III. ON THE TREATMENT BY ESCHAR AND POULTICE.
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.
It is generally necessary to repeat the application of the caustic every second or third day, or every day if the inflammation and swelling of the part be considerable, and the cold poultice may be renewed about every eight hours. At length, however, the inflammation having subsided, the attempt may be made to form an adherent eschar.
I have seen many cases, in which, by this mode of treatment, much suffering and perhaps the loss of some of the smaller joints have been prevented, particularly cases of deep seated inflammation of the fingers, which, having been neglected, have issued in severe inflammation, abscess, and terrible fungous growths. In these cases it is not only necessary to apply the caustic to the surface of the sore, but in every cavity or orifice which may be formed by the disease.