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On The Adherent Eschar

Sources: Application Of The Lunar Caustic In The Cure Of Certain Wounds And Ulcers

It appears scarcely necessary to describe the immediate and well known

effects of the application of the lunar caustic to the surface of a

wound or ulcer. It may, however, be shortly observed that the contact

of the caustic induces, at first, a white film or eschar which, when

exposed to the air, assumes in a few hours a darker colour, and at a

later period, becomes black; as the eschar undergoes these changes of

it gradually becomes harder and resembles a bit of sticking

plaster; in the course of a few days, according to the size and state

of the wound, the eschar becomes corrugated and begins to separate at

its edges, and at length peels off altogether, leaving the surface of

the sore underneath, in a healed state.

In the formation of this eschar several things require particular

attention. 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.

At the same time, much attention must be paid to the degree in which

the caustic is applied. In cases of recent wounds unattended by

inflammation, it may be applied freely; but when inflammation has come

on, too severe an application of the caustic induces vesication of the

surrounding skin, and the edges of the eschar may in this manner also

be loosened and removed. If every part is touched, a slight

application of the caustic is generally sufficient.

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.

Not only the cause just mentioned, but every other by which the eschar

might be disturbed, must, therefore, be carefully avoided; and

especially, as the eschar begins to separate from the healed edges of

the sore, it should be carefully removed by a pair of scissors.

To the surface of the wound the eschar supplies a complete protection

and defence, and allows the healing process to go on underneath

uninterruptedly and undisturbed. It renders all applications, such as

plasters, totally unnecessary, as well as the repeated dressings to

which recourse is usually had in such cases; and it at once removes

the soreness necessarily attendant on an ulcerated surface being

exposed to the open air. In many cases too, in which the patients are

usually rendered incapable of following their wonted avocations, this

mode of treatment saves them from an inconvenience, which is, to some,

of no trifling nature.

It has already been stated how important it is that the eschar should

be preserved adherent. To secure this still more effectually, I have

found it of great utility to protect it by a portion of gold-beater's

skin. The skin surrounding the wound is simply moistened with a drop

of water, and the gold-beater's skin is then to be applied over it and

over the eschar, to which it soon adheres firmly, but from which it

may be removed at any time, by again moistening it for a moment with

water; the same bit of gold-beater's skin admits of being again and

again reapplied in the same manner.

The other circumstances which render the eschar unadherent will be

mentioned hereafter. In the mean time the fact stated p. 6, will

sufficiently establish the propriety of treating distinctly of the

adherent eschar.

I now proceed to mention some other effects of the application of the

caustic. The first is that, in cases in which there would be much and

long continued irritability and pain, as in superficial wounds along

the shin, all this suffering, and its consequences in disabling the

patient, are completely avoided. 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. But if this inflammation be not

severe, and if the eschar remain adherent, all inflammation, both that

induced by the application of the caustic, and that existing

previously, entirely subsides. 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. On the subject of

scabbing I must refer my reader to the well known work of Mr. John

Hunter. The advantage of healing by eschar over that by scabbing is

quite decided. By comparative trials, I have found that whilst the

scab is irritable and painful, and surrounded by a ring of

inflammation, the adherent eschar is totally free from pain and

inflammation; and that whilst the scab remains attended by

inflammation and unhealed, the eschar is gradually separating, leaving

the surface underneath completely healed. To these observations I may

add that the success of the plan of healing by eschar is infinitely

more certain as well as more speedy than that by scabbing.

I shall, in conclusion, briefly recapitulate the advantages of this

mode of treatment. In the first place, it will be found far more

efficacious and speedy than any other; secondly, it has the great

advantage of saving the patient much suffering and inconvenience; and

thirdly, it renders the repeated application of dressings and

ointments quite unnecessary. Its utility is extremely great,

therefore, where the time of the poor, the expense of an

establishment, and the labours of the medical officer, as well as the

sufferings of the patient, require to be considered; and it will I

imagine be found of no little advantage, in all these respects, in

many cases which are incident to the soldier and sailor.