ULCER. 



or organ, fuch as fecondary fypliilitic ulcers. Of diathefes 

 predifpofnig to ulcers, we have examples in the fcrophulous, 

 fcorbutic, and arthritic diathefes, and alfo in the fyphiloid 

 diathefis, or that which arifes not unfrequently in thofe who 

 have had fypliilie, from the too free and injudicious ufe of 

 mercury. 



In addition to the foregoing obfervations, felefted from 

 the valuable leftures on inflammation, lately publifhcd by 

 profeflbr Tliomfon of Edinburgh, we fubjoin from the fame 

 excellent authority a few more general remarks on the fub- 

 jeft of ulcers. 



The appearances, fays Dr. Thomfon, which different 

 ulcers exhibit, feem at firft view to afford an excellent 

 foundation for diftinftions among them ; and fo they un- 

 doubtedly do in many refpefts. Surgeons have accordingly 

 endeavoured to obferve, arrange, and claflify, the various 

 morbid appearances which occur in ulcers, and to give to 

 tliefe appearances appropriate and peculiar names. It is 

 probable that every morbid affeftion, to which the human 

 body is liable, poffefles charafters, or exhibits appearances, 

 which are peculiar to itfelf. To difcover thefe appearances 

 in the fymptoms of difeafes, and in the various modes of 

 their commencement, progrefs, and termination, is at all 

 times the great objeft which the fcientific praAitioner pro- 

 pofes to himfelf. It is to be regretted, however, that the 

 charafters upon which the dillinftions of ulcers, as well as 

 of many other local difeafes, are founded, are neither very 

 uniform in their appearance, nor very eafdy diftinguidiable 

 from one another. Not only are the local appearances, 

 which prefent themfelves in fimple ulcers, liable to great 

 variations in the different ftages of the fame individual affec- 

 tion, but they are often apparently the fame with, or at 

 leaft not eafily diftinguifliable from, thofe which occur in 

 fpecific difeafes, and which require for their cure peculiar 

 modes of treatment. It is this circumftance which renders 

 it fo neceffary for us, in endeavouring to diftinguifli and to 

 cure ulcers, to avail ourfelves of all the information which 

 we can procure from the hiftory of the ulcer, from the na- 

 ture of the exciting caufe by which it has been induced, and 

 from the effefts of the remedies which have been employed, 

 as well as from the particular appearances which the ulcer 

 ilfelf exhibits. But though the dillinftions, which are 

 taken from the appearances of ulcers, may not at all times 

 enable us to diliinguifti thofe which are fimple in their 

 nature from others which arifc from fpecific caufes, llicy 

 are not, fays profeffor Thomfon, to be regarded as unim- 

 portant or ufelefs ; for, he believes, it will be found, that 

 fimilar appearances in ulc-rs require in general, though not 

 always, the fame local applications, and fimilar modes of 

 management, whether the ulcers be of a fimple or fpecific 

 nature. 



Specific difeafes render fomc parts more liable than others 

 to attacks of ulceration. Thus, fecondary fyphilis appears 

 moll frequently in the throat ; fcurvy in the gums ; cancer 

 in the lower lip ; and lupous and fcrophulou?^ ulcerations in 

 the upper lip, or in the nofe. Cancer fcldom or never ap- 

 pears primarily in the upper lip ; but fyphilis, when it 

 attacks this part, puts 0:1 many of the appearances of can- 

 cer ; a faft which profeffor Thomfon fird Icirncd from Mr. 

 Pearfon, and which he has fince had feveral opportunities of 

 feeing confirmed. 



Ulcers upon the lower extremity, citteris paribus, are 

 longer in healing than fores in other parts o( the body. 

 This comparative backvrardnefs of ulcers of the legs to heal 

 is probably owing to three principal rircnmftances : firfl, 

 the diftance of thefe parts from the fource of the circul.-.tion ; 

 fecondly, the retardation of the venous blood in ihcm in the 



Vol. XXXVII. 



eretS pofition of the body ; aad, thirdly, the difturbance 

 and irritation to which fuch ulcers are frequently expofed, 

 by the patient imprudently walking about, and negleding 

 himfelf. The common pofition of the lower extremities is 

 alfo very unfavourable to the quick paffage of the lymph 

 through the trunks of the abiforbents ; and this may be the 

 reafon why even the flighted injuries of the lower extremities 

 are often accompanied with a confiderable degree of oedema- 

 tous fwelling. 



Sir Everard Home, in his Praftical Obfervations on the 

 treatment of ulcers of the legs, mentions feveral fafts, 

 which feem to prove that ulcers are more common in tall 

 than in thort men ; and that ulcers of the legs heal with 

 more or lefs difficulty, according as they are feated nearer 

 to, or more remote from, the feet. Ulcers, unconnefted 

 with any fpecific difeafe in the conftitution, may occur on 

 the legs, as well as other parts of the body, from external 

 or from internal caufes. Among the external caufes, fays 

 profeffor Thomfon, we may rank contufions, wounds, 

 burns, and the application of every fubftancc capable of 

 exciting inflammation. Among the internal caufes we 

 ought probably to rank the predifpofing caufes. Of thefe, 

 we have not only the diftance from the heart, and retrograde 

 motion of the blood, but peculiarities of conftitution, fuch 

 as temperaments, diathefes, and idiofyncrafies ; which often 

 become manifeft only from the effefts to which they give 

 rife. Thus, the flight fcratch, or excoriation, which in 

 one perfon will heal without any trouble ; in another, 

 though placed in circumftances precifely ahke, becomes a 

 difagreeable and troublefome ulcer. An ulcer, alfo, which 

 is produced in the leg of a perfon of a fcrophulous diathefis, 

 though the difeafe may never have appeared in the general 

 fyftem, often difcovers a backwardnefs to heal, and in fome 

 inftances exhibits fymptoms that are peculiar to itfelf. The 

 age, mode of life, and habits of the patient, are circum- 

 ftances alfo which will modify the appearances, and tend to 

 increafe the backwardnefs to heal and the ubftinacy of ulcers. 

 Thus, the aged, the fedentary, and the diffipated, are 

 known to be more hable to ulcers of the lower extremities, 

 than the young, aftive, and fober. See Thomfon's Lec- 

 tures on Inflammation, p. 426 — 433. 



We fliall next endeavour to defcribe the feveral principal 

 varieties of ulcers, and the moft approved methods of treat- 

 ment. 



Simple purulent or healthy Ulcers. — The ulcers, termed 

 ftmplc purulent by Mr. Benjamin Bell, fir Everard Home 

 denominates ulcers in parts, ■which have fujficient Jirenglh to 

 carry on the aSions necejfary for their own recovery. As Dr. 

 Thomfon has obferved, the defcriptions, which have been 

 given of thefe ulcers by different authors, will loon apprife 

 us, that they differ in no refpeft from hcikhy fuppurating 

 furfaccs. The pus is of a white colour, thick confiftencc, 

 and readily feparatcs from the furfacc of the fore. When 

 diluted, and examined with a microfcope, it ii found to be 

 compofed of fmall globules, whicii fwim in a tranfparent 

 fluid. The granulations of a healthy ulcer are faall, florid, 

 and pointed .it the top. As foon as they have rifen to the 

 level of the furrounding fltin, thofe which are next to the 

 old fl<in become fmooth, and covered with a thin, tranf- 

 parent film, which is afterwards rendered opaque, and con- 

 verted into cuticle. 



The main indications in the treatment of iK-allhy ulcers 

 are, to keep the furfacc, and efpccially the adjoining in- 

 teguments, clean, and to prevent the natural proccffes from 

 being interrupted. According to lir Everard Home, this 

 will in general be beft accomplilhed by the .ipplicaliun of 

 dry hnt, in order to ahforb and retain the Iccreted matter, 

 S f which 



