On the Cure of Ulcerated Legs

  1[Johnston] with New Observations and Improvements        London Printed for F. Newbury-- 1771Mr. Rowly in an Essay on the Cure of Ulcerated Legs
without rest- says the Medicine which I most
depend on in the Cure in Nitre, which I commonly
order in large doses and in a dissolved state, joined
with the spirit Sal: Ammonia or Camphor
which will prevent its having those ill effects on
the stomach, most frequently complained of.  2Formula Rx [untranscribed Latin]

I most commonly begin with one scruple, and
according to the constitution of the patient and
circumstances of the case increase the dose to one
dram & a half, which I order to be taken three or
four times a day, dissolved in any convenient liquor
with the addition of twenty or thirty drops of Spt 
Sal: Ammoniac or with some of the Julepium e Camphor;
which last I prefer to the volatile spirit in cases
which are violently inflammatory.
The Laxative which I order for the irregular Patients
is composed of about one fourth of Put[s]: Jalap to three
fourths of powder’d Nitre, which may be given from
[di] to [Zr] and at the same time the Nitrous draught
must not be omitted--
These remedies most commonly occasion very great pain
all round the Ulcers, when they are first taken, but
the pain gradually decreases as the Ulcers advance in
their Cure; and they promote in general, a most
copious Urinary discharge.

I shall not give any description of dressing, as it
will be unnecessary--
In some particular cases when the patient has been
of a robust Constitution or in very foul Ulcers, which
have a foetid discharge, I have succeeded by giving
the Calomel from three to give grains every Night; and
every third morn’g a gentle Cathartic; at the same
times I have fumigated the Ulcer with Cinnabar
& Ethiops Mecurial eaqual parts--
He disapproves of Issues, Rest & Horizontal Position
of the limb in the Cure of Ulcers: -- and goes on to say
the Ulcers which I propose curing by Nitre, or
the Phagadenic, all old callous Ulcers, and every
Ulcer attended with inflammation-- He gives
upwards of thirty cases to illustrate his
practice and concludes with some General
Observations, the only case in which he forbids
exercise in the cure when an Ulcer happens
to be on any part of the Gastrocnemius Muscle 
or on the upper part of the Tendo Achilli: for the
pressure and Action of these Muscles will infallibly
prevent the incarnation of the Wound in common
and a Cicatrization can scarse ever be obtained without
rest --. 

Mr. Bell divides Ulcers into two general classes
in the first he comprehends all such as are
merely local, and that do not depend upon
any disorder of the system.
In the second class are included all such
ulcers as are the consequence of, or that
are connected with, any disorder of the
constitution. ~
Under the first division of Ulcers, are considered
the following different species~

1. The simple purulent Ulcer
2. The simple vitiated Ulcer
3. The fungous Ulcer
4. The sinonous Ulcer
5. The callous ulcer
6. The carious ulcer
7. The cancerous ulcer; and
8. The cutaneous ulcer

In the second class of Ulcers, are included all such
sores as are the consequence of, or that are
connected with, any disorder of the system.

The different species of which are

1. The venerial ulcer
2. The scorbutic ulcer; and
3. The Scrophulous ulcer

Mr. Bell concludes his Treatise upon Ulcers with
the following General Coorollaries.

1. It appears, that except in a few instances,

 [Vizt in Sues] Veneria, Scrophula, and Scurvy,
that Ulcers are always to be considered merely
as local affections.
2. That, excepting in on or other of the above
 mentioned disorders, the varieties in the
 matters discharged by Ulcers depend always
 on some particular affection of the Solids in
 the part diseased and not on any morbid state
 of the blood or other fluids. ~
3. That Ulcers appear to be useful or otherwise
to the Constitution, not by the quality quality
of matter afforded, but by the quantity;
and accordingly, that the cure of even the
oldest sore is render’d perfectly safe by the
introduction and preservation of such

of such an issue as will yield the same
quantity of fluids the system has by
means of the Ulcer, been accustomed to
throw off. ~
4. That in the cure of Ulcers, the first
circumstance to be determined, is, whe-
-ther they are to be considered as general
or topical complaints. If they appear
to be of the former kind such remedies must
be administered as are known to be most
effectual for the correction of the disease
they happen to be connected with: in
other respects the treatment of such
sores is nearly the same with those
originally of an unmixed simple nat-
-ure. ~
5. That in the topical treatment of
ulcers of every kind, the principal
object to be had in view, is, to reduce them
as nearly as possible to the state of
simple purulent sores; for which purp-
-ose the different remedies have been
pointed out in the several proceeding
sections.

6. That Ulcers being once reduced to this
simple state above mentioned, their
farther treatment, in general, becomes
a very easy matter; the cure being there
to be entirely affected by a propper
attention to three following circums-
-tances ~

  3The remaining text is partly obscured by an unrelated newspaper clipping.1. To, the introduction of an issue, as was lately
[...] of such a size as may carry off nearly
[...] quantity of fluids the system has
[...] of the sore been accustomed to get
[...] ~

[...] the preservation of the matter discharged,
[...] purulent form, the several means
[...] which have been already fully point-
-ed out; but the principal of these, it may
be remarked, are, the avoiding every kind of
irritations, by using the [the mildest] dressings
only: and preserving in the parts affected,
a proper degree of heat ~
_
[3] To the application of gentle compression,
not only upon the ulcer itself, but on the
neighbouring sound parts also: This, in the
cure of every sore, has been shown to be a
very material piece of practice. ~