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On The Unadherent 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

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

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

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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