ULC
fcurvy, or dropfy, of fome other confiitutionai complaint, be in the way, it may be cured as cafily as a frqfh wound. Hei- Jler's Surgery," p. 251.
Cutaneous Ulcers. Such of thefe as attack the fkin of the face, both in infants and adults, approach very much to the nature of the truly phagedenic Ulcers ; for they, like thofe, arife from an acrimony of the blood, and are very apt to fpread abroad ■.
In both thefe eafes therefore purging medicines, -with fuch as fweeten the blood, will always prove of fervice. Decoclions of the woods, or of the fharp-pointed dock root, or the herb fumitory, mould be drank ori thefe occafions, half a pint at a draught, as hot as can well be borne, three or four times a day. And fome of thefe draughts fhould be taken in bed, and a gentle fweating be promoted for fome time afterwards. And abforbent and fweetening powders ; as thofe prepared from •antimony and flower of brimftone, mould be taken at the fame time. When this cafe happens to infants at the. breaft, they can only take fome flight dofes of .medicines to open the bowels ; but the mothers' or nurfes ought to be enjoined the regimen juft mentioned. .
In _ regard to the external applications, oil of tartar per deli- quium will be found of great fervice ; a pencil or feather is to be dipped in this, and rubbed over the parts three or four'times a day. This may either be" thus ufed alone, or elfe mixed with oil of eggs and wax, and a plafter laid" over it, of the de minio, or any other of the It-ad plafters, or one of fperma ceti and camphor.
If the whole face be affected, which in infants is not unfre- quently the cafe, a: plafter would prove highly troublefome ; but, in this cafe, the proper ingredients may 'be fpread in a fofter form over a hnnen mafk. Lime-water is a medicine of great power and value alfo in thefe cafes, as is likewife the water ufed in the warning diaphoretic antimony. The tillers may very properly be warned with either of thefe, and the li- tharge or pompholyx ointment afterwards applied ; to which, in very ftubborn cafes, a little crude mercury may be added ; and fumetimes a fmall admixture of red precipitate is found neceflary ; and finally, if thefe Ulcers are attended with a large and foul difcharge, it will be proper to fprinkle them with fome of the abforbent powders, as tutty, lapis calaminaris, cerus, chalk, or the like, mixed up occasionally with a little native cinnabar, or red precipitate ; or, if it be found more
- convenient, thefe powders may conveniently enough be made
into an ointment with cream. Hajlcr's Surgery, p. 247.
Fijiulous Ulcers. When it is difcovcred, either by the eye or probe, that Ulcers are become fiftulous, though the fiftuhe cr iinufes are not yet become callous, the readieft way of curing them is by laying them open, if that can be conveniently done, down to the bottom with the knife, and after this they may be cleanfed and healed. As patients, however, are al- ways averfe to the knife, the cure of thefe may be attempted hy injecting them with the decoctions of vulnerary herbs, fuch as agrimony, birth-wort, or ladies mantle, and drefling them with digeftive ointments or lint. Many furgeons are, in thefe cafes, fond of thrufting their dreffings to the bottom of the fi- nus with tents ; but they are very apt to do mifchief by their hardnefs, and too great length, often bringing en a callus, in- flammation, or too great flux of humours on the part. They ought therefore either wholly to be laid afide, in thefe cafes, or elfe to be made as foft and as fhort as the nature of the cafe will admit. The next particular, in the cure of thefe fiftulous finufes, is to prefs the fundus as near to the mouth or opening as poflible ; and when the wound is cleanfed, and the proper dreffings applied, a fmall comprefs, or a flip of plafter, doubled up in the form of a fmall comprefs, muft be laid on the part where the fundus, or bottom of the fiftula, is judecd to be feated, fecuring all on. by a larger comprefs, and the proper bandages. In rolling up, in thefe cafes, the proper method is always to place the beginning of the roller upon the fundus of the fiitula, or at leaft to make the preflure tight upon that part ; the continuation of this will urge the contained matter up toward the opening, and the fundus, or bottom of the finus, will naturally be the firft part that heals. When thefe finufes penetrate fo deep, that there is no coming at their bottoms with the dreffings, vulnerary injections muft be fre- quently ufed ; and, of thefe, none are more ferviceable in thefe cafes, than the following : Take of the common digeftive, prepared with turpentine, diflblved in the yolk of an e™, an ounce and half j honey, either fimple, or the honey of rofes, or of celandine, an ounce ; common-proof fpirit, nine ounces ; mix thefe together for an injection. Or take of a'deco&ion of fcordium, or elfe of fouthern-wood • or agrimony, eight ounces; common-proof fpirit, three ounces ; elixir proprieta- tis, or elTence of myrrh and aloes,' one ounce; honey of rofes, two ounces ; mix all together. Thefe are to be injected at every drefling, and the opening of the fiftula muft afterwards be kept clofed, to keep them in its cavity for fome time, which will much haften the agglutination of the part. If this method of cure does not fticceed, recourfe muft at laft be had to the knife; and, indeed, in very m.my of thefe cafes, there is no great probability of relief from any other means, parti- cularly where the fundus lies directly downward, or- where the fiftula takes fuch an irregular courfe, that the fundus of it 3
■ " cannot, with any fuccefs, be prefled toward the opening 1 , la this cafe there is no relief to be had, but by laying it open to , the bottom.; To do this, a grooved probe, or dingers
- ihou d be gently palled down the fiftula, and then direflihg
! ■ the knife * lSn £ the groot-e, the'flefh, and common inte<m- . nients, are to-be laid-open, as far as is fafe and neceflary ; a , free paflage is, . by this means, given to the corrupted niatter, and the part may be come at with the proper dreffings.- If the opening is attended with a large difcharge of blood, as is fre- quently the cafe, the wound "muft be, at the firff'dreffing, filled with dry lint, and afterwards it is to be drefled with the '■common digeftive, with a fmall mixture of the /Egyptian
- ointment, or with a little red precipitate, till the wound is
perfedtly cleanfed, and it may then be eafily healed' in the , common way. , liclfter'a Surgery, p: 244. Putrid Ulceus. When Ulcers become putrid or fetid, this accident arifes either from a very bad habit of body in the pa- tient, or elfe from the negligence and unfkilfulnefs of the fur- geon.
" The acrimony of the blood is by all poffible means to be taken oft in thefe cafes, • and the Ulcer to be frequently drefled, and every time thoroughly cleanfed. When wounds are drefled but l'eld'om, as will be the cafe after the (harp engagements in an army, where great numbers' have been wounded, it can- not happen, but that the injured parts, in many patients, will be annoyed with heat, putrefaction, and worms. To prevent and remedy thefe, the wounds muft be drefled with the /Egyptian ointment, mixed with Wurtz's brown ointment, or the phagedenic water-may be ufed with great fuccefs, as alfo red precipitate, either alone, or mixed with burnt alum, orwith the common digeftive. Thefe applica- tions are to be continued till' the fungous flefll feparates from the bottom of the Ulcer ; and while this is doing, it Will be very proper to cover the part with lint, dipped in fpirit of wine, which is a very powerful remedy againft putrefaction. When the putrid parts are caft off, the cure will be perfcaed by the common means ufed in Ulcers ; and where there, are ' worms bred in the Ulcer, no particular cautions need be given againft them, fince the fame applications anfwer the purpofe, whatever refills putrefaction, will alfo be found to deftroy worms. Ulcer: fometimes prove, however, fo very malign
• ' and obftinate, that they will give way to none of thefe reme- dies ; and in thefe cafes, though there be nothing venereal at the bottom, yet the only relief feems from a falivation. Hei- Jler's Surgery, p. 248.
,Rur.r.ing Ulcers. When ftubborn Ulcers are attended with a large difcharge, there is reafon to apprehend that the blood abounds with too large a quantity of a thin acrimonious ferum, 'This cannot be drawn off any way more properly than by ca- thartic medicines ; thefe and diuretics are to be repeated as often as , the ftrength of the patient will conveniently permit, and he muft be particularly cautioned againft drinking too freely.
Mdlepedes, in any form, are very properly prefcribed to be taken internally in thefe cafes, as are alfo the effence of am- ber, myrrh, balfam of Peru, tinfiure of fait of tartar, tarta- rized tinflure of antimony, and the like ; large and frequent draughts of fmall liquors are frequently the caufe of thefe dif- orders, and are therefore moft carefully to be avoided ; ftrong ale, or old wine, fhould be drank fparingly at meals, and no- thing between them.
Such meats are beft, on thefe occafions, as have feweft juices in them, and are very well roafted, and the external medi- cines muft be thofe which have the greateft reputation as dryers.
The principal of thefeare lime-water, lapis calaminaris, tutty, chalk, maftic, frankinfen.ee, colophony, and native cinnabar ; when any of thefe have been fprinkled in fine powder upon the Ulcer, a plafter of diapompholygos, or the like, is to be laid over it. He'ijler'% Surgery, p. 246.
Venereal Ulcers. Thefe are almoft always fituated either in the groins, after the fuppuration- of venereal bubo's, or elfe in the prepuce, framum, or glans penis, which is ufually termed a chancre. In females they are frequently fituated in the vagi- na, or labia pudendi, and in either fex fometimes in the nofe, palate, lips, "fauces, tongue, and uvula ; and fometimes the osfrontis,' and other bones both of the head, and other parts of the body, are'fubject to therri.
The great intention, - in thefe cafes, is to expel the vene- real poifon by. proper remedies ; for one Ulcer of this' kind, if neglecfed or ill-created, will produce an univerfal pox. The internal medicines are principally calomel, mixed with purg- ing medicines;- and 'in the intermediate times, decoctions of ■the -woods, with tinfture of antimony, and the like ; thefe laft are to be taken before rifing in themorning, to bring on a gentle fweat, and may be repeated afterwards many times in the day. A ftrid regimen of diet ought alfo to beobferved ; wine, and all vinous or fpirituous liquors, are to be forbidden, - and all aromatics, fpices, fart, arid-acrimonious or acid things, are poifon to perfons in thefe cafes : If fuch a regimen, and a ' courfe of thefe medicines, will not effedt a cure, fuch quanti- ties of mercury muft be fentipto the blood, as will- raife a falivation, by which both the Ulcers and the pox, which was the caufe of them, will be cured at the fame time. When the
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