Scorbutic ulcer is now rarely met with; it begins with lassitude, indigestion, bleeding of the gums on the least touch, and roughness of the skin resembling that of the goose. The muscles become rigid, the gums spongy, effusions of blood take place in dif ferent parts of the body, frequently under the skin in the form of large livid blotches like ecchymosis, and generally on the lower extremities; and the slightest bruise produces a tumour containing effused blood, which is very liable to ulcerate. The legs become oedematous, the face presents a livid bloated appearance; he is early attacked with diarrhoea, which is often accompanied with blood, hemorrhage being either spontaneous or arising from the most trifling injury. The least degree of exertion produces laborious breathing, and any attempt to raise himself to the erect posture is liable to produce fainting and even death. If the individual has been formerly affected with ulcers. these break out again, and if he has had a fractured bone, the union dissolves and the ends separate. Ulcers also occur spontaneously, and one and all are characterized by livid edges, which are puffed up by luxuriant fleshy excrescences under the skin, by want of granulations, the flesh at the bottom of the ulcer presenting a dark grumous appearance, soft and spongy, and generally covered with cakes of coagulated blood, which adhere so closely as to be with difficulty wiped off. The discharge is thin, fetid, and mingled with blood. As the ulcer ad vances, a soft bloody fungus shoots forth, which acquires in twelve hours an enormous size, and even when removed with the knife, is as quickly re generated. This was compared to the liver of the bullock by the sailors of Anson and Cook. Scurvy is produced by living solely on animal diet.
The treatment of this disease consists in the in ternal use of fresh fruits and vegetables, particularly of such fruits as have the citric acid, and those vegetables which are acid and succulent, as in the class Tetradynamia; also the alliaceous plants in the class Hexandria. Porter and spruce beer are bene ficial remedies. The patient should be in a large well-aired apartment, and have plenty of fresh air, remain constantly in the horizontal attitude, taking his food out of a cream-jug or tee-pot, and using a bed-pan and urinal, when the calls of nature occur. The ulcer is to be treated with lime or lemon-juice and gentle bandaging, but the chief object is to change this peculiar diathesis to one of health, and then the ulcer soon heals, and even disunited bones are again consolidated.
When the syphilitic ulcer has been imprudently treated with mercury, without science or system, it inflames, becomes irritable and phagedenic, and is then named the mercurial ulcer; it has irregular hard edges, a deep sloughing base, a dark coloured inflammation around; is apparently healing in one part having a delicate pellicle, while it is increasing rapidity in another. Its treatment consists in ap plying to the ulcer opiate fomentations and poul tices, giving up the mercury; in abstracting blood from the system if it can bear it, giving large doses of the sulphate of magnesia, small doses of sulphur, frequently repeated, the use of the warm bath, and avoiding every exertion.
The other ulcers, the syphilitic, scrofulous, Ecc.
are treated of, under the diseases to which they belong, and for which the reader is referred to the Article MEDICINE.
Chilblains is that kind of phlegmonous inflam mation which attacks the fingers, toes, and heels, and occasionally the nose, lips, and ears in cold weather, particularly of those leading a sedentary life, and women more frequently than men, and children oftener than adults. The parts affected are swollen, of a purple colour, hot and painful, and not unfrequently suppurate, and even mortify. Small serous vesicles often appear, which burst, and become fretful, troublesome ulcers. These oc casionally penetrate to the bone, and discharge a thin ichorous or sanious matter, producing caries, which ultimately requires amputation of the limb. These ulcers are sometimes covered with sloughs, or the inflamed part at once ends in gangrene, and then sloughs. Chilblains should be treated, in the inflammatory stage, like phlegmon; during the suppurative, as acute abscess; and while in the ul cerative stage, the same as the irritable, simple, or callous ulcer, according to appearances; and when gangrene occurs, the same treatment as that de tailed under mortification should be adopted; and if caries supervenes, the same remedies employed as recommended under that disease of the bones. When chilblains have been cured, the parts should be rubbed with rubefacients, kept warm, and in as frequent motion as possible, as they are very liable to recur. In surgical works, the most hetero geneous medley of remedies is given.
Furunculus or boil, a species of phlegmon, is an exceedingly hot and painful inflammatory tumour, about the size of a pigeon's egg, circumscribed, hard, prominent, of a purple colour, and of a coni cal shape. A white or occasionally livid pustule soon forms on its apex, but the tumour suppurates slowly, secreting only a small quantity of matter mixed with blood; the greater proportion of it be coming gangrenous, and forming a firm slough or core, as it is named in common language, which is dead cellular substance. If left to itself, this tu mour is very slow of bursting and discharging the slough, and there remains a deep cavity, with a circumscribed hard base, which continues to dis charge the same bloody matter, and is very long of healing. When there are two or more boils at once, which is no uncommon occurrence, there is more or less symptomatic fever; and they also fre quently occur in succession. They generally take place in loose cellular tissue, as that on the nates and back part of the thighs, occurring commonly about puberty, and in the spring, apparently from the excitement given to the constitution at this pe riod of the year, and when the system is undergo ing those changes peculiar to that time of life The treatment of this tumour, during its inflamma tory stage, is the same as that for phlegmon, and when suppuration has taken place, by a crucial in cision. The treatment for the ulcerative stage, is the same as that recommended for ulcers, whether of the irritable, simple, or callous types. The slough is very tardy in being thrown off, and re quires hot dressings. To prevent the recurrence of boils, the diet should be mild and nutritive, the bowels attended to, and the patient take plenty of ex ercise in the open air.