NIVERSITY OF LOUISVILLE THE LANCET. VOL. VI.-No. 1.] LONDON, SATURDAY, JAN. 8, 1825. SURGICAL LECTURES, DELIVERED BY MR. ABERNETHY. [Price 6d. monious, that when it runs over the sound skin, it will excoriate it. It is an acrid ichor; sometimes it is so acrid, that it is necessary to butter, as it were, the edges of the sore, to wash the parts round very frequently, and clean them thoroughly. It was one of the propositions of Mr. HUNTER, 7 heatre, St. Bartholomew's Hospital. whether the secretion acted on the LECTURE 13. GENTLEMEN, I shall surface of the sores, so as to keep up the irritation in them; but he thought from observation that it did not, and for many reasons, certainly, which I should be leading you away from the do not now want to relate, because I In the last Lecture I mentioned Mr. HUNTER's opinion respecting absorption, and as I am uncertain whe-point that I wish more particularly to ther you understood me or not, dwell upon. Another description of repeat it here; he said that absorption called sanies, which means a viscid discharge is, that which has been is a process set up to avoid a more sedischarge; sometimes it is rather rious evil, namely, mortification, I shall now speak of the '; bloody, and then it is called a bloody sanies. Sometimes a thick discharge adheres to the edges of a wound, of a dark colour, which has been called sordes. Well, all these circumstances are observable in the incarnization of a sore, and afford an evidence of the unhealthy state of the parts. have to correct these unhealthy dispositions in the healing of sores, and the first step is to stop the progress of disease. Different kinds of Ulcers, and the Treatment which they require. When the reparation of an ulcer is carried on in a healthy manner, the granulations which fill up the chasm are small, conical in figure, and florid in appearance. They are florid, hecause the circulation goes on well in the part. But when the process of reparation is not carried on in a healthy manner, the granulations are large, flabby, flat on their surface, and of a bad colour. When this process is carried on in a healthy manner, the secretion from the surface of the sore is a good pus; and even when ulcers are sinous, as they say, you may judge of the state of the surfaces of the ulcer by the discharge which takes place; this is the information obtained by common observation. When the process of reparation is not carried on in a healthy manner, the discharge varies exceedingly. Sometimes there is a watery discharge called ichor; sometimes it is so acri We I think that Sir EVERARD HOME'S book is the most scientific which has been published on ulcers, and I have been in the habit of making some comments upon it. He has divided ulcers into such as are weak or indolent, and irritable sores, to which he has added such ulcers as manifest some morbid peculiarity. He describes the kinds of sores very well which he speaks of As to the weak sores, he says that they are pale and flabby, that the gra nulations have not a healthy appearance, and that they are slow in healing. He says, that if you dress such a sore with bark it will improve in its appearance, and that if there be two such sores, one near the knee and the other on the ancle, and you give the bark internally, the sore on the knee. will heal first tion to posture.I say that your object should be to quiet irritation. After you have quieted the irritation, granulations will grow, but these granulations will not be healthy; ulcers do not form in healthy people.... Indolent Ulcer." As to the irritable sores, I can make out nothing different in the description from the circumstances which generally attend the commencement of an ulcer. The bottom of the sore is rough, the edges are ragged and The granulations grow after the irirritable, and the granulations are ritation has been quieted, but they are very few and `indolent. What you of an indolent kind, and now constihave to do, is to oppose the disease tute the common ulcer which we see which has produced the ulceration, by so often in the Hospital. The granuquieting the irritable state of the parts. lations are large and flabby, the surI know nothing so good for this pur- face of the granulations is not of a posé as a weak solution of opium in good colour, the discharge is not good, water. You may rub down two and the edges of the sore become scruples of opium in eight ounces thickened, Weakness, it is said, is the of warm water, and strain the so- essential character of the ulcer, but lution through a little tow, or you it is only the substitution of one name may dissolve in some cases half a for another; when weakness is prodrachm; some pieces of lint should voked it becomes irritable, and when be dipt in the solution and laid upon not provoked, it degenerates into inthe sore. It is something which quiets dolence. This is what nobody can the irritation, and I should tell you deny, I think; it is what is called a also that it should be applied luke- truism. In the Hospital you will have warm; all applications to sores as frequent opportunities of observing dressings should be of the same tem- these sores. The great art in the perature as the sore. Cold water is management of all ulcers is to quiet not a pretty thing to apply to a sore, them when they are irritable, and to especially an irritable sore; I say it is stimulate them gently when they are not a pretty thing, for we have no indolent. Then as to the substances right to chill parts, as I said when employed for the stimulation of indospeaking of the regulation of tempe- lent sores, they are very numerous : rature. When you apply a solution of there are various ointments made opium to sores, you should touch the with the different metallic oxydes edges of the sores with spermaceti' there is the red precipitate, the white salve to prevent the lint sticking, and precipitate, the different preparations over it pitt a bread and water poultice of zinc and lead. I knew a gentlemade with poppy water, or you might man who once told me, when speakput over it linen folded, dipt in the ing of the various stimulating dresspoppy water, and over the whole you ings which had been applied to sores, should apply a light bandage to steady that he never attended to all the farthe dressings. rago which has been laid down inbooks, but that he was in the habit of curing all the sore legs that fell under his notice by using only one thing, which was a solution of the corrosive sublimate in water. He said that he proportioned the strength of the wash to the state of were very Keeping the patient with a sore leg in bed is a thing of great consequence. In the horizontal position the blood returns from the part with greater, ease, but when the patient is erect, it has to mount up against its own gravity. Sir EVERARD HOME has shown, in the description which he has given * of weak ulcers, that the granula- plied it stroke sore; if the sore and indolent, he ap; if not very indolent," tions were red whilst the patient lay he used the wash weaker. The fact in bed, but when he stood up, the gra- is, that they are sores which you may nulations became immediately purple. dress with a great variety of stimulants; This seems to show the weakness of you may sometimes dress them with a the newly formed vessels, and the ad- thing which will agree very well for a vantage to be derived from an atten- time, and then it does not agree, and 14 |