II. In the second class of sores, or those with weak action, the
granulations are flabby, of a pale colour, and possessed of little
sensibility or vascularity; the discharge is gleety, and the surface is
liable to be destroyed by ulceration or sloughing, upon the slightest
excitement of the circulation in the part. The surrounding integuments
are generally of a bluish colour, in consequence of their separation
from the subjacent parts; and in several places of the neighbourhood,
small, unhealthy, detached abscesses may exist; at some points of the
sore, glairy fluid is seen to ooze out on pressure, and a probe can
be passed pretty deeply into the cavity of an abscess in the soft
parts beneath. These sores may arise from an unhealthy condition of
the cellular tissue, taking place spontaneously, or following slight
injury; they are attributable to the state of the constitution, and
may result from an ulcer, originally of a healthy character, which
has remained long open, in consequence of its great size, or other
impediments to its contraction.
It is the business of the surgeon, in cases of this description, first
to obtain a sound foundation, by destroying the unhealthy skin and
cellular tissue; the free application of caustic potass will answer
this end most readily and effectually. Its application is attended with
considerable pain, but the practice is more successful and less severe
than the removal of the unsound parts by the knife or other means. The
small abscesses may be all freely laid open; the diseased cellular
tissue may be cut into, or cut away; in short, incisions may be made in
all directions, and in every portion of the affected part; but still
it will be found that the granulations, as they appear, become pale
and flabby, that they spring from a loose and powerless base; matter
will again collect; the surrounding skin will again be undermined; no
progress will be made towards soundness. But by attention to the state
of the constitution, and the application of potass, the neighbouring
sound parts have their actions roused, and the healing is carried
on rapidly. After its application, a poultice may be applied for a
few days, and followed by water dressing, and then stimulants, both
internally and externally employed according to circumstances, the
parts being all along well supported. The long continued use of warm
fomentations, or poultices, is prejudicial, as tending to diminish
still farther the action of the parts; ointments can be of little
service, and will generally do harm.
Public-domain text, read in full here on John Shaqi.
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