When the patient applies too late after the accident to prevent the formation of a slough we must still treat the case by the caustic. It is to be applied over the bruised and inflamed part. The eschar remains adherent round the part occupied by the slough and prevents or moderates the inflammation, and when the slough separates an eschar is to be formed over the exposed sore.
In the neglected and severer cases of bruise attended by much inflammation, it will be found best to treat the part for a day or two by a cold poultice to give time for the inflammation to subside; otherwise the caustic might induce vesication of the skin, as I have mentioned already, [p. 5], and the eschar could not be adherent.
Case XIV.
The first case of bruise which I shall detail was not severe, but will serve to illustrate the mode of treatment by the adherent eschar.
Mr. Symons, aged 60, slipped off a chair and bruised the shin, last evening; the skin was removed to the extent of an inch in one part and a square inch in another. He applied a common poultice. During the night he had much pain, and to-day there is much inflammation round the wounds. I applied the lunar caustic over both wounds and covered the eschar with gold-beater's skin to prevent the contact of the stocking.
On the following day the eschar was found to be perfect. The pain had entirely ceased. There was a little vesication round one of the wounds. I simply evacuated the fluid of the vesication and left the part exposed to dry.
On the third day there was no pain or inflammation, and the eschar remained adherent.
From this time no remedy was required. The eschar separated leaving the surface healed, in about a month from the occurrence of the accident. The patient suffered no sort of inconvenience nor was he confined from his labours a single day.
Case XV.
The following case was far more severe, but the mode of treatment was not less efficacious.