SECT. II.
Of Ulcerations
This is a part of surgery that many pretend to, but what very few really understand. There are however laws in the animal œconomy, which when they are violated, leads us to trace its many evil consequences.
An ulcer is a dissolution of solids, occasioned by acrimonious humours, which not only act spontaneously upon each other, but prevent the remaining circulating part from the formation of unnatural substances.
Exulceration, strictly speaking, is what every part of the animal fabric is subject to; from the external surface, to the very substance of the bone itself. In this sense, every eruption, as well as the carius of the bones come under that denomination; but more particularly, the corruption of the softer parts on the surface of our body, is here the subject.
I shall not enter into a detail of the many kinds of ulcers generally enumerated; they have all in common an corruptive acrimony, and a depraved accretion of excressence in their nature; which differ only, according to the parts ulcerated, and the habit of body; and I have ever found in my practice, that one proper method serves for all; I shall therefore in a simple manner give such directions as will ever be attended with success.
The principal intention is to correct the malignity of the humour peculiar to ulcers; to bring them into a good suppuration, and nature, all kind Nature! will perform the rest.
When an ulcer is inflamed all round, filled up with fungous substance, of various colours, the matter thin, ferous, and is very fœtid; then first wash the sore gently with some good soap suds, or let the part ulcerated be steeped in it for some little time, which will draw out the malignity; then apply the following dressing:
Take the powder of burn’d Allum (17), and with a little lint dab it all over the fungous part, then spread a pledget of the salve mentioned in gun-shot wounds, No. [I]. and over which apply a good warm poultice there also mentioned. Let this dressing be repeated twice or thrice a day, till the inflammation ceases, and the fungous substance becomes reduced; when then, the washing, the allum and poultice may be left off, but the mentioned salve continued till the sore looks of a pale red, and begins all round the edge to heal up.
Cleanliness is very commendable; but in this case, when a sore looks well, the matter becomes of a pale yellow; wiping should be very sparingly; and then, dressing once a day (the morning) is full sufficient; for by wiping, and often meddling with it, the small granulations of the flesh is hindered from growing, and healing is retarded.
A sore leg is very troublesome, and very often attended with pain and expence, to no purpose. It generally swells, is inflamed and troublesome at night. Let the leg be bathed every night, (with the open sore) in some good warm soap suds; or instead of that, take what you can have plenty of, namely, sea water. If you can have it warm, it is well, if not, make use of it cold, rather half a dozen times of the day, than omitting it altogether; and by dressing the leg as before directed you’ll have reason to thank me for my good advice.
Sometimes the bone is affected; in which case, the cure with the best dressing in the world will frequently be tedious. A sore of this kind will not heal till the bone has discharged a scale, (termed exfoliation.) But tedious as it is, very often it is made more so, by unnecessary trouble. Without intending to give offence to my brother surgeons, I have frequently seen bad consequences attending methods taught with diligence in hospitals; take my word for it, you will do no good with your scraping tools, throw them over board, and you’ll succeed better than using them in this case.
The bones, though the hardest, are the most delicate parts in the whole body; but when it is affected, nature forms a new periosteum over the sound part, and gradually pushes forward the decayed scale. This wonderful work is performed by nature only, and must not be disturbed. By scraping, and boring of it, the tender periosteum will only be molested, the sound bone will become foul again, and so you may go on for ever; and I never saw a sore of that kind healed up by this improper method, till nature over-powered art, or the surgeon was tired with scraping, perforating, &c. but I have known many amputations in consequence of it, and many lives lost in consequence of that again; yet there is no rule without exception. There are cases where operations of that kind on the bones is required; but that ought to be referred to a judicious and experienced surgeon.
When the sore remains fungous, the proud flesh sprouts out in little bunches, and the matter is muddy and stinking, it is almost a sure sign the bone is foul; and if you examine with a probe, you may generally feel it, or even see it, and the bone, is sometimes black, brown, &c. and generally very rough on the surface. In such a case, continue the dressing as before observed, and frequently examine whether the scale loosens; at the same time examine (not too roughly) which way the scale inclines, also the bigness of it; and if there is a probability of extracting it, so that the fungosity only stops it, then freely use a bistoury to make way for it; but in this be not in too great a hurry, for care should be taken (as I have said above) not to extract the scale, till the separation from the fresh bone is mature.
If an ulcer is sinous, inject in the sinus, a mixture of burnt allum and water, viz.
No. VII
Take water two ounces; burnt allum (17) two drachms; mix them well for injection. After two or three dressings with this, inject the antacrid injection.
No. VIII
Take two ounces of water, with one scruple of calomel (N), as I have described in my treatise on the venereal disease.
This is the proper management of ulcers in general, and will ever be attended with success, even in the most inveterate kind. In venereal ulcers, the mercurial ointment with the precipitate, may be applicable, especially in shankers. I shall therefore end this section, for having directed the management of the worst of ulcers, the inferior kind will of course yield to the same method.