ery 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.

CHAPTER II.

ON THE APPLICATION OF THESE MODES OF TREATMENT TO PARTICULAR CASES.

I. OF PUNCTURES ETC.

In cases of recent punctured wounds the orifice and surrounding skin
should be moistened with a drop of water; the caustic should then be
applied within the puncture until a little pain be felt, and then over
the surrounding skin, and the eschar must be allowed to dry. In this
manner it is astonishing how completely the terrible effects of a
punctured wound are prevented; the eschar usually remains adherent,
and the case requires no further attention.

At a later period after the accident, when the caustic has been
neglected, some degree of inflammation is usually present, the orifice
is nearly closed with the swelling, and a little pus or fluid is
formed within. A slight pressure will evacuate this fluid, the caustic
may then be applied within the puncture, and over the surrounding
skin, beyond the inflammation, and must be allowed to dry. In this
manner we frequently succeed in forming an adherent eschar, and all
inflammation subsides. Any slight vesication which may be raised
around punctured wounds is not of the same consequence as when an
adherent eschar is wished to be formed over a sore or ulcer; one or
more small punctures may be made to evacuate the fluid and the part
may be allowed to dry.

If there is reason to think that an abscess has actually formed under
the puncture to any extent, it must be opened freely by a lancet and
treated with caustic and poultice, keeping the poultice moist and cold
with water.

In cases of puncture where the orifice is healed and where an
erysipelatous inflammation is spreading, attended with swelling, I
have applied the caustic fr