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Updated: June 15, 2025
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.
The importance of avoiding all causes which might detach the edges of the eschar will be apprehended by the following interesting observation, which I have been enabled to deduce from very extensive trials of the caustic; it is, that, in every instance in which the eschar remains adherent from the first application, the wound or ulcer over which it is formed, invariably heals.
The parts at the point of entrance of the current are charred to a greater or lesser depth. The eschar is at first dry and crisp, and is surrounded by a zone of pallor. For the first thirty-six to forty-eight hours there is comparatively little suffering, but at the end of that time the parts become exceedingly painful.
This case being less severe than the former one the eschar remained upon the wound during a much shorter period of time. An old man, aged 60, received a bruise upon the occiput from a fall; the skin was lacerated and removed to the extent of half-a-crown. I applied the lunar caustic soon after the accident. On the next day an adherent eschar was formed. There was neither pain nor swelling.
The eschar had the same character; a little fluid was again evacuated and the caustic applied to the orifice as before. This mode of treatment was pursued for nine successive days when the eschar remained adherent in every part. This patient continued her usual avocations all along.
In these, as in all other cases, the value of this remedy is greatly enhanced by an early application. In bruises on the shin I have not had a single instance in which I was not enabled to effect a cure by the adherent eschar, if application was made to me early.
A servant maid was bitten by a dog in four places severely on the forearm three days ago. Adhesive plaster had been applied. There is a wound across the arm two inches in length and three-fourths of an inch in breadth, attended by dull pain, and swelling of the arm. I applied the caustic to form an eschar, covering it with goldbeater's skin.
It must also be particularly borne in mind, that the eschar must be constantly defended by the gold-beater's skin, which must be removed and reapplied at each examination. I have here spoken of ulcers upon the legs.
The eschar was at length removed by the healing process and was separated together with the nail, and the case was unattended by any further inconvenience or trouble either to the patient or myself. It is scarcely necessary to contrast the advantage of this mode of treatment with that by plasters, poultices, &c.
But my patient contrived unfortunately to rub off the eschar about a week after its formation, and so to expose the subjacent wound unhealed; she suffered however no pain or inconvenience from it; and it was again shielded by means of a fresh eschar, which remained adherent until removed by the healing process underneath.
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