Herpes[83] is a disease which is very frequent, and often prevents large ulcers from healing, as these come to assume the action of herpetic ulcers, although, from their magnitude and depth, they do not put on the same appearance as when the disease is confined to the skin. The large ulcers are of a dark sloughy appearance, discharge thin matter, are painful, and are surrounded with herpetic ulcers, and scabs in the skin. This is a very frequent disease on the legs, and is very tedious. Bathing with warm sulphureous water is often of service, at the same time that we dress the parts in the intervals with camphorated ointment. Citrine ointment is also very useful; but the following liquor is one of the best, and most effectual applications:
R. Pulv. Calcis Vivi Recen. unciam.
Flor. Sulph. semiunciam.
Aq. Font. sesquilibram. Coque ad dimidiam dein cola.
This ought to be applied with cloths to the parts.
When, by these means, the disease of the skin, and the specific action of the ulcer is removed, pressure is often of service in completing the cure.
There is a specific ulcer, which is met with most frequently on the legs, and which is very troublesome. The skin becomes in several points inflamed, or of a dark red colour. These parts speedily ulcerate, and the sores belong to the suppurating kind, for no distinct granulations, or organic particles, are formed; but the surface is smooth and glossy, and the discharge thin and copious. These sores are generally pretty deep, in proportion to their extent, or of a cup-like appearance. They not unfrequently occur in scrophulous habits. Mercury, exhibited in small doses internally, appears to be useful. Precipitate, as a local application, generally answers very well; but, when the sores become irritable, or spread under this treatment, hemlock poultices succeed better.
There is a small ulcer, which sometimes is met with on the foot, of an irregular shape, fiery appearance, and surrounded with thick jagged margins, which, in particular parts, are white, and callous. The neighbouring integuments are of a dark red colour. The discharge is thin, and the pain considerable. Caustic, and afterwards the application of the adhesive plaster, are the best local applications. Internally, the use of hemlock is sometimes of service.
It occasionally happens, that, nearly about the same time, most of the patients in a ward of an hospital shall have their ulcers rendered unhealthy. They become foul, dark coloured, and spread: The discharge is thin, and the pain is greater than formerly. The application of cloths dipped in gastric juice is sometimes of service in these sores, and is one of the best remedies; but, not unfrequently, the patient must be removed to a different situation before a cure can be obtained.
Having made these detached remarks on some specific ulcers, I shall, in the succeeding dissertations, consider, at greater length, others, which are, in the general estimation, considered as more dangerous and alarming.