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Asian and African elephants are frequently afflicted by foot disorders that can be very challenging to manage even with aggressive therapy. Such conditions may have indirect life-threatening effects. Mohs' paste (zinc chloride based escharotic agent) was used to treat a female Indian elephant (Elephas maximus indicus) aged 39 years with foot disorder at Kanazawa Zoological Gardens. Degenerated hyperplastic tissue was observed inside the hoofs of digits 2 and 5. Mohs' paste was applied on the lesions, which coagulated the hyperplastic tissue and restrained its proliferation. Subsequently, the hyperplastic tissue could be trimmed with little pain, and the disorder became manageable. Mohs' paste treatment was effective and is expected to be an alternative treatment for hoof disorder.

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The history of zinc chloride therapy before and including Frederic E. Mohs' (1910-2002) early contributions to dermatologic oncology is presented. In 1932, Mohs devised a method of cutaneous surgery that employed zinc-chloride paste to devitalize basal or squamous cell carcinoma. Because zinc chloride coagulates malignant tissue without destroying cellular architecture, he described the surgery and its preservative effect as the fixed-tissue method. This method involved the serial removal of devitalized malignant tissue and the freezing and histologic examination of each layer; the process was continued until a cancer-free plane was reached. In 1953, a modified version of the micrographic system, the fresh-tissue method, was introduced. For improved efficiency, Mohs retained the systematic mapping of a neoplasm but eliminated the chemical escharotic. Although the fresh-tissue method has become the preferred treatment mode, zinc-chloride paste therapy remains in use today. Although the history of Mohs micrographic surgery is well documented, its background has not received sufficient attention. This paper surveys the chemical synthesis of zinc chloride, the formulation of zinc-chloride paste as a cutaneous escharotic, and the extent to which Mohs' method compares with those of 19th and early 20th century predecessors.

Giant omphalocele management has always been a challenge because of the large fascial defect and the associated anomalies. We managed successfully a neonate with giant omphalocele and no associated anomalies by delayed repair constituting escharotic therapy initially and later managed the ventral hernia by component separation technique before her preschool years. Her recovery was non-eventful with no recurrence of the hernia on follow up. Keywords: Omphalocele, Component separation technique, Escharotic therapy

The early surgical management of omphalocele major in Africa predisposes neonates to surgical complications which are often worsened by the presence of associated anomalies. Conservative management using available escharotics results in early skin cover by secondary wound healing. This delays the need for fascial closure and avoids neonatal surgical risks thus improving survival. We present a case of omphalocele major that underwent spontaneous closure during conservative management with honey dressing without surgical intervention.

Sanguinaria canadensis, also known as bloodroot, is a traditional medicine used by Native Americans to treat a diverse range of clinical conditions. The plants rhizome contains several alkaloids that individually target multiple molecular processes. These bioactive compounds, mechanistically correlate with the plant’s history of ethnobotanical use. Despite their identification over 50 years ago, the alkaloids of S. canadensis have not been developed into successful therapeutic agents. Instead, they have been associated with clinical toxicities ranging from mouthwash induced leukoplakia to cancer salve necrosis and treatment failure. This review explores the historical use of S. canadensis, the molecular actions of the benzophenanthridine and protopin alkaloids it contains, and explores natural alkaloid variation as a possible rationale for the inconsistent efficacy and toxicities encountered by S. canadensis therapies. Current veterinary and medicinal uses of the plant are studied with an assessment of obstacles to the pharmaceutical development of S. canadensis alkaloid based therapeutics.

A 60-year-old man with carcinoma of the right parotid gland judged to be inoperable was treated using the escharotic agent Mohs’ paste to improve quality of life (QOL). The tumor surface had become fixed where Mohs’ paste was applied by the next day and dried, reducing the offensive odor and stopping the bleeding. After approximately 40 days, the patient was able to be discharged. Mohs’ paste is effective for improving QOL for parotid carcinoma patients with local advanced, inoperable skin lesions.

Escharotic agents have been used as alternative therapy for treatment of skin cancer and skin problems for centuries. Internet web sites such as online health product stores and eBay have made them widely available to the general public. The use of these agents carries risk of incomplete removal of tumor, damage of surrounding healthy tissues and marked scarring with poor cosmetic outcome. We report the case of a 27-year-old man who presented with history of moles and self-treatment with an escharotic agent containing bloodroot in order to document the histopathologic findings of topical bloodroot treatment and to show the clinical consequences that may occur in the unsuspecting public. To the best of our knowledge, the histological features following use of bloodroot (Sanguinaria canadensis) have not yet been documented.

Mohs fresh-tissue technique for difficult cutaneous malignancies is well known and widely accepted. Less widely known by general dermatologists is Mohs chemosurgery, the technique that launched the career of Frederick Mohs, MD, surgeon. His technique used a dark escharotic paste containing zinc chloride, bloodroot, and stibnite for in situ tissue fixation followed by microscopically controlled mapped excision. Virtually unknown today is Perry Lewis Nichols, MD (the Nichols Sanatorium and the Nichols escharotic method). Dr Nichols developed a bsecretQ escharotic formula that was used to treat more than 70,000 patients with mainly skin, mucosal, and breast cancer. Starting in Iowa (1896), the sanatorium achieved remarkable growth in Hot Springs, SD (1905-1915), expanded to Excelsior Springs, Mo (1911), and had its greatest success in Savannah, Mo (1912-1956). My interest in Perry Nichols began, unknowingly, at 5 years of age when I first laid eyes on the frightening appearance of great uncle Joe at a family reunion with a stork-like white scarf around his head covering a hole in his sagging cheek. That interest increased when my practice was established in St Joseph, Mo, 13 miles south of the former sanatorium. In the last 4 years the interest has become intense with success in acquiring Nichols Sanatorium yearbooks (Cancer and its Proper Treatment—The Value of Escharotics: Medicines which will Destroy any Living or Fungous Growth in the Treatment of CancerLupus-Sarcoma or Any other Form of Malignancy) and interviewing nurses and employees who worked at the

Summary Medicinal leeches ( Hirudo medicinalis ) are commonly used in plastic surgery for the salvage of congested flaps and replanted parts compromised by venous congestion. Infection associated with leech therapy is a documented complication of leech application, with reported incidences ranging from 2.4 to 20% [De Chalain TM. Exploring the use of the medicinal leech: a clinical risk-benefit analysis. J Reconstr Microsurg 1996; 12 (3):165–72. 1 ]. We describe a case of delayed leech-borne infection, from the escharotic portion of a latissimus dorsi flap, which developed several days after stopping leech therapy for venous congestion in a reconstructed breast.

A growing era of alternative medicine is upon us. All who practice medicine have a small population of patients who eschew Western medicine and prefer alternative approaches, including botanical remedies, to treat their medical problems. Many alternative practitioners advertise and sell products on the Internet. Indeed, this trend now includes a growing number of topical treatments for skin cancer, including escharotic agents. Self-treatment of skin cancer requires a substance that will destroy tissue, usually indiscriminately. Escharotic agents are caustic, corrosive substances that produce a thick coagulated crust (an eschar) and subsequently a scar. The following case illustrates one representative situation.

Forty-six neonates with omphaloceles seen at the Children's Hospital and Medical Center in Seattle from 1975 to 1985 were reviewed. There was an 87 percent survival rate in those surgically managed. The 23 neonates who underwent primary closure all survived. The 13 neonates with giant omphaloceles with the liver in the defect who received silon chimneys had a 46 percent mortality rate and a high complication rate, with prolonged hospitalization. Two neonates with giant omphaloceles were managed by leaving the sac intact, and silver sulfadiazine cream was used as an escharotic agent. We believe it is a safer alternative than the silon chimney in neonates whose defects cannot be closed primarily.

An animal model was designed to compare the histology of the injuries resulting from dermabrasion and various escharotics presently used for face peeling. The results suggest that dermabrasion, although a superficial wounding process, leads to deep dermal and subcutaneous injuries. The deep dermal wound probably accounts for the correction of actinically damaged skin and wrinkling so often seen after dermabrasion. The injuries after peels were proportional to the concentration of the acid used: 50% phenol being stronger than 50% trichloracetic acid, which is stronger than 25% trichloracetic acid. The effects of epideraml irritants such as croton oil, the effects of occlusion, and the dose-dependent responses of phenol are all presented and discussed.

As early as 1500 b.c. carcinoma of the breast was treated by excision and by a variety of escharotics, including the Egyptian arsenical pastes. Hippocrates burned out carcinoma by cautery and, though the diagnosis was probably uncertain, this would seem to be the earliest record of destruction by heat. Incidence: According to Hoffman (22) the number of women dying from cancer in Massachusetts from 1920 to 1929 was 146.6 per 100,000 population. In 1935, according to the U. S. Census, cancer of the breast caused 13,226 deaths, which was 9.29 per cent of the total cancer mortality of that year. Assuming that the patient with carcinoma of the breast lives about four to five years from the time when the cancer began to the time of death, Behan (9) estimates, on this basis, that about five times 13,000, or 65,000, women (in the United States) are sufferers from mammary cancer. Spackman and Hynes (45) state that it has been estimated that 2 per cent of women die from carcinoma of the breast. Age (16): According ...

The healing process of exposed human dental pulps has been reported previously by us. In that study the healing process was observed under 2 widely used medicaments, calcium hydroxide and zinc oxidee eugenol. It was found that the superficial portion of the pulp in contact with the calcium hydroxide was rapidly necrotized; within 4 weeks healing took place beneath the necrotic area with the appearance of a new odontoblastic layer and a new dentine bridge. Zinc oxideeeugenol did not necrotize the pulp tissue; however, it elicited an inflammatory reaction, which persisted throughout the course of the experiment. Pulp healing did not occur under zinc oxideeeugenol during the 12 weeks of the study. The question then arose whether or not the necrotizing action of calcium hydroxide was instrumental in promoting pulp healing. Since phenol is an escharotic drug, would its necrotizing action produce the same type of helaing under other capping as observed under calcium hydroxide? Good clinical results have been reported by phenolizing exposed pulp tissue before capping. Some clinicians use phenol before treating vital pulps with calcium hydroxide; however, there is no experimental evidence to substantiate its use. The next question was whether the use of phenol would reduce or enhance the beneficial action of calcium hydroxide in the process of pulp healing. In order to answer these questions, our original

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As a result of experimental work by Juliusberg1and Wile and Kingery,2molluscum contagiosum has been considered for many years to be caused by a filtrable virus. Prior to the advent of chemotherapy, treatment had consisted of local destruction of individual lesions by curettage or escharotics. Within the past 10 years several chemotherapeutic agents have been used, including sulfapyridine,3sulfathiazole,4and recently aureomycin.5All of these, however, have been of limited or no value in many cases, and there have been recent reports of failures with aureomycin.6With this in mind, another antibiotic was used. B. D. a 2-year-old Negro girl, was seen on July 24, 1951. She presented about 25 to 30 typical lesions of molluscum contagiosum. One lesion was noticed several months ago, and new ones have continued to appear. Because of the extreme difficulty of curetting these lesions in an

THE creeper, Ipomoea pes-caprae (L.) Roth, of the family Convolvulaceae, which is found in abundance along the warmer seashores of both hemispheres, is used as a medicant in many parts of the world. The leaves are usually used—either boiled for external appfication as an anodyne in colic or rheumatism, or powdered and incorporated in an ointment said to have good local effects on bedsores—but they may also be used as an escharotic in the treatment of ulcers. Previous reports1,2 suggest that the extracts of the plant have no pharmacological effects.

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Mrs. R. E., 20 years of age, in August, 1895, swallowed an indefinite quantity of a solution of potassium hydrate, commonly known as concentrated lye, of uncertain strength. Whether any of the chemical reached the stomach is not known, but its escharotic effect was markedly exerted in the esophagus. I did not see the case for some weeks after the accident and am unable to say what, if any, constitutional effects the drug produced. The attending physician treated the case by quieting pain, giving demulcent drinks and liquid food. No attempt was made to preserve the lumen of the esophagus by the systematic passage of bougies during the time cicatricial contraction was taking place. While such a procedure is advocated in many of our text-books it is of doubtful utility; for gradually and persistently stenosis and atresia succeed each other. In December, 1895 the case was referred to me, as

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Many metallic poisons which are non-corrosive in character show the limit of their exhibition in the human system by manifestations of some nature in the oral cavity. Some of the corrosive metallic poisons also show this limit in the mouth. This is especially the case with the escharotic corrosive metallic poisons. In both acute and chronic metallic poisonings are found oral manifestations; but this paper wishes to direct the attention to the oral manifestations arising from chronic metallic poisonings. There is a slight suspicion that the prolonged exhibition of arsenic, in proper doses to produce medicinal effects, may result in the death of the pulp of one or more of the teeth in the individual so treated. There is no authenticated case of this nature, but the theory of it, based upon a knowledge of the accumulative nature of arsenic, is a good one. Arsenic in its action has a

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Case 1.—Patient.— Male, aged 51. He had a rounded nodule in the middle of his right cheek three or four years before the date of the examination referred to below. I saw him once at this time. Later he was subjected to various escharotic treatments. When he returned, to me he brought from a competent pathologist the simple diagnosis of "cancer." Within a short time I requested that he get the pathologist to make another examination microscopically. This was refused because the latter believed his original diagnosis correct. Examination. —January, 1902. The disease occupied an area from the right zygoma over the lower one-third of right cheek and chin, as well as slightly below inferior maxillary border and a little under the ear. The unbroken parts were livid, swollen, the surface partially cicatricial, partially open and irregular. In the raw surface and in the borders were pits from

When the history of 20th-century burn care is written, topical antibacterial agents are unlikely to receive the credit for contributing to progress in burn care that they have been awarded during the past two decades. Modern-day burn salves are probably no different in principle from the oils, foodstuffs, and escharotic agents that were applied throughout the 19th century; they hide the problem and delay the surgeon's primary task — skin replacement. The deficit in any full-thickness burn injury is skin, and that problem cannot be addressed by obscuring the wound with even the most pharmacologically refined lather. The widespread clinical . . .

The treatment of benign tumors of the larynx has, of necessity, been varied, depending on the condition as presented. In some instances a surgical removal is the most advisable procedure, whereas in others the topical application of solutions is resorted to. Of these solutions, some are used as escharotics, others as corrosives, others as astringents and, finally, others as stimulants to tissue repair. Further, radium has been employed also. It may be said of all the benign tumors of the larynx that they bear some relation to chronic inflammation. Jonathan Wright stated that if these tumors are not the result of chronic inflammatory changes, then chronic inflammation at least plays an important role in their etiology. I will report the treatment and cure of a patient with myxoma of both vocal cords by the topical application of an escharotic solution. REPORT OF CASE Mrs. B. B., aged 35, referred to

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It has long been recognized that cauterization of posterior and middle nasal hypertrophies, even if practiced with every caution in the selection of cases, method, and accompanied by every required antiseptic precaution, is not unattended by dangers. This warning is often not heeded until personal observation and experience have afforded convincing proof of its truth. Formerly, when the use of the galvano-cautery and other escharotic methods to effect the shrinkage of the hypertrophied areas of the mucous covering of the inferior turbinates was more general and their application more reckless, it not infrequently came to pass that acute pyogenic infection of the middle ear, of the ethmoidal cells, and even septic infection resulted as a complication in cases even where the operation was clearly indicated and necessary. The destruction of posterior hypertrophy in particular is fraught with risk and danger. Fierce resentment on the part of the cauterized region, altogether

At a time when the markets are flooded with new remedies, each one backed by innumerable clinical observations, it would indeed seem reckless presumption to speak about one laden with age. But, while in the wide range of applicability the drug for which I propose to take up the cudgels this evening falls far below many of the recent ones, yet in effectiveness, circumstances and conditions remaining the same, it outdoes all the latest rivals and arrivals. My object here is to speak about nitrate of silver, its value in the local treatment of diseases of the skin. The physiologic action of nitrate of silver as applied locally, depends upon the strength of the salt employed. It may be caustic, escharotic, astringent and alterative, each condition resulting from the use of the mitigated, pure, saturated or very weak solution. A quality of silver nitrate passed unmentioned by writers on materia