ULCER. 



which ferves as a foft covering for tlie granulations. A 

 pledget of fimple ointment muft alfo be laid over the lint, 

 for the purpoie of hindering the evaporation of the fluid 

 parts of the pus. By this means, the dreflings will continue 

 foft and moift, be prevented from becoming adherent to the 

 furface of the fore, and kept in a ftate in vphich they can 

 always be removed without pain, or irritation. 



In fome particular examples of healthy ulcers, fir Everard 

 Home has found rollers or bandages d:fagree, caufing un- 

 eafinefs in the part, and making the fores lole their healthy 

 appearance. This, however, is not the ufual eifeCl of a 

 roller in fuch cafes ; but, whenever it is obferved to be fo, 

 the bandage muft of courfe be difcontinued. 



In a few other inftances, ointments are found to irritate 

 and inflame the neighbouring fl<in, fo that it becomes necef- 

 fary to leave them off. In fach cafes, the furgeon may 

 apply over the lint a comprefs of fnie linen, wet with water, 

 or the lotio plumbi acetatis. 



There are alfo certain fuperlicial ulcers, which will not 

 heal, while kept in a moiil itate, unexpofed to the air ; but 

 which readily heal when allowed to become dry, and covered 

 with a fcab. Sir Everard Home has made the following 

 general remarks on the fubjeft of dreflings for healthy 

 ulcers. 



1. Applications in the form of vapour, and fomentations, 

 fliould never be employed, as they render the texture of 

 the granulations loofer, and diminifti the difpofition to form 

 fldn. 



2. With refpeft to fluid applications, fir Everard Home 

 alfo very properly condemns poultices, as well as fomenta- 

 tions. He fpeaks of alcohol, as being an application, 

 which promotes the formation of a fcab, wlien this mode of 

 cure is chofen. 



3. In regard to ointments, their only ufe, in cafes of 

 healthy ulcers, is to keep the matter from evaporating. 

 The moft fimple ointments are the beft for the purpofe, par- 

 ticularly the one compofed of white wax and olive oil. 



The great objections to the common fimple ointments are, 

 that they fometimes difagree viith the fliin, even when re- 

 cent, and free from all rancidity. When they have acquired 

 the latter quality, they ftill more frequently create a greater 

 degree of irritation. 



4. With refpeft to applications in the form of powder, 

 fir Everard Home remarks, tliat when it is delirable to form 

 a fcab on the ulcer, any inert powder may be fprinkled on 

 the fore ; but he prefers dry lint. Nothing (hould touch 

 the powder, or lint ; and to prevent this circumftance, lir 

 E. Home recommends applying a little boUler on each 

 fide of the fore, and over them a roller, which will go from 

 one boUler to the other, in the manner of a bridge. 



For healthy ulcers, dry Imt is to be regarded as being, 

 upon the whole, the moft eligible application. When the 

 fore does not fccretc pus enough in twenty-lour hours to 

 moiften the lint, the dreflings are only to be changed every 

 other day. 



When a moderately tight bandage is not forbidden by 

 conftitutional peculiarities, it is ufeful, both in fupporting 

 the mufcles and fixin, which are often in a flabby ftate, from 

 the uncxercifed ftate of the limb, and in defending the 

 nev.-ly formed parts. 



We fliall prefently have occafion to fpeak of Mr. Bayn- 

 ton's plan of drefling old ulcers of the leg with ftrips of 

 adhefivc plafter. This method is now not confined to old 

 ulcers, but often adopted with advantage in cafes of fimple 

 healthy fores upon the lower extremities. 



Of irv'itahle Ulcers. — Thefe are called by Mr. Benjamin 

 '&t:\\ ftmpU vitiated ulcers ; and by fir Everard Home, ulcers 



in parts, luhofe aSions are too violent to form healthy granu- 

 lations, either from the flate of the parts, or of the conjlitution. 

 Mr. Bell charafterizes this fpocics of ulcer chiefly by the 

 vitiated ftate of the difcharge ; while the other gentleman 

 ranks all ulcers under the denomination of irritable, which 

 require fedative apphcations for their cure. 



According to the obfervations of the latter writer, an 

 irritable and an indolent ulcer cannot always be diftinguiftied 

 from each other by mere appearances, though they can be 

 fo in a few inftances. The difpofition of an ulcer, like the 

 difpofition of a conftitution, can only be accurately afcer- 

 tained by determining the aftions, which arife from the dif- 

 ferent impreflions made upon it. 



Tlie following appearances, however, are faid to afford a 

 decifive indication of the iiTitable nature of an ulcer. The 

 margin of the furrounding fliin is jagged, and terminates in 

 an edge, which is fliarp and undermined. The bottom of 

 the fore exhibits concavities of different fizes. There is no 

 diftinft appearance of granulations, but a whitifh fpongy 

 fubftance is feen, covered with a thin ichorous difcharge. 

 Every thing which touches the furface gives pain, and very 

 commonly occafions hemorrhage. The difcharge is altered 

 from common pus to a thin fluid, in proportion to the de- 

 gree of irritability communicated to the fore by conftitu- 

 tional caufes. The pain of an irritable fore in general 

 gradually diminifties. When it is not conftant, but comes 

 on in paroxyfms, chiefly in the evening, or night-time, with 

 great violence, convuliive motions of the limb are apt to 

 occur, and to extend to various other parts. 



When the foregoing figns of an irritable ulcer are not 

 prefent, we muft form a judgment of the nature of the fore, 

 by attending to the hiftory of the cafe, and the effefts of 

 various apphcations upon the difeafe. But when fuch in- 

 formation cannot be obtained, it is the advice of fir Everard 

 Home, that the treatment fliould always begin with the fup- 

 pofition of the ulcer being of an irritable nature. 



When an ulcer occurs juft over the malleolus externus, it 

 is generally of an irritable kind, in confequence of the nature 

 of the part on which it is fituated, quite independently of 

 any conftitutional or local difpofition to irritability. Sir 

 Everard Home conceives that the periofteum, which here 

 lies immediately under the fl<.in, becomes the feat of the 

 ulcer, is the caufe of its being very difficult to heal, and 

 gives it an irritable appearance. The faft, that fores fitu- 

 ated upon the ligament of the patella, and over the peri- 

 ofteum of the anterior furface of the tibia, affume a fimilar 

 appearance, and are equally difficult to heal, made the above 

 gentleman more confirmed in his fentiment. 



I. On the fubjeft of applications to irritable ulcers, fir 

 Everard Home entertains a favourable opinion of thofe 

 which are in the form of vapour. The fteam of warm water 

 has very beneficial effefts ; but it is not often ufed alone ; 

 and, what feems curious, its utihty is faid to be greater in 

 thefe cafes, when the water is mixed with fpirits. Fo- 

 mentations, containing opium, ai'e alfo defcribed as pro- 

 ducing confiderable benefit. The tiiifture of opium, 

 fprinkled on flannel wrung out of hot water, and flannels 

 M-et with a warm iolution of the extraft of opium, or with 

 a decoftion of poppy -heads, are enumerated as eligible ap- 

 plications. A decoftion of chamomile flowers, the tops of 

 wormwood, or hemlock leaves, may alio be ufed with ad- 

 vantage. 



There are fome particular irritable ulcers, however, fpe- 

 cified by fir Everard Home, which are rendered more pain- 

 ful by warm apphcations. Thefe fores are reprefented as 

 being generally attended with a mottled purple difcoloura- 

 tion of the limb for fome diftance from them, and a coldnefs 

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