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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.
The plan of curing ulcers is exactly what has been described in the treatment by the unadherent eschar. For in these cases the eschar is generally unadherent at first.
On the following day the eschar remained adherent round the edges, but had a puffy feel in the centre; I pierced it with a penknife and a little bloody fluid escaped, and I touched the orifice thus made with the caustic. The swelling remained as before, with a degree of soreness. On the next day the swelling had subsided.
This a little experience will readily teach. It is further to be particularly observed that the inflammation attendant on a recent wound is removed by the caustic, when the same degree of inflammation at a later period, and with suppuration, would be aggravated and require the cold poultice and lotion, and render the formation of an adherent eschar impossible.
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.
It then ceased and the eschar became complete; and there was rather less inflammation and swelling. The patient had kept in bed. I prescribed a pill with the hydrarg. submurias, to be followed by an aperient draught. On the succeeding day my patient went down stairs and disturbed the eschar, and experienced more pain. The inflammation and swelling were still less.
Eschar, makes a great com plaint against the English, that they did help the Spaniards against the French the other day; and that their Embassador do demand justice of our King, and that he do resolve to be gone for France the next week; which I, and all that I met with, are very glad of. Thence to Paternoster Row, where my Will did receive the L50 I borrowed yesterday.
I applied the lunar caustic to the wound immediately. On the following day the eschar was found to be adherent, and there was neither pain nor swelling. The eschars separated in nine days leaving the wounds healed. It is remarkable that the eschar remains a greater or less time over the wound according to the severity and exigency of the case.
An adherent eschar is generally readily formed, and no further application is required. If the ulceration be more extensive and deeper, the lunar caustic may be applied, and the eschar treated, exactly as in common ulcers. It may be well to illustrate these points, by the following cases. A little girl, aged 10, scalded her breast a week ago and has treated it with the ordinary remedies.
Wakefield, aged 36, had an extensive ulceration with excoriation on the upper part of the right breast, of two months continuance; it had been greatly aggravated by improper treatment. I applied the lunar caustic over the whole ulcerated and excoriated surface. It gave much pain. On the following day I was concerned to find that part of the eschar had been separated by the patient's dress.
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