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Updated: June 15, 2025
I applied the caustic to the parts of the ulcer exposed by the injury done to the eschar. During the two following days the inflammation subsided entirely; I evacuated a little fluid from beneath the eschar. On the next day the eschar appeared adherent, except in the centre which was occupied by the slough. On the succeeding day, I evacuated a little fluid from beneath the slough.
From this day until the tenth the fluid required daily evacuation; the eschar became adherent, and I allowed my patient to walk about. In about six weeks the eschar was nearly separated and I removed it by the scissors, leaving only a portion adherent of the size of a pea. It had been prevented from being removed from the beginning, by the gold-beater's skin.
I prescribed an emetic and purge, and a cold poultice and lotion. In the space of a week I again attempted to form an eschar over the larger wound, for the smaller one had quite healed. The next day I discharged a little fluid from the centre, and again on the eight or nine succeeding days, giving saline purgatives. After this time the eschar remained adherent, and no further remedy was required.
It is generally necessary to repeat the application of the caustic every second or third day, or every day if the inflammation and swelling of the part be considerable, and the cold poultice may be renewed about every eight hours. At length, however, the inflammation having subsided, the attempt may be made to form an adherent eschar.
It is improper to employ the caustic when the ulcer is too large to admit of the formation of a complete eschar; or when it is so situated as to render it impossible that the eschar should remain undisturbed, as between the toes, unless, indeed, the patient be confined to his bed; or in cases attended by much inflammation, or by much oedema.
A blush of inflammation forms around the eschar, but this gradually subsides without any disagreeable consequences, and the inflammation which would otherwise have been set up is entirely prevented by the due formation of the eschar. If inflammation be previously established, it is increased, at first, by the application of the caustic.
It is necessary therefore in all cases, except those of very small ulcers, to examine the eschar, making a small puncture or rather smooth incision in its centre, so as to evacuate the subjacent fluid if there be any, taking great care not to break down or bruise the eschar so as to leave its inferior surface at all ragged.
Baynton's plan is inadmissible, the caustic is invaluable; in these cases the cold poultice and lotion should precede the application of the caustic, for a few days, that the irritability and inflammation of the sore and surrounding skin may be first subdued; and after the eschar is formed, the part must be kept exposed to the air and defended from external injury, by enjoining the patient to wear trowsers and to be careful not to disturb the eschar.
I repeated the application of the caustic and again directed the part to be exposed and carefully protected from being disturbed. The breast required to be supported being full of milk. On the succeeding day an adherent eschar existed over all the ulcerated parts, and the pain, redness, and irritation had nearly subsided. On the fourth day there was still less pain and inflammation.
The poultice was discontinued, and the caustic was then applied in order to form an adherent eschar, in which I was successful.
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