ULCER. 



Camphorated ointments are reprefented as being parti- 

 cularly applicable to cafes, in which there is prefent a degree 

 of indolent thickening. 



Befides ointments fomewhat ftimulating in their nature, 

 bandages have been found particularly ferviceable to indolent 

 ulcers. The laced flocking was much ufed, and is parti- 

 cularly recommended by Wifeman. As Dr. Thomfon re- 

 marks, however, it is in appearance only, that this mode 

 of bandaging in ulcerated, or varicofe legs, has any advan- 

 tage over that by the common circular roller. The ufe of 

 the circular bandage, with dreffings compol'ed of unguentum 

 refmofum and red oxyd of mercury, in different proportions, 

 was fome years ago recommended in a particular manner to 

 the attention of the Englifh public in a very ufeful treatife, 

 which Dr. Underwood publiflied upon the treatment of old 

 ulcers of the legs. He allowed his patients to go about their 

 ordinary occupations, under this mode of treatment, firft, 

 becaufe it was inconvenient for many of them to be confined ; 

 and fecondly, becaufe it was found, that many of thofe pa- 

 tients whofe ulcers were healed up during reft, broke out 

 again as foon as they began to take exercife. It muft be 

 acknowledged, that many indolent ulcers do get well under 

 the mode of management recommended by Dr. Underwood. 

 In many perfons the bandaging, and that degree of cleanli- 

 nefs which is occafioned by the regular dreffing of their 

 fores, are of infinite fervice ; but it is a mode of treatment 

 which does not anfwer in all old and indolent ulcers ; for 

 many of them, according to the experience of Dr. Thomfon, 

 become inflamed and irritable under its ufe. He obferves, 

 alfo, that the recurrence of ulcers in perfons who begin to 

 take exercife after being cured, has appeared to him to be 

 often occafioned by their leaving off the bandaging, by their 

 ftanding or walking too much, and by accidental injuries. 

 The part which has been healed up during reft is weak, 

 and requires fupport and careful defence, which it very 

 feldom receives from the clafs of individuals who are molt 

 liable to this fpecies of ulcer. Leftures on Inflammation, 

 p. 447. 



The treatment of ulcers with bandages has had of late 

 years a very zealous advocate in Mr. Whateley, who, in the 

 year 1799. publifhed ftrongly in favour of the plan, in his 

 Praftical Obfervations on the Cure of Wounds and Ulcers 

 on the Legs, without reft. In the cafes adduced in this 

 eflay, very little variety of drefling was employed ; and, with 

 fome exceptions fpecified by the autlior, preffure was prin- 

 cipally rehed upon as the means of cure. This gentleman 

 gives a preference to fine flannel rollers, fomewhat lefs than 

 four inches wide. 



But of all the improvements which have of late vears 

 been introduced into the treatment of old indolent ulcers of 

 the legs, that which was firft propofed and praftifed by 

 Mr. Baynton, of Briftol, is by far the moft interefting and 

 important. 



Mr. Baynton acquaints us, that the means propofed by 

 him will, in moft intlances, be found fiifficient to accomphfh 

 cures in the worft cafes, without pain or confinement. After 

 having been repeatedly difappointed in the cure of old 

 ulcers, Mr. Bayuton determined on bringing the edges of old 

 ulcers nearer together by means of Jl'ips of adhefive plaflers. 

 To this he was chiefly led, from having frequently obferved^ 

 that the probability of an ulcer continuing found, depended 

 much on the fize of the cicatrix which remained after the 

 cure appeared to be accomplifhed ; and from well knowing, 

 that the true Ikm was a much more fubftantial fupport and 

 defence, as well as a better covering, than the frail one 

 which is obtained by the aflSilance of art. But when he 

 had recourfe to the adhefive plafter, with a view to leffen 



the probability of thofe ulcers breaking out again, he little 

 expected, that an application fo fimple would prove the 

 ealieft, moft efficacious, and moft agreeable means of treat- 

 ing ulcers. 



Although the firft cafes in which Mr. Baynton tried this 

 praftice were of an unfavourable nature, yet he had foon 

 the fatisfaftion to perceis-e that it occafioned very little pain, 

 and materially accelerated the cure, while the fi/.e of the 

 cicatrices were much lefs than they would have been, had 

 the cures been obtained by any of the common methods. 



At firit, however, the fuccefs was not quite pevfecl ; as, 

 in many intlances, he was not able to remove the flips 

 ot plafter, without removing fome portion of the adj.icent 

 fl<in, which, by occafioning a new wound, proved a difa- 

 greeable circumllance, in a part fo diipofed to inflame and 

 ulcerate, as the vicinity of an old fore. He th.ercfore en- 

 deavoured to obviate that inconvenience, by keeping the 

 plaflers and bandages well moiflened with fpring-water, for 

 fome time, before they were removed from the limb. He had 

 foon the fatisfaftion to obferve, that the inconvenience was 

 not only prevented, bat that every fucceeding cafe juftified 

 the confidence which he now began to place in the remedy. 

 He alfo difcovered, that moiftening the bandages was at- 

 tended with advantages which he did not expett : while the 

 parts were wet and cool, the patients were much more com- 

 fortable in their fenfations, and the fiirrounding inflamma- 

 tion was fooner removed, than he had before obferved it 

 to be. 



By the mode of treatment here recommended, Mr. Bayn- 

 ton found, that the difcharge was leffened, the offenflve 

 fmell removed, and the pain abated in a very Ihort time. 

 But befides thefe advantages, he alfo found, that the cal- 

 lous edges were in a few days level with the furface of the 

 fore ; that the growth of fungus was prevented, and the 

 neceflity of applying painful efcharotics much leffened, if 

 not entirely done away. Mr. Baynton gives the following 

 defcription of his method. 



" The parts fhould be firft cleared of the hair, fometimes 

 found in confiderable quantities upon the legs, by means of 

 a razor, that none of the difcharge, by being retained, 

 may become acrid, and inflame the Ikin, and that the dref- 

 fings may be removed with eafe at each time of their re- 

 newal, which, in fome cafes, where the difcharge is very 

 profufe, and the ulcers very irritable, may perhaps be ne- 

 ceffary twice in the twenty-four hours, but which I have, 

 in every inftance, been only under the neceffity of perform- 

 ing once in that fpace of time. 



" The plafter fhould be prepared by flowly melting, in 

 an iron ladle, a fufficient quantity of litharge plafter, or 

 diachylon, which, if too brittle, when cold, to adhere, may- 

 be rendered adhefive by melting half a drachm of refin with 

 every ounce of the plafter : when melted, it fliould be ftirred 

 till It begins to cool, and then fpread thinly upon flips of 

 fniooth porous caUco, of a convenient length and breadth, 

 by fweeping it quickly from the end, held by the left hand 

 of the perfon who fpreads it, to the other, held firmly by 

 another perfon, with the common elaftic fpatula ufed by 

 apothecaries ; the uneven edges muft be taken off, and the 

 pieces cut into flips, about two inches in breadth, and of a 

 length that will, after being pafted round the hmb, leave an 

 end of about four or five inches. The middle of the piece 

 fo prepared, is to be apphed to the found part of the limb, 

 oppofi^e to the inferior part of the ulcer, fo that the lower 

 edge of the plafter may be placed about an inch below the 

 lower edge of the fore, and the ends drawn over the ulcer 

 with as much gradual extenfion as the patient can well 

 bear ; other flips are to be fecured in the fame way, each 



above 



