and omentum, came into view, all protruding through an extensive wound on the left side of the abdomen.
My first care was to examine the protruded viscera, when I found the ileum completely divided, the tear extending at least an inch into the mesentery. I brought the divided edges of the intestine together by four sutures. I then returned the stomach and bowels; but, owing to the great length of the wound, the latter could not be retained in their place. I therefore contracted the space, by applying four or five sutures at the upper or umbilical part of the wound, when the intestines were easily retained in the abdominal cavity. Nine sutures, in the whole, were made use of, and further secured by adhesive straps.
My attention was next called to a laceration on the left side of the chest, five inches in length, passing across the fifth and sixth ribs. A communication with the cavity of the chest, for the space of two inches or more, had been made by the tusk of the animal penetrating below the sixth rib, commencing at its cartilage, passing obliquely backwards across it, and under the fifth rib; leaving a space between the fractured portion of rib wide enough to admit the introduction of the finger. A portion of the under side of the fifth rib was also carried away. The integuments, not being lacerated exactly in the same direction with the fractured rib, formed a flap which, in a great measure, closed the opening to the chest; but, on lifting up this flap, air rushed out of the wound with some force. I passed my finger between the fractured portions, and satisfied myself there were no detached portions of bone to be removed. I united the centre of this flap with one suture, and the remainder by adhesive straps, A compress of linen was applied over the abdominal wound, and
the whole further secured by a broad bandage that went once only round the body. He was then placed on his back on clean linen, in the middle of the room, in a small cot. He went through the operation with wonderful fortitude, nor would he allow his eyes to be covered. He smiled when I had finished, and said I had not hurt him much.
During the operation, I had to wash the blood from the bowels with warm water, as well as some fluid and feculent and gritty matter that had escaped from the intestinés. The stomach and bowels were handled in the most delicate manner possible. The stomach was much distended. On returning it, he complained of some little pain and sickness, and retched once or twice. Soon afterwards he expressed a desire to have some cold water, which was given him. The bowels were particularly empty, which I considered as a very fortunate circumstance. On inquiry, I found he had taken his usual breakfast of tea, with bread and butter; that, at this meal, he always ate very sparingly; that he had been from home the whole morning, and had no dinner; that, at Newton, he had eaten a small portion of bread and ham, and the two apricots above-mentioned, the stones of which he had swallowed. The omentum was lacerated from the stomach downwards, its whole length. The vessels of the mesentery were beautifully injected with blood, and the circulation very evident. The wound in the parietes of the abdomen commenced about an inch below the anterior inferior spinous process of the os ileum of the left side, and extended six and a half inches in length, in an oblique direction, above and beyond the umbilicus, to the right side of the scrobiculus cordis. The pulse was not much affected. He was allowed cold water for his drink, with directions not to give him more than a tablespoonful at a time; to be kept cool and quiet; and to take the saline mixture. I left him soon after seven o'clock in the evening, in better spirits than could be expected. I did not think sufficient reaction had taken place to allow me to bleed him.
Thursday, August 24th, nine o'clock A. M.-It was reported to me that he had slept but twice, and for not more than half an hour each time, the whole night; that he had frequent startings. He did not appear to have much fever until about two hours ago; his pulse is now full and quick; skin hot and dry; breathing short and laborious; tongue and lips dry and parched; belly much swollen; he has passed his urine freely. I bled him to the amount of about four ounces; the extremities and face were. washed in cold vinegar and water; the bandage removed, and the abdomen fomented; an enema of four ounces of water-gruel was injected. From these means he experienced some relief.
The glyster and fomentations were ordered to be repeated every four or five hours; the bandage to be removed each time the abdomen was fomented; the body to be washed in cold vinegar and water as often as the skin became hot. I saw him again about eight o'clock P. M. I found his pulse full, cordy, and much quicker; respiration more difficult; thirst considerable, and complaining of a fulness at the stomach; in every respect much worse. The blood drawn in the morning was slightly buffy in the centre. He had just awoke from sleep when I first entered the room, and did not answer me in that coherent manner he had previously done; but after half an hour, this gradually subsided. The nurse has given him two more gruel glysters, the whole of which he has retained; he has taken no food; his drink has been water, and a little of the saline mixture; urine has been passed in full quantity. About five ounces more blood was now taken from the arm, which had a strong size upon it, and was cupped. The pulse immediately became easily compressible, but not the least faintness followed. Another glyster was given him as before; the fomentation renewed; his face and extremities were well washed in cold water, which reduced the heat of skin. About ten o'clock, I ordered him three grains of calomel made into a pill with aromatic confection, and a spoonful of a solution of Epsom salts every three hours.
Friday, August 25th, ten o'clock A. M.-I was informed by the nurse, that he had slept from the time I left him (ten o'clock last evening) to two o'clock this morning; that his sleep had been occasionally disturbed by startings. Soon after he awoke he drank some cold water, which he immediately (and for the first time) vomited, bringing up along with it a considerable quantity of fluid of a greenish colour, and somewhat offensive, and one of the apricot stones; a second vomiting took place in half an hour after, when the other stone, with three lumbrici, were ejected; since then his vomiting has been frequent; almost every thing he drinks immediately returns. The last ejected fluid contained some of the pulp of the apricot and ham undigested, along with some yellowish bile. He now felt much relieved from the oppression at the præcordia; the belly is evidently reduced in size. These efforts of the stomach were accompanied by a rumbling noise. He has less fever, and complains very little of pain; has a better countenance, and is more cheerful. He now informs me, he feels as if he could have a stool. Every effort as he lay being tried in vain, I caused him to be carefully taken in the arms of the nurse, and placed in a little night-chair for that purpose, but without effect. He expressed a desire to be placed in bed again after sitting five minutes. I gave him