ULCER. 



greater in weak and delicate perfons, than in the ftrong and 

 robuft. Change of weather has confiderable influence over 

 the heahng of fores. Sir E. Home mentions, in proof of 

 this fa£t, tliat when there were feveral hundreds of ulcers in 

 the Naval Hofpital at Plymouth, in 1778, every time the 

 weather changed from a dry to a moift ftate, the ulcers uni- 

 verfally afTumed an unliealthy appearance ; but put on a 

 better afpeft when the weather became dry again. 



In the treatment of this kind of ulcer, tonics are to be 

 exhibited, particularly bark and fbeel ; and every thing 

 which difagrees with the conftitution is to be avoided. 

 Wine and cordial medicines are alfo iifuaUy prefcribed. 

 Porter, however, is deemed better than wine, for working 

 people. 



Sir E. Home obferves, that the firft objeft in the local 

 part of the treatment, is to keep the granulations from 

 rifing above the edge of the furrounding (Icin. This gen- 

 tleman very judicioufly reprefeiits the greater propriety of 

 preventing the granulations from ever becoming too high 

 by the employment of proper applic.:tions, than following 

 the common plan of deftroying the high granulations with 

 efcliarotics, after they have rifen to an improper height. 

 There cannot be the fmallefl doubt, that if the granulations 

 could always be prevented from rifing up too much, the 

 patient would fuffer a great deal lefs pain. 



Inftead of applying to the furface of the ulcers, now 

 under confideration, lunar cauftic, blue vitriol, red precipi- 

 tate, &c. fir E. Home prefers mixing thefe efcharotics 

 with other fubftances, fo as to render them only ftrong 

 ftimulants, and ufing them in this latter form. He con- 

 ceives that, when the high granulations are deftroyed with 

 efcharotics, the difpofition of the furface underneath to re- 

 produce them is increafed, but that this is not the cafe 

 when the luxuriant parts are only ftimulated fo as to be- 

 come abforbed. 



The fame gentleman fcems to think, that when animal 

 fubftances grow with great rapidity, they are, like vege- 

 table ones, weaker than when produced in a flower man- 

 ner. Hence fir E. Home is of opinion, that the growth 

 of granulations ought to be checked in the early ftage of 

 their formation, by lome refiftance which they are juft able 

 to overcome, under which circumftances they derive ftrength 

 from the limited increafe of atlion which they are obliged 

 to undergo. 



On the fame principle, according to fir E. Home, the 

 preffure of tight band.iges is advantageous ; and ulcers 

 which heal while the patient is walking about, are not fo 

 apt to break out again as when healed while the parts are in 

 a ftate of reft. 



In the treatment of thefe ulcers, when the granulations 

 have come to a proper height, and do not form a thin femi- 

 tranfparent pellicle upon their furface, they are to be con- 

 fidered as weak parts, and treated accordingly. Sir E. Home 

 thinks, that in this circumftance, the heft plan, when no 

 particularity of conftitution forbids, is preflure made with 

 a thin piece of lead over the drefTmgs, and fupported with 

 a tight bandage. 



Although, ftriftly, we have no topical applications 

 whi'ch can direftly communicate ftrength to granulations, 

 there are certainly fome which prevent the granulations 

 from exhaufting themfelves by luxuriant growth, and fti- 

 mulate them to draw more blood from the arteries, which 

 efFeAs, as fir E. Home remarks, render fuch granulations 

 ftronger. 



I. This gentleman very properly condemns, as appUca- 

 tions to weak ulcers, all relaxing fomentations commonly 

 employed ; and recommends inftead of them the ufe of 



9 



fpirits of wine and tlie decoftion of poppies, in equal pro- 

 portions, not however to be apphed hot. 



2. With regard to moift apphcations, the fame gentle- 

 man exprefles his difapprobation of poultices, and mentions 

 a weak folution of the argentum nitratum as the moft 

 eligible apphcation in an aqueous form. 



3. On the fubjeft of powdered fubftances, as applica- 

 tions to weak ulcers, fir E. Home fays he has often tried 

 bark, and the lapis calaminaris, without perceiving that the 

 former had any power of ftrengthening granulations, or the 

 latter any virtue in difpofing them to form new fltin ; pro- 

 perties commonly imputed to thefe applications. 



Sir E. Home entertains no better an opinion of plafter of 

 Paris, or powdered chalk, employed with a view of pro- 

 moting the formation of fltin. Powdered carbon, he fpeaks 

 of, as being more adapted to irritable, than weak ulcers. 

 He praifes powdered rhubarb, as particularly applicable to 

 the latter kind of ulcer, becaufe it repreffes the luxuriant 

 growth of the granulations, renders them fmall and com- 

 pact, and difpofes them to form flcin. When, however, the 

 granulations have rifen above the level of the fltin, it is not 

 powerful enough to reduce them. When the rhubarb is too 

 ftimulating, it is to be mixed with a fourth part of crude 

 opium in powder. 



A piece of lint, a little lefs than the fore, is always to be 

 put over the powder, and covered with a pledget of firaple 

 ointment. 



4. Ointments, according to fir E. Home, are particu- 

 larly apt to difagree with weak ulcers. When other ap- 

 plications fail, however, greafy ones may be tried, and the 

 above gentleman gives a preference to the ung. hydrarg. 

 nitrat. mixed with hog's-lard, in the proportion of one to 

 five, or elfe to common cerate, blended with a fmall quan- 

 tity of the hydrarg. nitrat. ruber. 



Of Indolent or Callous Ulcers — When the edges of the 

 flcin furrounding an ulcer become thick, prominent, 

 fmooth, and rounded, and when the bottom of the ulcer is 

 covered with fmooth and glofly raw flefli, which, as Dr. 

 Thomfon remarks, can fcarcely be faid to be raifed into 

 granulations, the cafe is called an indolent or callous ulcer. 

 This is the difeafe which fir E. Home has denominated an 

 ulcer in parts, tuhofe adions are too indolent to form healthy 

 granulations. 



Under the name of callous or indolent ulcer, as profcffor 

 Thomfon obferves, authors have included by far the greater 

 number of ulcers which affeft the lower extremities. This 

 is the ulcer which, of all the varieties to be mentioned, is 

 perhaps the moft deferving of attention ; for the callous or 

 indolent ftate is that into which almoft all ulcers of the 

 lower extremities have a tendency to pafs, and in which they 

 often continue ftationary, or nearly fo, for months or even 

 for years. Moft of the general rules which have been laid 

 down by praftical authors, refpefting the treatment of 

 ulcers qf the legs, and moft of the improvements which 

 have of late years been introduced into this branch of fur- 

 gery, relate chiefly, if not folely, to the treatment of the 

 callous or indolent ulcer. The parts furrounding this 

 ulcer may be inflamed or uninflamed. If uninflamed, the 

 cafe is fimply a callous ulcer ; but if inflamed, it then be- 

 comes a callous ulcer in an inflamed, vitiated, or irritable 

 ftate. This laft is the ftate in which moft patients, affeded 

 wFth ulcers of long ftanding, apply to medical men for 

 advice and afliftance. It is the ftate in which patient* 

 affeAed Avith this complaint are almoft always found, upon 

 their admiffion into pubhc hofpitals. Leftures, &c. 

 p. 438, 439. 



According to fir E. Home, the indolent ulcer forms in 



its 



