Part 11

The same observations apply to the use of the gastric juice. Cloths dipped in this sometimes make the overacting surface slough off, and leave the parts below more healthy. The same may be said of the expressed juice of sorrel.

Lime water sometimes operates in the same way.

Red precipitate, mixed with its weight of powdered opium, and half its weight of camphor, may be usefully sprinkled over the surface.

A pound of the recent leaves of hemlock, boiled for half an hour in two pounds of milk, and then expressed, forms an application which sometimes abates the pain, and renders the action more healthy. The juice is to be made into a poultice with crumb of bread.

Decoction of the walnut tree leaves, applied by means of pledgets of linen, or made into a poultice with bran, is occasionally of service.

When, by any of these applications, the morbid state of the ulcer is removed, it is to be dressed according to the genus into which it is then converted.

After these remarks, the treatment of this genus of ulcers may be comprised in the following observations:

First, In the first variety of the first species, or the simple fungous ulcer, the cure is to be attempted by pressure, and gentle stimulants, which render the action more natural, and the granulations, in consequence, more perfect and compact.

Second, In the second variety of this species, we are to employ the same remedies, as palliatives, or as means which may promote the exfoliation of the bone. But, if the disease in the bone be more extensive and tedious, we must cut down through the ulcer, and apply caustic, or mechanical cures, such as perforation, to the caries.

Third, In the incipient stage of the first variety of the second species, we must avoid motion, and all other such causes as tend simply to increase action. When the disease has consisted of one short paroxysm, which has terminated, we must promote the absorption of the diseased granulations, and the process of replacing them with others which are more perfect, which is effected by such remedies as render the action which forms them more natural. This is best done by gentle pressure, and sometimes by poultices. If, however, the paroxysm continue longer, but in a moderate degree, we must use such applications as tend more directly to change the action, and diminish the morbid condition; such as camphorated and opiated preparations, and sometimes the vegetable acids.

Fourth, When this state becomes confirmed and progressive, the action being violent, we must use remedies nearly similar to those which are employed in the last case, and which are useful in the cure of the inflammatio debilis, at the same time that we enjoin rest, and keep the part as easy as possible. In some instances, the action cannot be overcome directly by any application, but is rather increased by them. In this case, we must lay these aside, and use mild and light applications; such as fine oil, fresh cream, &c.; at the same time that we avoid the general causes tending to increase action; such as motion, heat, spirits, &c.

Fifth, When this state occurs in chronic ulcers, we must use such remedies as tend to remove the dead or dying granulations which frequently cover the surface, and such as at the same time produce a more natural action, and restore to the succeeding granulations greater powers and perfection, and a more healthy mode of acting. Stimulating applications frequently have this effect; such as the fermenting poultice, precipitate ointment, &c.; at other times, narcotic applications; such as cicuta, &c. are useful.

Sixth, In these ulcers, the redness and pain of the skin which surrounds the ulcer, is to be treated as the inflammatio assuefacta, by being dusted with the powder which has been already mentioned, or by similar remedies.

Seventh, In all of these ulcers, where the action is violent, much benefit will be derived from inducing the general narcotic action to a considerable extent. Anodynes are therefore to be freely administered, at the same time that we employ the proper local remedies.

Eighth, Whenever the ulcer becomes more healthy, and the action less morbid, the strength of the application is to be diminished; and, when the state of overaction is destroyed, it must be treated as the indolent ulcer, because the granulations are still feeble. Pressure is most useful in this case.

GENUS IV.

Of the Inflammatory Ulcer.

It sometimes happens, that the ulcerative action becomes converted into the inflammatory; the discharge diminishes, and sometimes ceases; the surface is red; and the edges and surrounding skin are elevated and inflamed. This, which has been called the phlogosis ulceris, strictly speaking, does not belong to the division of ulcers, because the ulcerative action is destroyed; but, as it is preceded, and very quickly followed by this action, and as the solution of continuity, and other external appearances continue, this affection may be allowed to rank as a genus amongst ulcers, in conformity to common language.

“Siccitas rubido et phlogosis ulceris facile cognoscuntur; dolore, pruritu, calore stipantur; ca impediunt carnis excrescentiam, adeoque indicant remedia emollientia,” &c. Sauvage Nosol. Meth. Tom. II. p. 613.

When the pain and inflammation are considerable, leeches are frequently applied with utility in the vicinity of the sore; but it is more generally useful to apply warm poultices, which restore the secretory state, and the ulcerative action.

GENUS V.

Of the Suppurating Ulcer.

This genus, like the last, accurately speaking, does not belong to the class of ulcers; but, as it is so intimately connected with it, both in its causes, and treatment, and appearances, it is of some practical utility to admit the arrangement.

When an abscess is opened before the ulcerative action is induced, we have an open suppurating sore; but this is not the sore which is meant to be described here.

The suppurating ulcer is, when simple, and independent of any specific action, most frequently only a high degree of the overacting ulcer; but, as its symptoms are somewhat different, and as it nearly resembles some specific sores, differing from these only in the absence of the peculiar action, resulting from the application of a poison, it may be proper to consider this as a separate genus.

When the ulcerative action is very imperfectly carried on, which often arises from overaction, we find, that the organic particles are thrown out, not in the form of granulations, but in a more inorganic state, and lie upon the surface, mixed with the discharge from the other set of vessels. This has the appearance of very thick tough pus, and the sore which yields it may properly be considered to be in a suppurating state. This ulcer is distinguished by the pain which attends it, by a redness which surrounds the margin, and a hardened base, whilst the cavity of the ulcer is filled up with a thick straw-coloured substance, somewhat like lymph, which adheres firmly to the surface. This is improperly called a slough.

This appearance and condition may be excited in a simple ulcer, without any apparent application of contagion; but it is still more frequently the consequence of some morbid matter acting on the part, and producing specific ulceration, which will be afterwards considered. I may only here observe, that it has, in some of these cases, been considered as a species of gangrene, as, for instance, in the cynanche maligna; but, whatever may take place in the advanced stages of this disease, there is at first no gangrene, but a suppurating ulcer, which throws out imperfect granulations, or rather a morbid purulent discharge (for the one runs naturally into the other), which forms what is called a slough.

The treatment of this ulcer consists first in procuring a separation of the tenacious covering, by such remedies as shall, at the same time that they do this, make the action more healthy.