[54] The degree of pressure necessary for producing this effect is proportioned to the susceptibility of the granulations, or organic particles, for receiving the impression of being in contact. When a part is healthy, the mere circumstance of juxtaposition is sufficient for this purpose; and, in a healthy ulcer, the weight of the body applied, such as powdered chalk, or plaster of Paris, or at least the gentle pressure of a stocking, or easy bandage, is all that is necessary. But, when the action is too low, and the granulations are consequently imperfect, both in their structure, power of acting, and capability of receiving impressions, the contact, in order to operate, must be nearer, and more complete; or, in other words, the pressure must be greater. In these cases, bandages not only act on the surface, but also on the parts below, and, therefore, increase the degree of contact of the newly-formed organic particles, and thus strengthen the part.
[55] An ointment composed of these resinous substances is much recommended in the Acta Med. Berolin. Tom. VII. p. 58.
[56] These acids coagulate the pus, and thus afford an artificial covering, or film, which remains in close contact with the granulations, and thus, by producing the natural circumstance of contact and covering, the effects of which have been already mentioned, as well as by creating a more vigorous action by their specific action, they frequently bring those sores into a healthy state.
[57] This operation is performed by making an incision through the skin which covers the vena saphena below the knee; a ligature is then passed under the vessel, by means of a blunt needle, and the vessel is tied. In two or three days the ligature may be removed, its circle being previously divided with a pair of scissars.
[58] By this I mean more perfect in its state of overaction.
[59] In highly overacting ulcers, the granulations seem to possess a middle state, betwixt proper organic particles and the morbid substance, called pus.
[60] This affection of the ulcer, produced by a disease of the parts below, is induced with a frequency nearly proportioned to the aptitude of the part below for becoming diseased, by the continuance of an ulcer over them. Tendons and bones are particularly apt to be injured in this way; and, therefore, ulcers seated over tendinous parts, or bones thinly covered, are more apt to affect these, and to be reacted on themselves, than when seated over fleshy parts. On the same account, ulcers on the foot, or ankle joint, are worse to heal than those a little farther up the leg; and the difference is greater than can be explained wholly, by the circumstance of distance from the heart, and possessing less power of performing action properly. Recent ulcers likewise heal easily on the feet, by proper treatment. It is old ulcers alone which are difficult to manage, and the cause is obvious.
[61] L’eau mercurielle is a solution of mercury in nitrous acid.
[62] In the description of this variety, it was mentioned, that there frequently was a small opening in the surface, which communicated with the bone; but, even where this is not the case, the layer of dead bone, when it exfoliates, comes through the granulations; for the granulations of the sound bone below raise it up, in consequence of which, pressure is made from within outward upon the ulcer, by which absorption is produced at that part, in a greater degree than deposition; and, therefore, a vacuity is produced.
[63] The ammonia hepatizata is prepared by passing a stream of hepatic gas through the aqua ammoniæ.