ULCER. 



above and in coiil;itt with tlic other, until the whole furfacc 

 of the fore and the hmb are completely covered, at leaft one 

 inch below and two or three above the difeafed part. 



" The whole of the leg (hould then be equally defended 

 with pieces of foft calico, three or four times doubled, and 

 a bandage of the fame, about three inches in breadth, and 

 four or five yards in length, or rather, as much as will be 

 fufReient to lu nort the hmb from the toes to the knee, 

 (hould bo applied as fmoothly as can be poffibly performed 

 by the furgeon, and with as much firmnefs as can be borne 

 by the patient, being firft pafled round the leg, at the ankle 

 joint, then as many times round the foot as will cover and 

 fupport ever)' part of it, except the toes, and afterwards up 

 the limb till it reaches the knee, obferving that each turn of 

 the bandage (hould have its lower edge fo placed as to be 

 about an inch above the lower edge of the fold next below. 



" If the parts be much inflamed, or the difcharge very 

 profufe, they fhould be weU moiilened, and kept cool with 

 cold fpring-water poured upon them as often as the heat 

 may indicate to be neceflary, or, perhaps, at leaft, once every 

 hour. The patient may take what exercife he pleafes, and 

 it will be always found, that an alleviation of his pain and 

 the promotion of his cure will follow as its confequence, 

 though, under other modes of treating the difeafe, it aggra- 

 vates the pain, and prevents the cure. 



" Thefe means, when it can be made convenient, (hould 

 be applied (oon after nfing in the morning, as the legs of 

 perfons alfefted with this difeafe are then found mod free 

 from tumefaction, and the advantages will be greater than 

 when they are applied to limbs in a fwollen ftate. But at 

 whatever time the applications be made, or in whatever con- 

 dition the parts be found, I believe it will always happen, 

 that cures may be obtained by thefe means alone, except in 

 one fpecies of the difeafe, which feldorn occurs, but which 

 will hereafter be dcfcribed. The firft application will fome- 

 times occaiion pain, which, however, fubfides in a (liort 

 time, and is felt lefs fenfibly at every fucceeding dreding. 

 The force with which the ends are drawn over the limb, 

 muft then be gradually increafed, and when the parts are 

 reftorcd to their natural ftate of eafe and fenfibility, which 

 will foon happen, as much may be applied as the calico will 

 bear, or the furgeon can exert ; efpecially if the limb be 

 in that enlarged and incomprelfible ftate which has been 

 denominated fcorbutic ; or if the edges of the wound be 

 widely feparatcd from each other." 



In adopting the preceding method, Mr. Baynton fome- 

 times obfcrved a breaking of the (l<in near the ulcers ; a 

 circumftaoce which fometimes proved troublefome, and 

 arofe partly from the mechanical eff^eft of the adhefivc 

 plafters, and partly from the irritating quality of the plafter. 

 Mr. Baynton, however, only confiders fuch fores of ferious 

 confequence, when they are fituated over the tendon of 

 Achilles, in which fituation they are fometimes feveral weeks 

 in getting well. In order to prevent them, Mr. Baynton 

 recommends a little bit of foft leather to bo applied to the 

 parts which are in danger of being affetted. 



The cures will generally be accompUdied very well by 

 the mere application of the flips and bandage ; but when 

 the parts are muc!i inilained, the fecrction great, or the fea- 

 fon hot, Mr. Baynton ftates, that the frequent application of 

 cold v/aier will be found a valuable auxiliary. See A 

 Defcriptive Account of a New Method of Treating Old 

 Ulcers of the Legs, by Thomas Baynton, zd edit. 1799. 



Of the Mulignimt or Putrid Ulcer ; or Hofpital Gangrene. 

 — This is a difeafe which is of a very pccuhar nature, and 

 its hiftory muft be highly intcrefting to every praftitioner, 

 whofe avocations make him likely to have the care of a 



large number of patients who are afHitted with ulcers or 

 wounds, and collefted together in one building. The fur- 

 geons of the army and navy in particular, and thofe of great 

 hofpitals and prifons, ought to be fully acquainted with the 

 fubjeft ; for they are all liable to be fuddonly called upon 

 to exert their ikill in checking the ravages of this fevcre 

 complaint, the treatment of which is far from being either 

 fimple, or well determined. 



The fymptoms by which the mahgnant ulcer, or hofpital 

 gangrene, is charafterized, are partly of a local, and partly 

 of a conftitutional nature. According to profeilbr Thom- 

 fon, thefe two claflTes of fymptoms are not invariable in the 

 order of their appearance ; but his own obfcrvations lead 

 him to believe, that the conftitutional fymptoms ufually 

 precede the local. He obferves, that, in the progrefs of 

 the conftitutional fymptoms, a general uneafinefs is felt 

 before any vifible change takes place in the wound, or fore, 

 which is attacked with hofpital gangrene ; the tongue 

 becomes foul, with a fenfation of bitternefs in the moutii ; 

 the appetite decreafes, and the patient begins to loathe his 

 food ; the pulfe becomes very quick, but is in general rather 

 weak than ftrong ; the flciii feels hot ; and the patient in 

 the progrefs of the diforder becomes affefted with great 

 anxiety and reftlcfsnefs. 



The local appearances of wounds, fores, and ulcers, are 

 foou altered after the commencement of an attack of hofpi- 

 tal gangrene. Their furfaces become pale ; the difcharge 

 of pus, becomes lefs copious and lefs healthy than formerly ; 

 their edges fwell, inflame, and become exceedingly painful ; 

 they are fometimes ragged ; at others reverted, and exhibit 

 a foft fpongy appearance. A dufl<y red-coloured circle of 

 inflammation, having more or lefs of a livid tinge, extends 

 from thefe edges into the furrounding integuments, and is 

 often the forerunner of gangrene and fpliacelus. Inflamed 

 lymphatic abforbent velfels are (ometimes to be oblerved, 

 extending from the furfaces affettod with hofpital gangrene, 

 to the contiguous, or communicating, cervical, inguinal, or 

 axillary glands. 



The local affeftion in hofpital gangrene feldom occupies 

 at firft the whole furface of extenfive wounds or lores. It 

 more frequently appears in the form of dirty white afli- 

 coloured (loughs, occupying only one, two, or more fmall 

 fpots, and from thefe, it gradually extends itfelf over the 

 whole of the difeafed furface. In fome inftances, hofpital 

 gangrene begins in th^- form of a fmall inflamed pimple, or 

 veficle, without our being able to perceive any previous 

 injury of the part in which it appears. More frequently, 

 however, it attacks parts whicli have been fcratched, 

 bruifed, or wounded, or which have had the integuments 

 injured by ulceration, burns, or bliitcrs. Specific fores, or 

 ulcers, feem to be lefs liable to att.icks of hofpital gangrene, 

 than thofe which arc of a fimple nature. Dr. Thomlon has 

 feen it, however, repeatedly attack cancerous fores and 

 venereal idcers. In fome inftances, it has been faid to have 

 produced a cure of tluie difeafes, deftroying by mortifica- 

 tion tlie parts on which they were fituated. In fevere cafes 

 of hofpital gangrene, the furface of the wound, or fore, 

 whicli it attacks, is foon changed into fphaceliis, and 

 covered with dirty wiiite-colourcd floughs. During the 

 feparation of thefe floughs, an ill-coloured and fanious dif- 

 charge, having a peculiar fetid fmell, takes place from the 

 furface of the woiuid, or fore. This furface is often feen 

 covered with a tenacious vifcid pus, whicli firmly adheres 

 to the furface from wliich it is fecrcted. In mild cafes, the 

 deftrudive elfefts of liofpital gangrene arc confined to tlie 

 fliin and fubjacent cellular membrane ; but it often extends 

 its ravages beyond tliefe textuies, dcllruying tendinous 



fafcix. 



