John Higginbottom

“ 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 [15] 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. ”

“ It is improper to employ the caustic when the ulcer is too large to admit of the formation of a complete [20] 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 œdema. ”

“ In many cases in which it is impossible to adopt either the mode of treatment by the adherent or the unadherent eschar, it is of great utility to apply the caustic first and then a cold poultice made without lard or oil: this plan is particularly useful in cases of punctured wounds attended by much pain and swelling, and in cases of recently opened abscesses. By this application the pain and swelling are much subdued and a free issue is secured for the secreted fluid; and in no case have I seen the original inflammation increased by it. ”

“ 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. ”

“ An adherent eschar is generally readily formed, and no further application is required. If the ulceration be more extensive and deeper, the lunar caustic may be applied, and the eschar treated, exactly as in common ulcers. ”

“ Any slight vesication which may be raised around punctured wounds is not of the same consequence as when an adherent eschar is wished to be formed over a sore or ulcer; one or more small punctures may be made to evacuate the fluid and the part may be allowed to dry. ”

“ A young man, aged 18, came to me with a painful swelling of the middle [123] finger of the right hand; suspecting deep-seated abscess, I made a free incision and evacuated a little pus. I then applied the lunar caustic within the cavity and directed a cold poultice to be applied with lotion. ”

“ For such [97] sores are very apt to spread and to remain long very troublesome.
An old gentleman came to me with an oblong ulcer on the shin about an inch in length; it was very painful and inflamed. I applied the lunar caustic to form an eschar and requested him to call on the following morning. He did not come, however, but on seeing him the next day it was requisite to evacuate a little fluid; this was repeated on they third day, after which period the eschar remained adherent, and the part totally free from pain. ”

“ The advantage of these modes of treating punctured wounds will however be best explained and established by a selection of cases, to which I can add particular remarks as they may be suggested by peculiarities in the cases themselves. ”

“ 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 ”

“ 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. ”