on of particular
interest, both in a pathological and curative point of view; it is,
that the formation of this slough has always been prevented by an
early application of the caustic, in the cases which have hitherto
fallen under my care. This fact may probably admit of explanation in
the following manner; the bruise partially destroys the organization
of the part, and the subsequent inflammation completing what the
injury had partially effected, a loss of vitality takes place, and
the slough is formed. The early application of the caustic has
already been shown to have the remarkable effect of preventing the
inflammation consequent upon certain wounds, and thus the part is
suffered to recover from the injury done to its organization, and its
vitality is preserved.

Whether this mode of explaining the fact be correct or no, the fact
itself is extremely important, for the formation of a slough, which
the early application of the caustic can alone prevent, renders it
quite impossible to effect the formation of an adherent eschar.

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