Imagens das páginas
PDF
ePub

iritis, being equally subservient to its duly appreciated powers. Having now completed the description and treatment of the superficial primary ulcer, and its usual constitutional effects, (illustrations of which are so frequently presented to the notice of the surgeon, as to render the details of cases superfluous,) I pass on to the consideration of the second class of primary sore, of which, with its ordinary consecutive sequelæ, I propose to treat.

CHAPTER X.

SECOND CLASS.

2. Primary ulcer, distinguished by elevated margins, centre slightly excavated, and even without granulations. This species of sore is perhaps the rarest form of ulcer encountered as a primary affection. I have met with but three or four instances which might strictly be classed under this head. In its origin it is similar to that last described, but differs from it in not presenting its diagnostic characters, until the second or third week from the date of its advent. If we examine it at this period, we will find that its edges are raised above the surrounding surface; that they are destitute of induration, and evince no disposition to assume a fungoid appearance; that its centre is smooth, and on a plane a little inferior to the cutaneous margin that encircles it.

Treatment.-As in the preceding variety, the free application of the nitrate of silver, or the acid nitrate of mercury, should at once be resorted to; after which, water dressing should be employed in

promoting the healing process. The more frequent use of escharotics is calculated to excite an irritative action in the part. Mercury, when given for the cure of this affection, is generally productive of injurious results; instead of hastening the normal process of cicatrization, under its influence the edges have become undermined, and the healthy action of the sore has either been arrested altogether, or materially retarded.

The constitutional affections which usually succeed to this description of primary ulcer are,

1. Increased vascularity, with a dry and granular appearance of throat.-About five or six weeks subsequent to infection, the patient complains of a soreness and dryness in the throat, which is peculiarly distressing in the morning; a sensation of roughness is experienced at the back of the pharynx, and he is constantly swallowing saliva, with a view to the moistening of the parts; deglutition is performed with much difficulty, during the process of which he is frequently sipping some fluid which he manages to have within his reach. This affection is sometimes preceded by fever, but more usually a mere sense of lassitude and depression are its only precursors. Upon examination, the posterior part of the pharynx presents a dry and granulated aspect, occasionally accompanied by a superficial apthous ulceration. This latter symptom is observed to engage the mucous membrane only, and never involves the subjacent tissues.

Treatment. The local application of nitrate of silver or the acid nitrate of mercury, conjoined with the internal administration of the iodide of potassium, seldom fails in effecting a cure. After one or two applications of the caustic, gargles of chloride of lime, or muriatic acid, will be found sufficiently stimulating in contributing to restore the diseased parts to their healthy tone and action. From the tendency which mercury has been known to evince, in this affection of the throat, by causing deep-seated ulcerations at the back of the pharynx, its employment would seem to me to be altogether contraindicated. The next form of constitutional taint, and which frequently coexists with the foregoing, is,

2. A pustular eruption. This species of eruption, like that last described, is usually ushered in by much constitutional disturbance; but, like the primary ulcer, upon which it most commonly results, is far less frequent in its occurrence than the papular variety. It presents in the shape of minute red pimples, on the apices of which pus is quickly generated, discernible first on the trunk and then on the extremities. One or two spots are generally seated on the eye-brows, and at a later period the scalp is extensively engaged. These spots are caused by a circumscribed inflammatory condition of the skin, terminating in the effusion of purulent matter beneath the cuticle; in consequence of which, the epidermis exhibits a raised

or elevated appearance. They are situated for the most part upon a hard red or brown base; and on the rupture of the pustule, a thick hard crust, created by inspissation of the purulent matter, covers the ulcer. When these incrustations fall off, superficial sores, thinly coated with a sanious pus, possessing an offensive odour, through which a granulating surface is perceptible, come into view. The pustules forming this species of eruption are distinctly divisible into two separate groups; the first, constituting the psydracia of Willan, or the miliary syphilitic pustule of Alibert, are small, thickly scattered, arranged in clusters, and show a disposition to become confluent. When they heal, a slight depression of the cuticle, surrounded by a bright red areola, denotes the point of cicatrization. The second, the phlyzacia, are composed of isolated spots, distinct in themselves, and never running one into the other. They are more inclined to spread than the former variety, and exhibit less of a healthy aspect.

Treatment. During the first stages of the disease, and when much febrile excitement is present, antiphlogistic measures must be put in force, and a low form of dietary adhered to. The exhibition of opium and the use of the warm-bath are highly advantageous in allaying the constitutional irritability, which is almost a universal concomitant symptom, both in the earlier and in the later periods of the eruption. When the pain and irritation have

« AnteriorContinuar »