I have here spoken of ulcers upon the legs. But the same observations apply to ulcers on other parts of the body, and these are, in general, far more manageable than the former, and do not require the same rest during the unadherent state of the eschar.
Mrs. Butcher, aged 52, has two ulcers a little above the outer ankle, one the size of half-a-crown, the other, of a shilling, of four months duration, which are now in a healing state by the application of cerate and poultice; the healing process is going on very slowly. These ulcers were caused by a fall which bruised the part but made no wound at the time; two small spots, which she compared to the pustules of small-pox, formed, broke, and gave rise to the ulcers. I applied the lunar caustic to form eschars.
At this time I had not begun to defend the eschar by the gold-beater's skin, and in consequence both these eschars were torn by the patient's stocking having adhered to them, and there was an oozing of fluid from the centre of each eschar on examination on the following day. I again applied the lunar caustic.
On the succeeding day, I found that the large eschar had again been disturbed, the patient having applied a little linen, instead of leaving it exposed. I reapplied the lunar caustic.
On the next day both eschars were complete, but there was a little fluid under the centre of each, which required to be evacuated by an incision. There was little inflammation or pain.
On the following day, my patient expressed herself as astonished at the rapid amendment. A little fluid was again evacuated from beneath the centre of the eschar.
On the next day the smaller eschar was quite adherent; under the large one, there was still a very little fluid.
About the ninth day, both the eschars were perfectly adherent. In two days afterwards the eschars began to separate round the edges, and in a few days more, it was necessary to remove the separating portion by the scissors.--In the course of time the eschar separated completely, leaving the ulcers healed.
Mrs. Butcher had no pain after the first four days from the application of the caustic, and in a week was able to attend to her household affairs.
J. Copeland, blacksmith, aged 38, came to me with many deep ulcerations, from the size of a horse bean to that of a pea, attended with great pain, heat, itching and excoriations of the surrounding skin, obliging him to rest at different times, for several days together. These ulcers came without any apparent cause, have continued for many weeks, and have only been a little benefitted by rest, although he has applied many kinds of ointment, the last consisting of equal parts of mercurial and of the tar ointment. I applied the lunar caustic upon each ulcer, but not over the excoriation, and I enjoined the patient to leave the whole exposed to dry.