Ulcer, is an ichorous or purulent solution of soft parts. This affection may arise from a variety of causes, such as cancer, scro-phula, scurvy, etc. but, as a discussion of these would exceed our limits, we shall only give an outline of the general treatment.
In order to effect a re-union of the diseased part, recourse should be had to such applications as will cleanse the wound; for which purpose, emollient poultices are eminently serviceable. If the edges become foul and hard, it will be advisable to apply the caustic (see vol. i. p. 470); an expedient requiring great precaution, but which is far preferable to the knife.
To soften the wound, or to induce a discharge of good matter, the yellow BasilicOn ointment, either alone, or with the addition of turpentine, or red precipitate, will generally prove efficacious. - Where excoriations appear around the ulcer, they should be anointed with spermaceti, or any other cooling ointment. Sometimes they are of so indolent a nature, as to heal very slowly: in such instances, they may be washed with lime-water, or dressed with a pledget dipped in tincture of myrrh. If the patient be afflicted with considerable pain, inflammation, or fever, blood-letting, and a cooling regimen, together with rest, will, in most cases, procure the desired relief. Inveterate ulcers ought never to be healed precipitately; for such practice may be attended with asthma, and other disorders : a liberal use of the bark will, in general, be productive of benefit, in obstinate ulcerations.
A new and ingenious method of treating old ulcers of the legs, has lately been recommended by Mr. Baynton, of Bristol ; and which has since been successfully adopted by many respectable surgeons. It consists in carefully drawing the skin that surrounds the ulcer, towards its centre; and which is gradually effected at each dressing, by the aid of slips of adhesive plaster (for instance, that of diachylon, or litharge), spread on smooth linen cloth. These slips must be made 2 inches broad, and of such a length that, after passing round the limb, from 4 to 5 inches may remain : the middle of this piece is to be applied to the sound side of the limb, opposite to the inferior part of the ulcer, about one inch below the lower edge of the sore, and the ends are drawn over the ulcer with as much gradual extension as the patient can bear. Other strips are then to be placed in a similar manner, each above and in contact with the other, until the whole surface of the sore and limb be completely covered, at least one inch below, and two or three inches above, the diseased part. Next, the limb is to be defended by rollers of soft calico, passed round as smoothly as possible, above and below the ulcer. Incases of violent inflamma-tion, and considerable discharge, Mr. B. recommends repeated affusions of cold water : the patient should take frequent exercise, and apply this bandage early in the morning ; as the limb is then less liable to swelling. In' a short time, the pain, which at first is considerable, will be found gradually to abate, while the limb recovers its tone and sensibility.
Without entering into a discussion of the different kinds of ulcers, together with the proper treatment of each, we shall subjoin a few directions relative to their general management.
The first object of attention will be, to promote the discharge of a thick purulent matter; which may often be effected by the common green or digestive ointment; but, in case the sore do not digest favourably, in consequence of such application, it will be advisable to dress the part with a mixture of the salve before mentioned, and spirit of turpentine ; at the same time laying an emollient poultice (see vol. ii. p. 491) over the whole. If, notwithstanding these remedies, the lips of the wound become cal lous, they must be fomented with strong and hot decoctions of marsh-mallow and chamomile; after which the surrounding parts must be superficially scarified, and dressed with the following digestive ointment ; such scarification being repeated till the callosity be removed: Let 2 oz. of yellow, and 1 oz. of black, basilicon, be melted together over a fire: on taking off these ingredients, 1 oz. of turpentine should be gradually added ; and, when the mixture is cool, half an oz. of finely pulverized red precipitate must be duly incorporated. As soon as the callosities have disappeared, and the discharge has acquired a proper consistence, it will be necessary to dress the wound with a small portion of yellow or black basilicon, and to cover the whole with a pledget of tow, spread with the following ointment: Yellow basilicon, and black resin, 4 oz. ; Burgundy pitch, 2 oz. : let these ingredients be melted in a pint of olive-oil; and, after taking the mixture from the fire, 2 oz. of turpentine should be added.
After these applications, the wound will incarn; and, when the scar is nearly formed, the cure may be completed, by dressing the surface with a small portion of the tincture of myrrh.
This treatment is generally pursued in common ulcers; but, if any sinuses, or cavities, be formed, they must be opened; then filled with a pledget of lint ; and well covered with warm digestive ointment; over which must be laid a second pledget, consisting of tow spread with the same unguent. Such dressing ought to be repeated two or three times, or oftener, if necessary : where callosities arise, . they may be removed by adopting the means above stated ; after which a similar method will be sufficient to heal the ulcer.