ON A NEW METHOD OF TREATING ULCERS

P COWEN
1872 The Lancet  
705 substance of the soft tissues by a process of boring. As observed in the present example, it had clearly perforated the mucous coat and had become encapsulated in the submucous tissue. As before stated, the body of the animal was remarkably soft as compared with the tough chitinous capsule. Remarks.-There can be little doubt as to the real position of this parasite amongst the Acanthocephala, being neither provided with mouth nor intestines, but obtaining its nutriment by a vicarious
more » ... a vicarious process of imbibition through the general surface of the body, and having a retractile proboscis, often termed the head, armed with a variable number of recurved hooks. The absence of distinct segmentation in the elongated body is favourable to the view that the sexes in this form are separate, and both characters would sufficiently distinguish it from the cestoid worms. Moreover, no sucker discs were perceptible, and the character and arrangement of the hooklets, though seen under considerable pressure, unequivocally shadowed forth a species of Echinorhynchus, for the'first time discovered as a representative of the Acanthocephala in the human body. The Echinorhynchi are found frequently enough in birds, and in fishes both marine and fresh-water, but always occupying the interior of the intestine anchored to the mucous membrane. This remark, however, might apply more particularly to their mature state, for Flaviceps and other genera with a very much more complex arrangement of booklets occur encysted in the loose cellular tissue after the manner in which the little subject of this paper originally presented itself. The example above described is brought forward rather with the intention of notifying the possibility of the presence of the animal in the human frame than with the idea of connecting it with any pathological condition. This latter must be worked out in the future. ON A SUCCESSFUL as many of the various plans of treatment of ulcer are, still too often they are very tedious in operation, very often the result is not at all commensurate with the care bestowed, and not unfrequently the ulcer will not heal at all. Rest in bed, various lotions and ointments, support by strapping and bandages, cold poultices, side incisions, blisters, irritants or caustics, internal remedies, all occasionally succeed (I speak of the worst forms of ulcer, many having existed for years), but too often the case becomes alike wearying to the surgeon and to the patient. It occurred to me on reflection, that, from whatever cause arising, whether constitutional or local, an ulcer could be considered as a local asthenia of skin and parts beneatha local weakness and loss of plasticity, a brittleness where softness, elasticity, ftnd pliancy, yet strength should exist, a local tendency to degeneration and death. Whether the cause was from venous varicosity, or blood-pressure from other causes, as indolence, or disease of the liver or heart, or from general decay of the tissues from intemperance or other enfeebling vices, or from senile decay, or want of food, or general feeble constitution, or from scrofula or syphilis; from any of these causes the ultimate result is, in an ulcer, the weakening and giving way of structures whose normal condition is to act as covering and protecting sheaths. In several of these cases the skin is specially weakened, in others gives way through pressure ; and in all cases the skin of the legs, from its depending, weight-bearing position, suffers the most. Knowing, as we do, that an ulcer has power of absorbing matters applied to its surface'(anyone can try the experiment with blackwash to a moderately sized ulcer for a few days, when mercurial salivation will begin), it occurred to me to avail myself of so excellent a property by applying locally matters having nutritive powers, so that the skin might be nourished locally at the weakened and degenerate spots, to enable the skin to take up such materials as would nourish its weakness and convert its brittle state into a plastic and healing one. The natural secretion of an ulcer, the so-called laudable pus, may it not be a nourishing juice specially thrown out to feed the young growing granulations ? If so, can we not add to this by artificial manuring ? P Such is the theory; and beg to record what has been the result of the practice. To carry it out I made the following mixture of glutinous ingredients:—Flour, four ounces; powder of acacia, one ounce ; powder of tragacanth, half an ounce; one egg; chalk, two drachms; cold water, one pint. These were all mixed together, and placed on the fire in a saucepan. Just as it began to boil, or after boiling a minute, it was removed, and allowed to cool. If found too thick, it was made thinner by adding a little boiling water, and stirring, so that it was of the thickness of ordinary paste; thin enough to be spread over the ulcer by means of a little brush, yet so thick that it will remain on the ulcer. Probably such a mixture is not necessary; either the nourpaste alone, or the acacia, might be sufficient; but I prefer it as it stands. The patient, provided with a pot and brush, thickly paints the ulcer all over three or four times daily, and covers the ulcer with a thin piece of soft rag. No other treatment nor washing is had recourse to, except to remove the rag. To keep the materials sweet, only sufficient is poured into the patient's pot for the day (pot and brush washed daily). The flour, acacia, tragacanth, and the egg, supply the ulcer with all the necessary materials for its repair; the chalk has a further good effect, by supplying lime. Now as to the results. During the six weeks I have tried the remedy, eighteen cases have been so treated-in fact, almost all the cases of ulcer we have had. G. G-, aged fifty-seven; a drinker. Admitted August 13th. Leg ulcer, three months, nearly size of palm of hand. No previous treatment. Applied the paste directly he was admitted. All healed in three weeks. W. Wiz, aged fifty-seven; degenerate body. Two small ulcers, one on each malleolus ; eight months; nothing would heal them. Paste applied; rest in bed. Healed in three weeks. S. C-, aged fifty-nine; general debility. Leg ulcer four inches by two, irritable, and spreading. Admitted August 8th. Had ulcer six weeks. Healed in six weeks.. J. T-, aged seventy-three ; decay. Had ulcer, more or less, twenty years; this time open two years. A large ulcer, eight inclies by six, covering front of leg. Healed in six weeks, all but a square inch, which will soon be also well. J. G-, aged fifty-three; a degenerate. drunkard. Leg ulcer eight years; this time open eight months. Healed in five weeks. R. L——, aged thirty-eight. A generally perforated condition of skin of leg; debility and syphilis five years; open this time six months. Healed in six weeks; paste locally, iodide of potassium internally. J. K-, aged eighty; senile decay. Large ulcer of leg two years. Half healed in six weeks. (I am not inclined to heal further on account of his age.) W. B-, aged thirty-seven. Ulcer of leg two years ; circumference nine inches. Rapidly healing in four weeks. W. B-, aged thirty-eight. Severe ulcer on leg two * years; unhealthy skin. Ulcer hpaling rapidly in six weeks. M. H-, aged sixty-three. Very large ulcer; leg much swollen; three years. An inch of cicatrix all round in a week. J. W-, aged fifty-eight. Ulcer of leg three years, Rapidly healing in a fortnight. R. B-, aged fifty-five. Very large deeply excavated ulcer; open eight years. Transplantation tried and failed. In a month granulations gained surface, and ulcer filled up; the skin process is beginning. -
doi:10.1016/s0140-6736(02)55775-5 fatcat:rofpdtjd3bgdphfizglooigbhy