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Updated: June 15, 2025
The same plan is to be adopted if the fluid ooze out at the edge of the eschar; it is to be fully evacuated by pressure, and the orifice is to be touched with the caustic. The healing process goes on best however when the orifice is in the centre of the eschar.
The first case of bruise which I shall detail was not severe, but will serve to illustrate the mode of treatment by the adherent eschar. Mr. Symons, aged 60, slipped off a chair and bruised the shin, last evening; the skin was removed to the extent of an inch in one part and a square inch in another. He applied a common poultice.
On the next day I found that the poultice had not been applied; there were more pain and swelling; an eschar was formed over the puncture which I removed and thus gave issue to a considerable quantity of pus; I again enjoined the application of a cold poultice kept constantly moist and cold with water. On the succeeding day, the inflammation had greatly subsided.
Montagu, where his man, Mons. Eschar, makes a great complaint against the English, that they did help the Spaniards against the French the other day; and that their Embassador do demand justice of our King, and that he do resolve to be gone for France the next week; which I, and all that I met with, are glad of. 17th. Captn.
The application of the caustic should be made over the whole surface of the sore; and indeed no part requires so much attention as the edges; to make a firmer eschar the caustic should even be applied beyond the edge of the wound, upon the surrounding skin, for the eschar in drying is apt to contract a little, and in this manner may leave a space between its edges and that of the adjacent healthy skin.
He has been long subject to ulcers of the legs, and he had a similar ulcer to the present one in the same situation, some years ago, which proved extremely difficult to heal under usual remedies. The veins are varicose. From the small size of the ulcer, I applied the lunar caustic and protected the eschar by the gold-beater's skin.
When the previous inflammation round the ulcer is considerable, however, the application of the caustic would induce vesication, and it should in such a case of course be avoided, and another mode of treatment to be described hereafter must be adopted. I would introduce in this place some observations on the comparative effects of healing by eschar and by scabbing.
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.
Whether this mode of explaining the fact be correct or no, the fact itself is extremely important, for the formation of a slough, which the early application of the caustic can alone prevent, renders it quite impossible to effect the formation of an adherent eschar.
I applied the lunar caustic and directed the part to be exposed to the cold air. On the succeeding day, I found that the eschar was quite adherent, and that the pain, redness and swelling had much subsided, although there was some stiffness of the elbow. On the third day there was still further amendment. From this time no remedy or attention was required.
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