ULCER. 



its appearance a cwnnditc conlrall to the irritable one. 

 The edges of the funoundiiiE Ikiii are thick, prominent, 

 fmooth, and rounded. The lurface of the granulations is 

 fmooth and gloffy. The pus is thin and watery, being 

 compofed of a mixture of pus and coagulating lymph. 

 The lymph confills of ilakcs, which cannot be eafdy fepa- 

 rated from the furface of the fore. The bottom of the 

 ulcer forms quite a level, or nearly fo, and the general 

 afpeft conveys an idea that a portion of fkin and parts 

 underneath has been for fomc time removed, without the 

 expofed furface having begun any new aftion to fill up 

 the cavity. When, however, the indolence of the ulcer is 

 not fo ilrongly marked, the fore does not correfpond to 

 the preceding defcription, but refembles in appearance the 

 ulcer which pofFefTes an inferior degree of irritability, and 

 it can only be difcriminated from it by the circumftance of 

 its receiving no benefit from foothing applications. 



When an indolent ulcer does form granulations, thefe in 

 fome cafes are all on a fudden abforbed, and in the courfe 

 of twenty-four hours the fore becomes as much increafed in 

 fize, as it had been previoufly leffened in as many days or 

 weeks. 



Two varieties of indolent ulcers have received diftinft 

 names. In one of thefe cafes, the ulcer is connefted with 

 one or more apertures, leading into hollow fuppurating 

 cavities : this forms what has been fometimes termed a 

 Jjjtulous, and at other times z. finuous ulcer. The other va- 

 riety of callous or indolent ulcer is that which is accom- 

 panied with a permanently enlarged, or varicofe ftate of the 

 veins of the limb. This cafe is often called the -varicofe 

 ulcer, and is frequently very difficult of cure. The prac- 

 tical obfervations which apply to this particular form of 

 difeafe, will be found in another article. See Vaiiicose 

 Veins. 



In the treatment of indolent ulcers, the indication is not 

 merely to heal them, but to render the cure as permanent 

 a« poffible. This is to be efl:e£ted by changing the nature 

 of the granulations, and ufing fuch dreffings as will give 

 them a more vafcular healthy appearance. When an 

 ulcer, which has exilled fix months, has been drclTed with 

 poultices for a week, the granulations will have partly filled 

 \ip the hollow of the fore ; but they will be found to be 

 large, loofe, and glofiy. Should the poultice be now dif- 

 rontinued, and fome proper llimulating application be ufed 

 for another week, the granulations at the expiration of this 

 time will have become fmaller, more compacEt, redder, and 

 free from the glofiy appearance. Now experience proves 

 that the ulcer, when healed by the latter application, will 

 not be fo likely to break out again, as when healed with 

 large, loofe, flabby, gloffy granulations. Indeed, fir E. 

 Home alfures us, that the number of indolent fores which 

 heal under the ufc of ftimulating applications, and do 

 not break out again, are, in compariloji with fimilar cafes 

 treated with mild drcfiings, as four to one. 



The callous, or indolent ulcer, as Dr. Thomfon obferves, 

 changes very readily into an inflamed or irritable one ; and 

 the fore is generally in the latter flatc, when patients firlk 

 apply to furgeons for relief. Their ulcers arc commonly in 

 a temporary ftate of irritation from iiegleft, excrcife, cx- 

 ccflTes, &c. 



We have already dated, that medicines, in the form of 

 vapour, cannot heal indolent fores, fo as to effeft a durable 

 cure. Such remedies, however, are proper, when thefe 

 \dcer8 affume a foul appearance, and are in a tempor:iry ftate 

 of irritation. Hence, for the firft few days after the com- 

 mencement of regular furgical treatment, poultices and 

 fomentations arc the beft applications. 



The fomenting liquor may be a decoaion of poppy-heads, 

 or chamomile flowers, or fimple warm water, which an- 

 fwers equally well. The beft poultices are thofe of bread 

 and milk, linfeed meal, and oatmeal. The moll advanta- 

 geous time for fomenting the fore is while the poultice is 

 preparing, which fliould be changed twice a day. 



When aa indolent ulcer does not appear to be attended 

 with any particularity, a folution of the nitrate of filver j? 

 confidered by fir E. Home as one of the beft watery apph- 

 cations. It ftimulatcs the granulations, and makes them 

 put on a more healthy appearance. Its ftrength is to be in- 

 creafed according to circumftances. An ulcer, which at firft 

 cannot bear this folution above a certain ftrength without 

 pain, and an abforption of the granulations, becomes able, 

 after the application has been ufed about ten days, or a fort- 

 night, to bear it twice as ftrong : a proof of the granulations 

 having acquired ftrength. 



The tinfture of myrrh, a deco6lion of walnut-tree leaves, 

 and the diluted vitriolic acid, have all been tried as applica- 

 tions for indolent ulcers, and with advantage. A fcruple of 

 nitrous acid, mixed with eight ounces of water, forms alfu 

 another ufeful local remedy, which, according to fir E. Home, 

 promotes, in a very uncommon manner, the progrefs of the 

 cure. The firft application of diluted nitrou» acid gi^^s a 

 good deal of pain, which, however, ceafes in about half an 

 hour. 



When an indolent fore heals with the diluted nitrous 

 acid, the procefs of flcinning is accompliftied with more 

 rapidity, than when other applications are employed ; and 

 the new fkin is faid by fir E. Home to be more completely 

 formed. 



The only application, in the form of powder, ever much 

 employed for indolent ulcers, is the pulv. hydrarg. nitrico- 

 oxydi. It cannot be ufed, however, except for the moft 

 indolent fores, as in faft it is an efcharotic, and, if applied 

 too freely, deftroys every attempt at the formation of 

 granulations upon the furface of the ulcer. When too often 

 ufed upon a fore of any material fize, it will alfo fometimes 

 produce a violent falivation of the patient. The writer of 

 this article has fcen many patients umntentionally falivated 

 in this manner. 



Ointments, containing ingredients which are more or lefs 

 ftimulating, have been at all times the favourite dreffings 

 for indolent ulcers. " Ointments containing refin, or oil of 

 turpentine, in their compofition, to which a fmall portion of 

 fome metallic oxyd, or metallic fait, has been added, were 

 (as profeflbr Thomfon obferves) till very lately the moil 

 approved applications in the management of callous ulcers. 

 Every variety and form of thefe ftimulating ointments had 

 its partifans and recommenders among praftitioners ; but the 

 truth is, that this kind of ulcer occafionally got well under 

 every divcrfity in the form and compofition of the ointments 

 employed." (Leftures on Inflammation, p. 446. ) Ac- 

 cording to fir E. Home, one of the beft ointments for indo- 

 lent ulcers confifts of one part of the unguentum hydrar- 

 gyri nitrati, mixed with three of hog's-lard. Its ftrength, 

 however, muft be increafed, after it has been ufed a ccrtaiT^ 

 time for the fame ulcer. This ointment is faid to have the 

 good effcdl of quickly removing the thickening of the edges 

 of indolent ulcirs, and the furrounding dark red colour of 

 the flcin. It alfo fcems to poftlfs extraordinary efficacy in 

 making the granulations affume a fmall hcaltliy appearance, 

 and the ulcer, when healed with fuch granulations, is lefs 

 likely to break out again. Sir E. Home thinks that the 

 refins and turpentines are not fo powerful as the acid? and 

 metallic falts, in giving the granulations a healthy appear- 

 ance, and adifpcfition to r< (ill being ablorbcd. 



Camphorated 



