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Updated: June 15, 2025
Previous to applying the caustic it will sometimes be necessary to enlarge the wound, in order that every part may be fairly got at; and the eschar having sloughed off, it will always be prudent to apply the caustic a second time, but more slightly, in order to destroy any part that may not have received the full influence of the first operation, or that, by possibility, might have been inoculated during the operation.
Then there is danger of re-inoculation; and it would seem that this fatal process is often accomplished. The eschar formed by the lunar caustic is dry, hard, and insoluble. If the whole of the wound has been fairly exposed to its action, an insoluble compound of animal fibre and the metallic salt is produced, in which the virus is wrapped up, and from which it cannot be separated.
In two days the eschar was separated leaving the ulcer with its fungous appearance. I removed the fungous part by scissors, and directed the poultice to be applied and to be continued for two days. I then formed another eschar.
On the succeeding day, the eschar was complete, adherent at those edges which adjoined the cuticle, and floating at the other edges over the ulcer, and in the latter part allowing the escape of matter; round the adherent edges of the eschar the inflammation had entirely disappeared, while it remained fiery as before round every other part of the ulcer.
When the patient applies too late after the accident to prevent the formation of a slough we must still treat the case by the caustic. It is to be applied over the bruised and inflamed part. The eschar remains adherent round the part occupied by the slough and prevents or moderates the inflammation, and when the slough separates an eschar is to be formed over the exposed sore.
On the subject of scabbing I must refer my reader to the well known work of Mr. John Hunter. The advantage of healing by eschar over that by scabbing is quite decided.
I applied the lunar caustic to form an adherent eschar. From this time the pain and inflammation subsided. The eschar remained firm and adherent, and in six days separated leaving the wound healed. From the preceding observations it would naturally be concluded that the lunar caustic would afford a remedy for the treatment of ulcers. This conclusion is perfectly just.
In the neglected and severer cases of bruise attended by much inflammation, it will be found best to treat the part for a day or two by a cold poultice to give time for the inflammation to subside; otherwise the caustic might induce vesication of the skin, as I have mentioned already, p. 5, and the eschar could not be adherent.
It may, however, be shortly observed that the contact of the caustic induces, at first, a white film or eschar which, when exposed to the air, assumes in a few hours a darker colour, and at a later period, becomes black; as the eschar undergoes these changes of colour it gradually becomes harder and resembles a bit of sticking plaster; in the course of a few days, according to the size and state of the wound, the eschar becomes corrugated and begins to separate at its edges, and at length peels off altogether, leaving the surface of the sore underneath, in a healed state.
I applied the lunar caustic to form an eschar and requested him to call on the following morning. He did not come, however, but on seeing him the next day it was requisite to evacuate a little fluid; this was repeated on they third day, after which period the eschar remained adherent, and the part totally free from pain. The eschar separated in about three weeks leaving the part healed.
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