ULCEK. 



of the lower part of the leg. They are likcwife faid to have 



a tendency to raortlficatioii, and it is remarked that this dif- 



■ agreeable event feems to be promoted by warm applications. 



2. With rcfpcA to moift applications, the linfecd-meal 

 poultice is tlie mod fimple, and mod cafily prepared ; and 

 as it does not neceflarily require any addition of oil, it is to 

 be prepared when the latter ingredient appears not to agree 

 with the fore. 



The lotio plumbi acetatis fometimes makes an ufeful fluid 

 for the compofition of poultices for irritable ulcers ; but it 

 does not always agree with thcfe fores ; and fir Evcrard 

 Home Hates, that if it be ufed a long time, it is apt to 

 excite a kind of paralyfis, known by the appellation of the 

 lead colic, or colrca piftonum. 



In cafes of irritable ulcers, the decoftion of poppy-heads 

 fhould not be forgotten, as it is a very excellent liquid for 

 poultice^. The carrot poultice is alfo found to agree 

 better, than moft other things, with a large number of ir- 

 ritable ulcers. 



If poultices be employed, their ufe is to be continued as 

 long as the granulations are fmall, and the ulcer is rapidly 

 diminirtiing in fize, even till the cicatrization is complete. 

 When the granulations become large, and loofe in their 

 texture, poultices (hould no longer be ufed. 



When the weight of a poultice cannot be Jforne, the 

 furgeon may try the application of lint dipped in one of the 

 foUowmg lotions, and rovcred with a pledget of any fimple 

 ointment : — a folulion of the extraft of opuim ; a decoftion 

 of poppies ; the tintture of opium ; a decoftion of cicuta ; 

 the lotio plumbi acetatis compofita ; or a diluted folution 

 of the nitrate of filver. 



ProfefTor Thomfon obferves with refpeft to poultices, 

 that, notwithllanding all that has of late years been laid 

 againft their ufe in tlie treatment of ulcers, he is IHll very 

 partial to their employment in a great proportion of the 

 morbidly inflamed and irritable dates into whicfi ulcers are 

 fo liable to pafs. He declares, that he has often feen irritable 

 ulcers, which had rcfifted all other means of cure, heal up 

 under the continued ufe of thefe appUcations. Ledtures, &c. 

 p. 444. 



3. Applications in the form of powders arc generally 

 found to be too dimulating for irritable ulcers. Carbon 

 has fometimes been tliought to do good ; and fo has pow- 

 dered extraft of opium, mixed with an equal quantity of 

 carbon, or linfeed flour. However, opium fometimes af- 

 fefts the conditution by being abforbed, and fometimes it 

 produces a great deal of pain, irritation, and (loughing. 



4. Ointments cannot be faid to be frequently proper ap- 

 plications for irritable ulcers ; as they are always more or 

 lefs rancid, and generally difagree with the flcin in fuch 

 cafes. Sir E. Home recommends cream as a very ufeful 

 application, efpecially in thofe examples in which warmth 

 is found to do harm. As a fubditute for it, the fame 

 writer mentions an ointment, compofed of hog's-lard, puri- 

 fied by repeated wadiing in fpring water, and then mixed 

 with a fmall quantity of white wax and rofe-wntcr. 



The obfervations made rtfpcdling fokitionsof lead, apply 

 to the unguentum plumbi acetatis. 



5. If the horizontal polition be neceflary in the cure of 

 fimple ulcers of the leg, it is dill more fo in every indance 

 of an inflamed or irritable fore. 



6. Irritable fores cannot generally bear the preffure of 

 bandages. According to fir E. Home, however, a flight 

 degree of prelTure does good to certain ulcers which anfe 

 from weaknefs, and are fomewhat irritable. 



7. In the treatment ot ulcers in general, and nf irritable 

 fores in particular, the furgeon will often find immcnfe ad- 



vantage from frequently changing the kind of dreffing em- 

 ployed. Few c::Ccs will continue to heal favourably longer 

 tlian a certr.in time under the employment of one fort of 

 application. The furgeon ought therefore to be acquainted 

 with the effefts of many dificrcnt kinds, in order that he 

 may make an alteration as frequently as the date of the 

 cafe liequires. 



Of the Fungous Ulcer In fome cafes, as Dr. Thomfon 



obfervei, the inflammation of tiie furface of an ulcer is 

 followed by an excefs in the growth uf granulations; in 

 fome, by the deatli or floughing of the granulations, and 

 of the pai'ts which furround them ; and in - "hers, portions 

 of the iurface and edge of the ulcer are removed by the 

 procefs of ulcerative abforption. The extremes of thefe 

 dates form fores, whicli are termed fungous, putrid or 

 floughing, and ulcerative or phagedenic ulcers. In mod in- 

 dances, however, the furface of an old fore upon the legs 

 manifeds but little difpofition, after an attack of inflam- 

 mation, to pafs into tlie date of granulation, or of ulcer- 

 ation. It often remains long in a dationary condition, 

 forming what lias been termed an indolent or callous ulcer. 



When the granulations of an ulcer, indead of being 

 fmall, red, and firm, become large, pale, loofe, foft, and 

 flabby ; and when, indead of rifing to, and remaining on 

 a level with, the furface of the furrounding fl<in, they rife 

 much higher ; the cafe is technically called z. fungous ulcer, 

 or ulcer with hypcrfarcofis. This is the cafe which fir 

 Everard Home has cliofen to name the ulcer in parts, zuhith 

 are too ivcal to carry nn the aSions necejfary for their recovery. 

 It is the difeafe which Mr. Burns delcribes under the name 

 of the o-ver-ailing ulcer. We think that profeflbr Thomfon, 

 of Edinburgii, is perfeftly right in regarding the old name 

 oi fungous, as L-fs exceptionable than thofe which have been 

 more recently propofcd as fubditutes for it. The old 

 name, as this gentleman obferves, involves no hypothefis 

 rcfpefting the date or aftion of the veflels, and merely ex- 

 prefles the faft, that in fome fuppurating furfaces, the gra- 

 nulations are fpongy in their confidence, and too luxuriant 

 in their growth. Ledlures, &c. p. 437, 438. 



The granulations of thefe fores are larger, more round 

 on their external furfnce, and of a lefs compaft texture than 

 thoie formed on ulcers in healthy parts. Sir E. Home has 

 alfo noticed their femi-tranfparcnt appearance. When 

 they have filled up the cavity of an ulcer to a level with 

 the furface of the body, they do not rerdily form flcin' but, 

 rifing up in a dill higher manner, often lofe altogether tlie 

 power of producing new cutis. When the parts are dill 

 weaker, the granulations fometimes continue gradually to 

 fill up the hollow of the ulcer, and then, all on a fudden, 

 are fuddenly abforbed, fo as to leave the fore as deep as it 

 was before. 



Ulcers may be weak from the fird, or become fo in the 

 progrefs of the cafe. Even granulations of the molt 

 healthy kind, if they are not ikinned over in a certain time, 

 gradually lofe their primitive ilrengtli. 



Sores on the legs are greatly under the influence of all 

 natural peculi;;ritie3 of the conditution, and every thing 

 which affcfts the health. When the conditution becomes 

 in the lead weaker or dronger, the appearance of the gra- 

 nulations becomes changed accordingly, and this effeft of 

 condilulional weaknefs or drength on ulcers, is greater in 

 proportion as the fores are further from the fouree of the 

 circulation. 



While the conflitution is undergoini; any kind of dif- 

 turbance, the healing of an ulcer is fiifpendcd. Mental 

 anxiety is very apt to retard cicatrization. 



Such cffcCls of the conditulional kind on ulcers are 

 S f 2 greater 



