absorption, and the bone, at these parts, is left bare. In this case,
no incision is necessary, except occasionally through some bands of
granulations which extend across the bare bone; and, therefore, we can
at once apply our remedies to the bone, or make perforation with the
trephine.
The second species requires to be treated differently, according to its
varieties.
As the incipient stage of the first variety frequently consists of only
one short paroxysm, it would often be unnecessary to have recourse to
any peculiar treatment; but, as it is impossible, a priori, to say
whether the state of evacuation is to continue, it is requisite, in
every instance, to vary our treatment, and apply the proper remedies
for the disease.
Poultices are frequently useful in this kind of ulcer, when the
surface is dark coloured, and the integuments are not yet affected.
They have sometimes an effect of checking the morbid state, if this
be not already done; but they more generally promote the absorption
of the morbid granulations, after which the surface becomes healthy.
If, however, the action be still greater, and more permanent, then the
ulcer is tending toward the confirmed, or perfect state of overaction,
and poultices are not of equal service; they are even sometimes hurtful.
Gentle pressure, accompanied with the use of cold water, is of service
in the same cases in which poultices are employed; that is to say, when
the action has not become perfect, but has rather begun to subside, and
the granulations remain dark coloured, and in a dying state. They are
absorbed, and replaced with more perfect and healthy granulations.
When, however, the action still continues in the same state of
overacting, or seems to be increasing, these remedies are rather
hurtful; and we will derive more benefit from using applications
of a gentle stimulating nature, which restore the action to a more
perfect and natural state, in the same way as they cure the inflammatio
debilis. For this purpose, one of the best applications is the
following:
R. Opii drachmas duas.
Camphoræ scrupulum.
Vini Albi uncias quatuor. Macera per triduum, dein cola.
This may be applied by means or a bit of lint to the sore. It generally
produces considerable smarting for a few minute, after which the pain
abates. The application is to be repeated every hour, or every two
hours, until the sore begins to look healthy, and the pain abates. The
adhesive plaster ought then to be substituted in its place.
Laudanum may also be employed with the same intention, but it is
inferior to the other.
Lemon juice is also sometimes useful, and may be employed where the
opiated wine fails, or is not at hand.
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