OVERVIEW OF SCARS AND ADHESIONS

I.  Physiological Considerations

    Scars are such a common occurrence in everyone's experience that little attention is paid to them unless a large area is involved or a cosmetic or functional problem results from the location of the scar.

    Scars are regarded as products of the natural repair of injured tissue.  The healing of surgical incisions or lacerations which are closed by approximation with sutures differs from the healing of open wounds such as third-degree burns, stasis ulcers, or decubitus ulcers.  Other types of scars may be produced by infections or certain inflammatory diseases.

    The healing of surgical wounds begins with the body's outpouring of blood and serum into the defect, the formation of fibrin from fibrinogen, and the migration of fibroblasts and blood vessels into this matrix.  New collagen is laid down by the fibroblasts, and a new epidermal surface forms from the migration of epidermal cells across the wound gap.  At first the newly formed collagen is very cellular and richly supplied with blood vessels, but in time both the cellularity and blood vessels diminish.  The bright red color of the new scar gradually fades to a pearly color in a year or so, and at this point the scar remains more or less stable.

    In superficial wounds, where only a portion of the dermis is destroyed, epithelial cells may migrate from the remnants of sweat glands or hair follicles to form the new surface.  The final healing might be a slightly depressed scar such as often is seen in acne or the deeper infections of impetigo or chicken pox.  Large boils or papular or cystic acne may produce considerably deeper scars, sometimes of the "ice-pick" variety.

    Large deep wounds - where the dermis is destroyed, such as in third-degree burns - pose a different problem for the body.  In the absence of adnexal structures such as hair follicles, sebaceous and sweat glands, repair of the defect is by way of granulation tissue.  Granulations are capillary buds extending upward to the surface and carrying with them fibroblasts and inflammatory cells.  Once a good granulating surface is established, epidermal cells may migrate across to cover the healing surface, but if the wound is large, grafts may be required.  Beneath the new thin epidermis new collagen is laid down.  The resulting scar may be smooth, but often it presents an irregular, sometimes ropy surface.  Shrinkage of the tissue may result in contractures and deformity.

    Keloids and hypertrophic scars result from an abnormal growth of collagen tissue in a scar.  They are elevated, swollen, tense, and sometimes painful.  Usually keloids and hypertrophic scars develop in recently healed wounds.  Keloids may be quite massive and deforming; excision frequently results in an even larger keloid.  This type of growth is most commonly seen in the black race, and often they are found on the upper portions of the trunk, neck, or ears.  Unlike keloids, hypertrophic scars may regress spontaneously after a few months, but at times the distinction between hypertrophic scars and keloids is impossible to make.

    Of the 16 readings in the Circulating File on scars, only two touch on the physiology of scars, and thus comments necessarily will be brief.  Do scars impair the normal functioning of the body?

    Apparently some do, as in 487-17, "any scar tissue detracts from the general physical health of a body, for it requires a changing in the circulation continually." In contrast, in 440-3, when asked if apparently extensive scars on the abdomen and legs were detrimental, Cayce replied, "little or no hindrance." The same reading also gives a tantalizing hint on the origin and nature of scar tissue: ". . where tissue has been in the nature of folds-or scar tissue, produced from superficial activity from the active forces in the body itself, in making for coagulation in any portion of the system, whether external or internal."

    Just what is meant by "folds" is difficult to guess.  Perhaps it refers to an as yet unappreciated feature of scar coliagen.  The term "coagulation" is used repeatedly in the readings. [2423] had a lack of it, and healing could not take place. [1377] had an abnormality of coagulation, and adhesions resulted, and in reading 440-3 it appeared to refer to a healing property.  It seems to be a broader term than simple clotting of blood, and might be referring to complex biochemical processes involving fibrinogen and other serum proteins and numerous enzymes. (Further study of many more readings mentioning coagulation may be necessary to clarify Cayce's meaning.  In Dr. William McGarey's commentary on " Leukopenia-Leukocytosis," coagulation is seen as the rebuilding of cells throughout the body.)

    The essential, practical point in these readings is that scars are not necessarily the end point in the healing process In some cases, at least, total eradication is possible; "remember the whole surface may be entirely changed if this is done persistently and consistently ... in the course of two to two-and-a-half years, a new skin!" (440-3) Some scars, however, cannot be entirely eradicated.  In 3167-1 regarding the scars from abscesses which had been lanced, "Can't pull out nail holes!. . may pull out the nails, but we can't pull out the holes!" This would seem to indicate that incision and drainage of abscesses indiscriminately would be a poor practice, although Cayce did recommend at times lancing of boils.

II.  Rationale of Therapy

    The treatment of cutaneous scars is covered in all readings but two which deal with adhesions and chronic inflammation.  These two will be discussed separately at the conclusion of this review.
In most of the readings on cutaneous scars, by which is meant healed wounds, camphorated oil was suggested, either alone, or alternated with olive oil and tincture of myrrh, or diluted with other oils.  The best description of the effects of these prescribed medicines is given here:

    ... olive oil - properly prepared (hence pure olive oil should always be used) - is one of the most effective agents for stimulating muscular activity, or mucous membrane activity, that may be applied to a body ... tincture of myrrh acts with the pores of the skin in such a manner as to strike in, causing the circulation to be carried to affected parts [scars] ... camphorated oil is merely the same basic force [olive oil?] to which has been added properties of camphor in more or less its raw or original state, than the spirits of same.  Such activity in the epidermis is not only to produce soothing to affected areas but to stimulate the circulation in such effectual ways and manners as to combine with the other properties in bringing what will be determined, in the course of two to two-and-a-half years, a new skin!   (440-3)

    The muscle activity stimulated by the olive oil may refer not only to striated skeletal muscle, but also to the smooth muscle in the intestinal walls, and in the walls of small arteries and arterioles.  Perhaps such activity stimulates the circulation within the scar tissue leading toward that activity which is necessary to absorb the scar collagen.  Both the camphor and tincture of myrrh were also described as stimulating the circulation.  Camphor is also called a soothing force.  Camphor is classified by Goodman and Gilman as a hydroaromatic gum obtained from the bark and wood of the tree, Cinnamomum camphora, which is grown in Taiwan and Japan.  It is classed as a rubefacient, which means it produces capillary dilatation, in accordance with the Cayce information.  If taken internally it causes nausea and vomiting, and large doses of solid camphor in children may cause convulsions.  Therefore, camphor lotions should be kept out of the reach of children.

III.  Suggested Therapeutic Regimen

    Since camphorated oil appears to be the key to the treatment of cutaneous scars, it is important that it be accurately defined.  Camphorated oil is no longer made commercially as it was in Cayce's day.  At that time, it was made with natural gum camphor in olive oil.  Presently available is a synthetic camphor in cottonseed oil; therefore, it may not be a satisfactory substitute for the camphorated oil referred to in the readings.

    Case [440] was experiencing extensive scarring on the legs and abdomen.  Massage was suggested alternating equal parts of tincture of myrrh and olive oil on one day followed the next day by camphorated oil. (The olive oil is to be heated before adding the tincture of myrrh, and only enough for the day's massage is to be prepared.) This sounds like an ideal program for extensive scars.

    The successful removal of severe burn scars on [2015] was accomplished with a formula that has become a classic Cayce remedy:

• Camphorated oil, 2 ounces
• Lanolin, dissolved, 1/2 teaspoon
• Peanut oil, 1 ounce

    Dr. James L. Rowland, D.O., Ph.D., of Kansas City, apparently has used this lotion successfully in wound scars and keloids.  The lotion should be gently massaged into and around the scar with the fingertips once or twice a day.

    For active acne in case [528], an interesting lotion was prescribed:

• Camphorated oil, 2 parts
• Witch hazel, 1 part
• Russian white oil, 1 part

    This lotion must be shaken very well and massaged for several minutes into the acne areas twice a day.  It was said to help clear the skin and treat and prevent scars as well. (Nujol is one form of Russian white oil.)

    Note that the camphorated Oil is diluted about in half in the last two formulas.  A similar dilution was suggested in a burn scar case (48717), but the diluent was sweet Oil (olive oil).

    Case [40031 had severe scarring, Possibly with calification and contractures, which followed an injury.  Treatment was aimepd at removing the scar by absorption and excretion through the respiratory, perspiratory, and alimentary systems.  Local therapy consisted of hot Epsom salts packs followed by massage using cocoa butter.  Exercise, hydrotherapy, colonics, and diet were also part of the program.

    Finally, in any healing, the spiritual status of the patient ma be most important.

    Let the scars be removed from the own mental, the own spiritual and mental self.  Turn to those things of making application of the fruits of the spirit of truth, love, patience, gentleness, kindness, long-suffering, brotherly love, putting away those little tendencies for being "catty" at times or being selfish or expressing jealousy and such.
    Let that mind be in thee as was in Him, who is the way and the truth and the light, and He will make the light of love so shine through thy countenance that few, if any, will ever see the scars made by self-indulgence in other experiences.   (5092-1)

A.  Adhesions

    Body cavities, such as the peritoneal cavity, are lined with serous membranes which extend around the organs in the cavity and allow them to slip over each other freely.  Inflammation of the serous membrane may cause it to lose its slippery character and stick to itself forming an adhesion.  The Cayce concept is much in accord with the traditional, but goes a bit further in defining the problem as system-wide.

    As indicated by that as has been given, the inflammation as produced in system that caused irritation to the general plasm of the blood supply tends to make the scar tissue [inflamed serous membrane?] become adhesive in its nature.   (1377-8)

    Treatment of adhesions was to be accomplished by vibratory applications to the back.

    These will keep the conditions so that the adhesions will be broken entirely by the absorption that is created in the active forces of the blood supply circulation; circulation here meaning not just blood supply but the lymph and emunctory circulation, and nerve circulation as well.  (1377-8)

    In addition, malt and codliver oil (in Pure Food tablets) were recommended for [1377] to "carry those vitamins in such quantities to assimilate best with the system." An improper coagulation in the blood apparently could be remedied by such vitamin forces.

B. Chronic Inflammation (Infection?)

    The situation in [24231's case is difficult to diagnose from this distance.  It may have represented a chronic paronychia or perhaps a granulating wound.  The finger had been sprinted, and this may have led to the diminished flexibility mentioned in a subsequent letter to Cayce.  The reading virtually ignored the finger, instead getting to important systemic disturbances:

    ... first an unbalancing of the chemical system, until little reaction, or assimilation of values of vitamin B-1 is possible, or the coagulating elements; then poisons from hydrochloric acid, or excesses of same in the system, as combined with influences without.
Hence the inability for the coagulation, or for abrasions or injuries to heal.   (2423-1)

    Treatment consisted of Atomidine and the "triple salt" combination:

• Rochelle salts, 1 level tablespoonful
• Sulfur, 1 level tablespoonful spoonful
• Cream of tartar, 1 level tablespoonful

    These are to be mixed with a mortar and pestle.  The use precipitated sulfur rather than sulfur flowers is suggested.  Precipitated sulfur is much finer grained, and thus presents a larger active surface for the same amount of sulfur.  A level teaspoonful was to be taken first thing in the morning for five days.

    The same prescription has been found in readings on acne, boils, and psoriasis.  At times the warning was given to avoid chills or wet feet while taking the prescription, and in some cases osteopathic treatment was to follow.  However, in [2423]'s case, the use of small doses of x-ray was to follow five days on the "salts." Local treatment was almost incidental.  Cayce suggested "cocoa butter that is dissolved or rubbed in with olive oil; as this will aid in preventing scars, even upon the areas where old sores and injuries have been so disturbing to the body." In addition the apple diet for three days was suggested for cleansing the system.  At the end of the three days a tablespoon of olive oil was to complete the purge.

    This case is indexed under "scars" because of the advice on prevention of scars with cocoa butter and olive oil.  Physiologically it may be more closely related to other cutaneous conditions such as boils or psoriasis.

[Note: The preceding overview was written by Robert Forbis, Jr., M.D. and is excerpted from the Physician's Reference Notebook, Copyright © 1968 by the Edgar Cayce Foundation, Virginia Beach, VA.]