ULCER. 



of the complaint, its wiflied-for termination is always an- 

 nounced by a dimimition of pain ; the piis acquiring a 

 white colour and more confillence, and lofing its fetid 

 naufeous {null. The edges of the ulcer fubfidc, while its 

 furface becomes lefs irregular, and puts on more of the ver- 

 milion colour. The red, purplifh, oedematous circle which 

 furrounds the difeaie, alTumes a true inflammatory nature, 

 and the folution of continuity, reftored to a fimple (late, 

 heals up with tolerable quicknefs, even when the deftruftion 

 of foft parts is fomewhat confiderable, unlefs any frefti un- 

 toward circumftanccs occur to interrupt cicatrization. But 

 fometimes, when the patient is on the point of being com- 

 pletely well again, his condition is fuddenly altered for the 

 ■worfe; ulcerated fpots make their appearance on the cicatrix, 

 and thefe fprcading ia different direftior.s occafion a relapfe, 

 which may happen feveral times. 



Hofpital gangrene mu(t be regarded as a ferious com- 

 plication of wounds and ulcers, fmce it confiderably retards 

 their cure. When, however, the folution of continuity is 

 rot extenfive, and the conftitution good, and in other re- 

 fpefts healthy, the difeafe is not dangerous. In this cafe, 

 as foon as the (loughs are detached, the ulcer heals up, and 

 leaves a cicatrix accompanied with very little disfigurement. 

 But when the folution of continuity is large, or of long 

 ftanding, the diforder commits much greater ravages, renews 

 its attacks repeatedly, and the relapfes prove exceedingly 

 obftinate. Tiie fame thing is faid to happen when it affefts 

 pcrfons labouring under fcorbutic or venereal complaints, 

 who are often put into great danger. Hofpital gangrene 

 proves particularly dangerous, and moftly fatal, when it 

 complicates large contufed wounds, attended with badly 

 fraftured bones. All the foft parts of the injured limb are 

 then frequently obferved to be progreffively deftroyed, and 

 the unfortunate patient falls a vidlim, fometimes to typhoid 

 fymptoms attending the complaint, fometimes to frequent 

 hasmorrhages, but ftill more often to heftic complaints, the 

 almoft inevitable confequence of long-continued profufe 

 fuppuration. 



The cfFcfts of hofpital gangrene fhould be carefully dif- 

 criminated from thofe of the fcurvy. Ulcers, attacked 

 virith hofpital gangrene, are not afFefted in any degree, like 

 fcorbutic ulcers, by the ufe of vegetable diet and lemon- 

 juice, and they occur among men who are fed upon frefti 

 meat and vegetables, as readily as they do upon thofe who 

 have been fed altogether upon fait provifions. (Thomfon's 

 Leftures on Inflammation, p. 482.) Hofpital gangrene 

 is almoft always accompanied with fevere febrile fymptoms ; 

 but, " as to fevers (fays Dr. Lind), it may indeed be 

 doubted whether there be any fuch as are purely and truly 

 fcorbutic. The difeafe is altogether of a chronic nature ; 

 and fevers may be juftly reckoned amongft its adventitious 

 fymptoms." (Treatife on the Scurvy, p. 106.) We may 

 alfo remark, that in cafes of hofpital gangrene, the general 

 fymptoms of fcurvy are abfcnt, fuch as forenefs and bleeding 

 of the gums, livid blotches and wheals on the flefliy part 01 

 che legs, oedematous ankles, Sec. 



The treatment of hofpital gangrene is cither preventive 

 or curative. 



With a view of preventing the diforder, it is effential to 

 remove all the caufes which have been fpecificd as capable 

 of producing it. Thus, the wards in which the wounded 

 arc placed Ihould not be crowded ; they ought to be freely 

 ventilated ; as much detached as polTible ; the utmoft atten- 

 tion 10 cleanlinefs fhould be paid ; and every fource of in- 

 fe£>ion obviated. The predifpofition of the wounded to 

 this fpccics of gangrene may be lefTened by a wcU-chofen 

 diet, by drinks acidulated with vegetable acids, or with the 



Vol. XXXVIl. 



fulphuiic acid, and by the moderate ufe of wine. Tin. 

 ftate of the ftomach and bowels fliould be particularly 

 attended to, and if found to be out of order, emetic's 

 and purgatives ought to be immediately employed, and re- 

 peated according to circumftanccs. In the beginning of 

 the conftitutional attack, Pouteau and Dunaflbis parti- 

 cularly recommended the ufe of emetics, and Mr. Briggs 

 alfo found them highly ufeful. It is by the advantageous ufe 

 of thefe remedies, that the tendency to bilious fevers is re- 

 moved, to which all wounded patients are fo liable, who have 

 not been evacuated in time ; and which (as Boyer obferves) 

 always retard cicatrization, and frequently impart to wounds 

 the moft fatal complications. After due evacuations, the 

 furgeon fhould prefcribe bitter aromatic decodions proper 

 to fupport the tone and funftions of the ftomach. The 

 dreffmgs fliould be apphed with extreme attention and 

 cleanlinefs, and too much care cannot be taken to pre- 

 vent the infeftious matter of one wound from coming into 

 contaft with another. All fatty refinous applications fhould 

 likewife be abandoned in the treatment of wounds and ulcers 

 threatened with hofpital gangrene. The drefHugs, fays 

 Boyer, fhould be of a quality calculated to keep up the 

 Kpne of the parts, without irritating them. According to 

 this profeffor, fuch are the decodion, or fimple infufion of 

 aromatic plants in fpirit of wine ; diluted alkaline lotions, 

 &c. Pledgets, kept conftantly wet with thefe applications, 

 are to be applied to the wound. 



Such are the means, which, judicioufly reforted to, will 

 prevent hofpital gangrene, or at leaft render its occurrence 

 much lefs frequent. Let us next confider what can be 

 done after the diforder has manifefted itfelf, with a view of 

 affuaging it, before it attains fuch a degree as puts the pa- 

 tient's life into danger. 



No doubt the moft certain mode of arrefting the progrefs, 

 or, at all events, of abridging the duration of the complaint, 

 would be to tranfport the wounded into a more healthy 

 fituation, fo as to remove them from an atmofphere con- 

 taminated by putrid contagious elBuvia, and in which the 

 difeafe has had its firft formation. But, as Boyer obferves, 

 this change of place is generally impoffible. In faft, where 

 is the hofpital in which can be found large well-ventilated 

 wards in referve, feparated from every fource of infeftion, 

 and into which the patients can be direftly moved on the 

 very firft appearance of the diforder i The beft built hof- 

 pitals offer no fuch accommodation. As then the patients 

 cannot ufually be tranfported into a different ward, the air 

 which they breathe fhould be purified, by renewing it as 

 much as pofTible, fixing ventilators, and efpecially by ufing 

 the oxygenated muriatic acid fumigations, as recommended 

 by Guyton-Morveau, or elfe thofe of the nitric acid. 



The nitric acid fumigations are made by putting into a glafs 

 vcffel on the ground, half au ounce of concentrated fulphuric 

 acid, to which an equal quantity of nitre is to be added 

 gradatim. The mixture is to be ftirrcd with a glafs tube, 

 when an abundance of white vapour will be produced. 



The oxygenated muriatic acid fumigations are made, by 

 mixing three ounces two drachms of common fait, with five 

 drachms of the black oxyd of manganefe in powder. Thefe 

 two ingredients are to bo triturated together ; they are then 

 to be put into a glafs vefTcl ; one ounce two drachms of water 

 are to be added, and then, if the ward or chamber be un- 

 inhabited, one ounce feven drachms of fulphuric acid are to 

 be poured upon the mixture all at once ; or gr.idually, if 

 the patients are there. This quantity wil! be fufficient 

 for difinfefting a very large ward. Sec LafTns Pathologic 

 Chirurgicalc, torn. i. p. 38, 39. 



When one or move of'^the patient* afflificd with the dif- 

 T t order, 



