_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.