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Updated: June 15, 2025
The lunar caustic was applied in half an hour after the accident. On the following day the eschar was observed to be adherent, and the patient reported that she had suffered scarcely any pain, after the smarting of the caustic had ceased. There was a slight swelling round the puncture but that of the arm had totally subsided. The caustic was applied over and beyond the swelling.
On the following day, my patient expressed herself as astonished at the rapid amendment. A little fluid was again evacuated from beneath the centre of the eschar. On the next day the smaller eschar was quite adherent; under the large one, there was still a very little fluid. About the ninth day, both the eschars were perfectly adherent.
C. aged 40, had two small irritable and inflamed ulcers, under the inner ankle. I applied the lunar caustic to form an eschar. It was requisite to evacuate a little fluid from under the eschars for three successive days; they then remained adherent. About the usual time the eschars separated, leaving a small point of the size of a pin's head, unhealed; this I again touched with the caustic.
On the succeeding day, I found that the patient had applied a little lint before the eschar was dry, which had prevented it from remaining adherent. I reapplied the caustic and desired that the eschar might be exposed to dry. The eschar remained adherent, the inflammation subsided and the case gave no further trouble.
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.
On the succeeding day I found that the eschar did remain adherent and that the inflammation was diminished, and the soreness had entirely subsided after that induced by the caustic had ceased. On the next day, the lameness was gone, and there was no sort of inconvenience from the wound. My patient continued her journey on the following day, so that I do not know when the eschar separated.
As the inflammation had subsided I proposed to adopt the mode of treatment recommended by Mr. Baynton, fearing that any attempt to heal the ulcers by eschar would fail on account of the oedema. This project was deferred, however, by the patient's wish to try the effect of sea-bathing.
It had remained stationary a whole fortnight under the ordinary treatment by bandage. I applied the lunar caustic to form an eschar and then the gold-beater's skin. The day afterwards, I found the eschar incomplete and I applied the caustic again. The eschar was still incomplete on the following day, and the caustic was again required to be applied to the denuded parts.
From the degree of inflammation still present, I applied the lunar caustic very slightly over the sore and not over the inflamed skin; I left the eschar to dry, but was very doubtful, from the same cause, whether it would be adherent or no.
This case is particularly interesting and important, as it illustrates the plans to be adopted in two circumstances of no unfrequent occurrence; 1. when there is an attack of fever and increased inflammation, and 2. when a scab forms underneath the eschar.
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