ULCEK. 



ai) unufual colJnefs in the liir^b, unattended with any pro- 

 penfity to mortification, tepid falt-water may be ufed with 

 infinite advantage. 



4. Ukers which may be curtd by the jlrgentum Nitratum. 

 — Sir E. Home notices, under this head, an ulcer, which 

 does not penetrate more deeply than the cutis ; but fpreads 

 in all direftions, producing ulceration on the furface of the 

 fkin, iind often extending nearly through its whole thick- 

 nefi. The part firft afFeAed heals, while the fltin beyond 

 is in a ftate of ulceration^ 



Of this defcription are", a leprous eruption, moftly feen 

 i;i TT.tn impreffed in Ireland ; a difeafe of the (kin induced 

 by buboes, which have continued a great while after the ve- 

 nereal virus has been dellroyed ; and the ring-worm. 



AU thefe difeafes are moft eafily cured by applying to 

 them a folutior. of the argentum nitratum. 



The leprous eruption is communicated by contaft, and 

 makes its appearance in the form of a boil. This is con- 

 verted into an ulcer, which difcharges a fetid fluid, by which 

 the furrounding fkin is excoriated, and the ulceration is ex- 

 tended over a large furface. The pain is the moft fevere, 

 and the difcliarge greateft, in hot weather. The parts firft 

 difeafed heal, while others are becoming iJcerated, and the 

 difeafe is always rendered worfe, by fpirituous liquors, fait 

 provifions, and catching cold. 



Sir E. Home remarks, that the difeafe in the flvin, pro- 

 duced by the effefts of very irritable buboes, in coiiftitutions 

 broken down by mercury, is attended with ulceration of a 

 more violent, deep, and painful kind than the foregoing dif- 

 temper. The progrefs of this diforder is, in other refpefts, 

 very fimilar to that of the leprous eruption. 



Although the ring-worm only occurs in the form of an 

 ulcer in warm climates, a mild fpecies of the affection takes 

 place in fummer-time in this country. It feems to be infec- 

 tious ; though it often occurs without infeftion. It com- 

 mences with an efflorefcence, which is attended with very tri- 

 vial fwelling, and fpreads from a central point. The cir- 

 cumference of the efflorefcence becomes raifed into a welt, 

 while the reft affumes a fcurfy appearance. The welt be- 

 comes covered with a fcab, which falls off, and leaves an 

 ulcerated ring, in general not more than a quarter of an 

 inch wide. The outer margin of this ring continues to ul- 

 cerate, while the inner one heals, fo that the circle gets 

 larger and larger. The difcharge confifts of a thin acrid 

 fluid, which feems to have a great ftiare in making the dif- 

 eafe fpread. 



For all the three preceding difeafes, a folution of the 

 argentum nitratum is ftrongly recommended by fir E. 

 Home. 



5. Ulcers which yield to Arfenlc The fores which are 



named noli me tangere, derive great benefit from this power- 

 ful remedy. Sir E. Home obferves, that they are nearly 

 allied to cancer, differing from it in not contaminating their 

 neighbouring parts by abforption, and only fpreading by im- 

 mediate coi.taft. 



From Come cafes which fell under fir E. Home's obferv- 

 ation, he difcovered that arfenic was not only efficacious 

 as an external, but alfo as an internal remedy. Indeed, ex- 

 perience proves, that, in all cafes of lupus, or noli me tan- 

 gere, if any medicine is entitled to more confidence than 

 others, it is unqueftionably arfenic. 



Sir E- Home is an advocate for its employment, both in- 

 ternally and externally, for ulcers of untoward appearance 

 on the legs. The fungated ulcer is particularly pointed out 

 by this gentleman as being benefited by arfenic. This ulcer 

 occurs on the calf of the leg, and on the fole of the foot. 

 From, its furface a fungus flioots out, which is entirely differ- 



ent from common granulations. The new-formed fiibllance 

 is radiated in its ftruAure, the bottom of the ulcer being the 

 central point, aud the external furface, which is continually 

 increafing, the circumference. The fubftance of this fungus 

 is very tender, and readily bleeds. The firft ftage of the 

 difeafe fometimes has the appearance of a fcrophulous affec- 

 tion of the metatarfal bones ; but the parts feem more en- 

 larged, and when the fltin ulcerates, a fungus (hoots out, and 

 betrays the nature of the cafe. 



One fpecies of the fungated ulcer is capable of contami- 

 nating the lymphatic glands, the other is not fo. The firft 

 is reprefented by fir E. Home as being incurable by arfenic, 

 or any other known medicine. 



The fecond yields to this remedy. Sir E. Home ufes a 

 faturated folution, made by boihng white arfenic in water, 

 for feveral hours, in a faad heat. He gives from three to 

 ten drops internally ; and, for outward ufe, dilutes a drachm 

 with two pints of water, making it afterwards gradually 

 ftronger and ftronger, till it is of double ftrength. The ap- 

 plication may either be made in the form of a poultice, or 

 by dipping lint in the lotien. 



The bell and fafeft preparation of arfenic, both for inter- 

 nal and external ufe, is the kali arfenicatum. 



6. Ulcers attended ivith Varlcofe Veins. — A certain kind 

 of ulcer is very apt to occur on the infide of the leg, and 

 is equally difficult to cure, and liable to break out again. 

 It has the look of a mild indolent fore ; but the branches 

 and trunk of the vena faphena are enlarged, and this varix 

 of the veins keeps the ulcer from healing. The fore is fel- 

 dom deep, ufually fpreads along the furface, and has an oval 

 fliape, the ends of which are vertically fituated. There is a 

 pain affefting the limb rather deeply, extending up in the 

 courfe of the veins, and exafperated by keeping the leg a 

 long while in an ereift pofture. 



This is a kind of ulcer which derives immenfe benefit 

 from a tight roller, applied from the toes to the knee, al- 

 though the direft operation of the prefTure of the bandage 

 on the fore is itfelf produftive of no particular good. 



Sir E. Home found, however, that many patients could 

 not bear to wear laced ftockings or tight bandages, and that 

 fome received no relief from them. Hence, this gentleman 

 was led to confider what elfe could be done for the cure of 

 the varicofe ftate of the veins. He reprefents, that, in con- 

 fequence of the fize of the vena faphena, and its numberlefs 

 convolutions, the return of blood from the fmaller branches ia 

 fo impeded, as to retard the circulation in the fmaller arteries, 

 and to interfere with their aftion in forming healthy granu- 

 lations. The coats and valves of the veins alfo become 

 thickened, fo that the latter parts (the valves) do not do 

 their office of fupporting the weight of the column of 

 blood. 



Thefe refleftions induced fir E. Home to think, that fome 

 benefit might be obtained by taking off a part of the pref- 

 fure of this column of blood, by making a ligature round 

 the vena faphena, where this vcfTel paffes over the knee-joint. 

 Thus the cavity of the vein at this part would be dbliterated, 

 and a kind of artificial valve would be formed. 



This gentleman recommends the following way of per- 

 forming the operation : " As the veins are only turgid in 

 the ereft pofture, the operation (hould be performed while 

 the patient is ftanding, and if placed upon a table, on which 

 there is a chair, the back of the chair will ferve him to reft 

 upon ; and he will have the knee-joint at a very convenient 

 height for the furgeon. The leg to be operated upon muft 

 ftand with the inner ankle facing the light, which will expofe 

 very advantageoufly the enlarged vena faphena pafTmg over 

 the knee-joint. While the patient is in this pofture, if a fold 



of 



