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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.
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.
When the inflammation had again subsided, I ventured, notwithstanding the oedema, to apply the lunar caustic to form an eschar, enjoining rest and the horizontal position. On the following day complete but unadherent eschars were formed over each sore. There, had been no pain after the smart of the caustic had ceased.
I applied the lunar caustic over the surface of the sore and upon the surrounding skin. On the following day, the eschar was unadherent and puffy, and on piercing it a little fluid escaped. The incision into the eschar was repeated three or four successive days, but the eschar still retained its puffy character; I therefore directed a poultice to be applied to remove it.
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.
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.
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.
On the following day, I found the eschar complete but unadherent by the effusion of a little fluid; this I evacuated daily in the manner already described, for about a fortnight, when the eschar became adherent. During the progress of the cure a little excoriation formed round the eschar.
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.
But the same observations apply to ulcers on other parts of the body, and these are, in general, far more manageable than the former, and do not require the same rest during the unadherent state of the eschar. Mrs.
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