ULCEK. 



ftoppeJ, and that fuppuration and the detachment of tl>e 

 (loughs are about to follow. In order to promote thefe de- 

 firable changes, Boyer recommends the inflamed parts to be 

 covered witli an emollient poultice ; but as foon as pus is 

 fecrcted, the poultice is to be difcontinued, as it might re- 

 lax too much, and fome gently tonic application employed, 

 fuch as the decoftion of bark. 



When tlie (loughs have fcparated, and the bottom of the 

 ulcer appears firm and of a vermilion colour, the reft of the 

 treatment ought to refcmble that of a common vround, and 

 the cure then generally follows with tolerable quickncfs. 

 However, cifl-ris paribus, wounds and ulcers, after an attack 

 of hofpital gangrene, heal more (lowly than other folutions 

 of continuity. 



But when, after the detachment of the efchars, the wound, 

 inftead of prcfenting a firm vermilion appearance, and dif- 

 charging healthy pus, is covered with pale flabby granula- 

 tions, the recurrence of hofpital gangrene is to be appre- 

 hended. With a view of preventing it, the patient is to be 

 purged with a decoftion cf tamarinds, which Boyer fays is 

 preferable to any thipg elfe, and fmall dofes of the acidu- 

 lous tartritc of potafla are to be given every other day. But 

 if the difeafe returns, the French furgeons direft the cautery 

 to be uled again, if the patient be not too much exhaudcd to 

 bear it ; for when he is, there is no hope from this or any 

 other means. Rflapfes feldom happen, except in wounds 

 and ulcers which are very large, and have confined the pa- 

 tients a long while in the hofpital. A relapfe, in thefe cafes, 

 is always an unfavourable omen ; for it fometimes proves 

 mortal, and if the patient gets over it, ftill the ulcers, or 

 wounds, which have been repeatedly affefted by it, are apt 

 to degenerate into chronic fores, which it is extremely diffi- 

 cult, or even impoffible, to heal. Boyer, Traite des Mala- 

 ,dies Chirurg. t. i. p. 320, et feq. 



By referring to the various publications, publilhed by 

 Englifh furgeons on hofpital gangrene, wc (hall find that 

 they have fucceeded in frequently (topping the difeafe, 

 without having recourfe to that heroic means, (as it is 

 called by M. Roux,) the aftual cautery. " The fer- 

 menting poultice, fpiriis, and turpentine, (fays profefTor 

 Thomfon,) are certainly much milder applications, and will, 

 I am convinced, when judicioudy ufcd, be found to be much 

 more efficacious in effedting a cure. If attention to cleanli- 

 ncfs in the dreffing of fores and ulcers be at all times re- 

 quired, it is needlefs for me to remark to you, how much 

 more impcrioufly it mull be required in holpital gangrene, 

 where the difcharge from the fores, and probably the effluvia 

 from the body of the patient, are of a contagious nature." 

 See Left, on [nflammation, p. 500. 



Befides the fermenting poultice, camphorated fpirits, and 

 turpentine, the following local applications feem eligible ; 

 •viz. decoftion of bark ; charcoal poultice, cfpecially when 

 the difeafe is (lopped, and the (loughs are feparating ; the 

 citric acid, with or without laudanum ; vinegar ; the diluted 

 mineral acids ; the vapours of the nitric, muriatic, and 

 oxygenated muriatic acids ; a folution of gum kino in equal 

 quantities of claret and port wine. 



0/ Ulcers attended -wilh fome fpecijic difeafed AHioti, either 

 conjlilulionat or local. 



1. Ulcers •which yield to Mercury — Here we (hall exclude 

 from confideration venereal ulcers, as this fubjeft is treated 

 of in the article LuEi Vknkhf.a. At prefent we fhall only 

 notice fuch fores as arc produced by other difeafis of the 

 general fyllem, or of the parts, and are capable of being 

 cured by mercury. 



Perhaps there is no greater fourcc of error in the whole 



praftiee of furgery, th»n the £uppofition, tliat a fore, when 

 it yields to mercury, muft be a fyphilitic ore. Surgeons, 

 however, who run into this abfurdity, can hardly be imagined 

 to be uniware, that fo potent a medicine muft have effects on 

 numerous difeafes of very different defcriptior.s. Sir E. 

 Home very truly remarks, that many ulcers, unconnefted 

 with the venereal difeafe, which receive no benefit from other 

 medicines, heal under a mercurial courfe, or yield to mer- 

 curial applications. In fome cafes, the ulcer remains in the 

 fame Hate while mercury is ufed ; but begins to look better 

 as foon as the medicine is difcontinued, in confequence of 

 the beneficial change produced in the fyftem by the mercu- 

 rial courfe. In thefe cafes, mercurial friftions are the beil, 

 becaufe they occafion leaft impairment of the conllitution, 

 in confequence of the flomach continuing undiflurbed, and 

 capable of digefting well. 



Another defcription of ulcers noticed by fir E. Home, 

 as deriving benefit from mercury, occur on the inftep and 

 foot, have a very thickened edge, and are attended with a 

 difeafed ftate of the furrounding ilcin, fo as to bear fome re- 

 femblance to elcphantiafis. They are frequently obferved 

 affefting fervants who live in opulent families in an indo- 

 lent and luxurious way. Sir E. Home ftates, that fumiga- 

 tions with the hydrargyrus fulphuratus ruber heal thefe 

 ulcers, and refolve in a great degree the fwelling of the fur- 

 rounding parts. In fome inftances, an ointment of calomel 

 and hog's-lard ; in others, the camphorated weak mercurial 

 ointment, is the bed application. 



Many difeafed ulcers, particularly fuperficial ones, with 

 a thickened edge, may be healed, when they are dreffed 

 writh a folution of one grain of the hydrargyrus muriatus, in 

 an ounce of water, containing a little fpirit. 



2. Ulcers -which are curable by Hemlock. — Sir E. Mome 

 places more reliance on hemlock as an external, than an in- 

 ternal remedy for ulcers. The ulcers which ufually receive 

 benefit from hemlock applications, look like thofe of an ir- 

 ritable fort ; but the furrounding parts are thickened, in 

 confequence of fome difeafed aftion. Such fores occur near 

 the ankle ; which joint is at the fame time enlarged. Some- 

 times, but not fo often, they take place over the ligaments 

 of the knee. On account of their fituation, and the fwell- 

 ing of the joint, they may be fufpcftcd to be fcrophulous, 

 though they are more fenfible than flrumous ulcers ufually arc. 

 The fores jnft defcribed are rendered lefs painful, their dif- 

 eafed difpofition is checked, and the fwelling of the joint 

 dinunifhed, by hemlock. Several irritable fcrophulous 

 ulcers are alfo particularly benefited by this medicine. 



Sir E. Home gives the preference to hemlock poultices, 

 unlefs their weight fhould be obje6\ionable, in which cafes, 

 he advifes lint to be dipped in a decoftion of the herb, and 

 put on the fore. 



Of the ointment made with the infpiffated juice, fir E. 

 Home feems to fay little in regard to its efficacy. 



3. Ulcers -which may he cured by Salt Water Sir E. Hoane 



takes notice of other fpecific ulcers which yield to this ap- 

 plication, after refilling other remedies. Poultices made 

 Willi fca-water are often employed ; but this gentleman 

 fecma to prefer keeping the part immcrfed in the water in k 

 tepid Hate, about a quarter of an hour, twice a day. 



When fea-water poultices bring out pimples, in cafes 

 of fcrophulous ulcers on the legs and feet, fir E. Home in- 

 forms us, that this difagrccable circumflancc may be ob- 

 viated by diluting fuch water with an equ.al quantity of a 

 decoftion of poppies. After a time, the fall-water may be 

 tried by itfelf again. While each fre(h poultice is pveparliig, 

 the part fhould alfo be immerfed in fuch water warmed. 

 When there is a tcndencv to anafaKca, or when there it 

 T t 2 < an 



