When, by any of these applications, the state of overaction is overcome, pressure is the best remedy for preserving our ground, and producing a cure; for, remedies which may be useful in the diseased state, will be hurtful when this state is removed.
In this sore, anodynes are to be freely employed internally; for, given sparingly, they do no good[64].
All the applications ought to be made gently, and lightly; because any mechanical irritation increases the disease.
The second variety of this species is a very troublesome ulcer, and admits, as has been already observed, of two divisions: First, it not unfrequently happens, that, after an indolent ulcer has been in a healing state for some time, a state of overaction is induced, by fatigue, or other causes, particularly by the natural inability of the newly formed, and not completely perfect granulations, to sustain the action which is necessarily induced in them by their connection with other parts (upon the principle of the communication of action). In this case, the sore becomes foul, dark coloured, and painful, whilst the cicatrix ulcerates, and the new granulations die, so that, in a short time, the ulcer regains its original size, and even spreads slowly to a greater extent. Second, an old ulcer may, without having been previously in a healing state, become converted into the overacting ulcer; because the surface has its power so weakened, that common agents, which naturally excite action in the part, excite a disproportioned and morbid action in the ulcer; but this action is of the low kind, and bears somewhat the same relation to the first species, (or overacting ulcerative action, in ulcers previously healthy,) that the inflammatio debilis does to the inflammatio valida. In this case, the surface is bloody, and the half-formed granulations are of a livid colour; the callus edges are of a dusky red, or modena colour; the integuments are generally mottled; the inferior part of the limb is cold and painful.
In the cure of the first division, we must enjoin rest, as in the second variety of the first species, and apply cloths, dipped in a mixture of two parts of laudanum and one of camphorated spirit of wine, which produces at first considerable smarting; but the sensation is different from the former pain; and, although uneasy, is yet more tolerable than the peculiar pain of the ulcer. This application ought to be renewed two or three times in the course of the day, until the surface becomes of a better appearance, and the pain abates.
The application of the powder of bark to these sores is sometimes, but very seldom, of service[65].
A poultice, formed of decoction of camomile flowers, opium, and charcoal[66], is frequently of use, and should be employed when the laudanum and camphorated spirit fail. This should be applied cold.
In the second division, the fermenting poultice[67] is often of service; but it must, like all other applications, be continued no longer than the state which it was intended to remove remains. If we continue it too long, we do hurt; for, if it be kept on when it produces continued pain, it induces a state of overaction, similar to that which it was intended to destroy. Whenever the surface becomes redder, and the pain less, it may be useful to employ some other application, such as laudanum, &c.
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.