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Medical ArticlesDeformities Of The Urinary Bladder The Operations Of Sounding For Stone Of Catheterism And Of Puncturing The Bladder Above The PubesThe urinary bladder presents two kinds of deformity--viz., co... Bruises Case Xiv The first case of bruise which I shall detail was not severe,... Methods Of Treatment Irritating applications probably provoke recurrences, becaus... Nursing Sore Mouth Sore mouth of nursing women, as the name of the disease indic... Kidney Complaints See Urinary Troubles. ... Punctures Case Iv The present case is somewhat more severe than those which hav... Lather How To Make One of the most powerful soothing influences which can be had,... Anchoring The Foreign Body Against The Tube Mouth If withdrawal be made a bimanual procedure it is almost cert... To Prevent Cholera _Camphor_ (_pellets medicated_ with the pure tincture) _Verat... Bruises Case Xix Robert Hill, aged 16, received a blow yesterday from a bone w... Limbs Uncontrollable This trouble is found in the double form; first, of limbs whic... Pleuroscopy For Disease Most pleural diseases require a large external opening for d... Extraction Of Soft Friable Foreign Bodies From The Tracheobronchial Tree The difficulties here consist in the liability of crushing or... Gravel Sometimes mere internal inflammation is mistaken for this dise... Don't Talk THERE is more nervous energy wasted, more nervous str... The Heart In Pneumonia As pneumonia heads the list of the causes of death in this co... Appetite Should be an indication that food in general or some certain k... Jaundice This disease depends upon derangement of the liver. The skin ... Paroxysm Drugs The part the nervous system plays in this paroxysm is shown b... Rubbing Sheet Substitute For The Half-bath It cannot be difficult to procure a wash-tub. Should you be s... |
On The Unadherent EscharCategory: ON HEALING BY ESCHAR. Source: Application Of The Lunar Caustic In The Cure Of Certain Wounds And Ulcers 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. If the eschar be unadherent by subjacent pus, it may be ascertained in the space of from twelve to twenty-four hours; the centre is generally observed to be raised and to yield to the pressure of a probe; sometimes the subjacent fluid has partly escaped by an opening at the side of the eschar. When a scab forms underneath the eschar, which does not happen except the fluid has been allowed to remain too long under the eschar without being evacuated, there are pain and some inflammation, the eschar does not separate, but remains long over the sore, and there is no appearance of healing. When it is ascertained that there is fluid underneath the eschar, a slight puncture is to be made by the point of a penknife, the fluid is to be gently pressed out, and the caustic is then to be applied to the orifice thus made. 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. After this treatment the eschar occasionally remains adherent, but more frequently the fluid requires to be evacuated repeatedly, and this should be done every twelve hours, or once a day, according to the quantity of fluid formed, taking care that the eschar be not needlessly separated by allowing the fluid to accumulate underneath. If, from accident, the eschar is separated before the sore be healed I would reapply the caustic. At length the eschar becomes adherent, and in due time begins to peel off, leaving the surface healed. In every case in which the eschar does not separate favourably, I begin to suspect the formation of a scab underneath, in which case the whole must be removed by the application of a cold poultice for two or three days; this has not only the effect of removing the eschar but of allaying any inflammation or irritation; afterwards the caustic must be reapplied as before. The gold-beater's skin is more useful as a protection to the unadherent than to the adherent eschar, as the former would be more liable to be torn off by accident than the latter. The gold-beater's skin must be removed in the manner already described, whenever the subjacent fluid is to be evacuated, and must be reapplied after touching the orifice with caustic. The pain experienced on the application of the caustic is greater or less according to the sensibility and size of the wound. In small wounds it is trifling, and of short duration; it is more severe in recent wounds than in ulcers; it soon subsides in every case, and then the patient enjoys greater ease than would be experienced under any other mode of treatment. Little or no pain is caused on applying the caustic after evacuating the subjacent fluid of an unadherent eschar. Altogether the pain inflicted by the caustic is far less than is generally imagined, and forms scarcely an obstacle to its employment. It may be proper, in this place, to notice such circumstances as render the employment of the caustic improper or inefficient. 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. I have found no kind of caustic so manageable as the lunar caustic; and this is best applied in the solid form. I have thought too, that the newly prepared lunar caustic is more apt to dissolve on being applied than that which has been longer made and more exposed to the air; the latter is therefore to be preferred. Next: On The Treatment By Eschar And Poultice Previous: On The Adherent Eschar
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