the ulcer is the confequence of fome conftitutional complaint, the complaint must be remedied, before the ulcer can be expected to heal.

In the third chapter, the author defcribes "the Treatment and Cure of Local Wounds, and other recent Accidents on the Legs, without Reft."

"It is well known," he says, "that bandages, with a free exercife and motion of the limb, have long been recommended by fome for the cure of these complaints; others have advised that the limb be kept ftrictly in an horizontal pofition. Either of these methods will anfwer the intention of cure very well. I have reasons, however, for preferring the former method." P. 23.

This mode is not, however, to be adopted, the author says, until the inflammatory fymptoms are fubdued, by rest, abitinence, bleeding, and other evacuants, and by the application of emollient poultices, renewed twice in the day; on which, in this stage of the wound, he places great reliance. When the inflammation is fubdued, the wound is to be dreffed with fome foft ointment (hog's-lard, or fpermaceti ointment, are preferred by Mr. W.) and the dreflings are then to be fecured by proper compreffes and bandages. The manner of applying the dreffings and bandages are particularly and minutely defcribed, as circumftances on which their efficacy peculiarly depends. For thefe, which appear to be judicious, we refer our readers to the work. But although by this management wounds of the lower extremities may ordinarily be expeditiously healed, yet, in certain cafes and conftitutions, even where there is no particular difeafe, the cure will fometimes proceed flowly, and interruptions will occur requiring additional affiftance. In fome cafes it will be neceflary to have recourfe to the bark; in others, where the granulations are luxuriant and unhealthy, efcarotics must be applied. In thefe cafes, the author has found touching the luxuriant fleth with nitrated filver fucceed better than the application of the red nitrated quickfilver, which is more commonly used. When the granulations rife above the furface of the fkin, washing them with a faturated folution of vitriolated copper is useful, applying over the part a pledger covered with hog's-lard, to ease the pain occafioned by the cauftic.

Mr. Wh. next gives directions for regulating the diet. In doing this, regard must be had to the conflitutions of the patients, and to their ordinary habits of living. When phlegmonous inflammation prevails, an abflemious diet, with evacuants, will be proper; but where eryfipelatous inflaınmation attends, particularly in perfons advanced in years, or of debi

litated

litated habits, a more generous diet must be allowed, and recourse must sometimes be had to wine, opium, and bark.

"Such is the great difference of conftitution that exifts,” the author observes, "in different perfons, that the best furgeon may, at the commencement, be fometimes undecided, whether it be most proper to pursue the evacuant, or the fupporting plan. In fuch cafes, it will be of confiderable ufe to attend to the ftate of the pulfe and the skin, and to observe the appearance of the tongue; by the state of which, compared with the afpect of the wound, and the parts around it, we may be much affifted in forming a judgment of the right mode of procedure. The pulfe is generally weaker and quicker, the tongue more furred, dry, and often times browner, and the heat of the skin more moderate, in those cafes where there is a lurking difpofition to eryfipelas and gangrene, than where the phlegmonic diathefis prevails." P. 54.

Chapter the fourth treats of the Cure of Local Ulcers on the Legs, without Reft." In the cure of old ulcers, the applications are required to be more ftimulating than in recent wounds. Mr. W. has found, that a compofition, confifting of ten grains of red nitrated quickfilver, mixed with an ounce of hog's-lard, is better than the strong bafilicons, and fuch compofitions, which oftener retard, he fays, than promote the cure. Ulcers of the legs, of long continuance, frequently prove extremely tedious and difficult of cure, and require a great variety in the treatment. The author defcribes minutely The different appearances fuch ulcers occafionally put on, to each of which he recommends appropriate remedies.

"Local ulcers of the legs, are frequently attended," he obferves, with difeafed affections of the skin, of which there are various kinds." P.81,

These are alfo defcribed. The most powerful applications in combating these affections are, tar ointment, the ointment of nitrated quick filver, and the ftrong quickfilver ointment. The late Rev. Mr. Clare, of Hoxton, ufed the nitrated quickfilver ointment, prepared after a formula of his own, in various inflammatory affections of the eyes, with fingular fuccess. He was used to distribute the ointment gratis, but chofe to conceal the mode of preparing it. He, however, gave the prescription to Mr. W. but with an injunction not to divulge it during his life. It is here publifhed; and as we know it to be a valuable preparation, we thall tranfcribe it,

"Take of fresh butter, eight ounces,

66 Quickfilver, one ounce,

"Aquafortis, one ounce by weight,

66

Camphor, two drams,

"Olive oil, two ounces by measure,

"Diffolve the quickfilver in the aquafortis, diffolve likewife the camphor in the olive oil, and whilft the former is yet hot, mix both of them with the fresh butter, previously melted, but beginning to concrete from being exposed to the air."

In the fifth chapter the author treats" of the Cure of Wounds and Ulcers on the Legs, connected with Diseases of the Conftitution." The moft ufual of these are the venereal, fcrofulous, or fcorbutic difeafes. The treatment must of courfe be varied, and adapted to the nature of the disease, which must be cured before the ulcers can be expected to neal; or rather, as it will ufually happen, the ulcers will heal during the progrefs of the cure of the difeafe, on which it depends.

In the next chapter the author treats of an erysipelatous affection of a peculiar nature, forming a variety, or new species of eryfipelas, as it should feem from his defcription of it, which occafionally appears, and spreads over legs affected with ulcers.

It has a regular courfe, Mr. W. fays, terminating in flight cafes in fix, in thofe that are more violent, in twelve or fourteen days. It begins with coldness and fhivering; these are fucceeded by heat, a quickened pulfe, and other febrile symptoms, which do not fubfide until the inflammation on the skin appears. It is fometimes fo mild, as fcarcely to make it neceffary to confine the patient to the house, at others fo violent, as to put his life into extreme danger. The treatment must be varied according as the fymptoms are more or less threatening and violent. When the inflammation is confiderable, it may be moderated by bleeding and gentle purgatives; but when the difeafe is purely eryfipelatous, attended with debility and difpofition to gangrene, wine, bark, and opium, must be liberally given. Although by these means the disorder may be mitigated, and the threatened danger obviated, yet no mode of treatment will, the author thinks, fhorten its duration. "Like other acute difeafes," he fays, p. 111, "its continuance is limited to a certain period of time, within which it fets all the means of oppofition at defiance.”

Chapter the feventh treats "of Carious Ulcers on the Legs." Carious ulcers, or ulcers of the bones, proceed from the fame caufes as ulcers of the foft parts, and like them are either local, or conftitutional. The treatment of them, recommended by this author, is alfo fimilar. After the inflammatory fymptoms are fubdued, or the conftitutional complaint, on which they may depend, is cured, his principal dependence is on keeping the parts well fupported by compreffes and rollers, and on ufing a proper portion of exercife. Thefe, he thinks, contribute

very much to forward the exfoliation of the difeafed bone, the only, or at the least, the most material circumftance, diftinguishing a caries of the bones from ulcers of the foft parts.

"Exfoliation," he fays, " is greatly promoted by preffure, and the free exercise of the limb. Thefe fhould therefore be used, when they are not interdicted by particular circumstances; for however strange it may appear to fome, there are no means more ferviceable than thefe,, in affifting nature to get rid of an unfound part of a bone. In common ulcers of the legs, it is not poffible to bring on a good state of granulation and digeftion, nor effectually to remove the floughs and foulnesses to which many of them are liable, unless either the erect pofition of the body be forbidden, or its effects be obviated by preffure, It is exactly the fame in carious ulcers of thefe parts; from the judicious application of preffure, the powers of nature will derive confiderable affiftance, and if any difeafed or dead parts of a bone are to be exfoliated, this defirable effect will be thereby greatly expedited. But if this treatment be neglected, and the inflammation, and action of the veffels, arifing from the erect pofition of the body, be permitted to continue, the feparation of the affected bones will confequently be delayed.

In conformity to thefe ideas, I have in no cafe whatever made ufe of any other artificial means but thofe abovementioned, in order to promote an exfoliation. We may bore and mangle a diseased bone, or puncture and tear up a flough on the foft parts, but after all, the procefs of feparation in both cafes, is altogether the work of nature; and if art attempt to force the effect by fuch harsh means, more harm than good may be the refult; the gradual operations of nature may be interrupted, and the intended effect retarded, by violent treatment.” P. 133.

Chapter the eighth treats" of the Safety or Danger of curing Ulcers on the Legs." An opinion, the author fays, prevails, that it is often dangerous to heal an old ulcer. The conftitution, accustomed to an outlet or drain for fome morbid humour, would be oppreffed, it has been thought, and injured, fhould the difcharge be stopped. But as ulcers of the legs are ufually attended with pain, and prevent the perfons afflicted with them, from taking a due portion of exercise, or of enjoying natural and undisturbed fleep, they are almost always prejudicial to health, which is ufually found to be much improved by healing them. When, however, any of the vifcera are difeased, they are either not to be healed, or if healed, their place must be supplied by iffues.

The ninth chapter contains " a Comparison of the different Methods of curing Wounds and Ulcers on the Legs, namely, with or without Reft." As the arguments here used, may be collected from what has been before faid on the advantages of exercife, affifted by preffure, in the cure of ulcers on the legs, we shall pass them, and proceed to chapter the tenth, and last,

which treats of the Method of preventing Relapfes after the Cure of Ulcers of the Legs." As the new fkin is more valcular and tender than the old, and is confequently lefs able to refift or fupport the preffure of the circulating fluids, it will be neceffary, Mr. W. obferves, to continue the ufe of the bandage for fome time after the ulcer is healed. The time cannot be precifely fixed; that muft depend on the conftitution of the patient, or on the length of time the ulcer had exifted. Perhaps, as long as there is a difpofition in the limb to fwell or enlarge towards the evening. In fome cafes, after curing ulcers of very long standing, it may be neceffary, he fays, that the patient continue to wear a bandage during the remainder of his life. To illuftrate his doctrine, the author relates the cafes of 167 patients who were cured of ulcers of the legs, by the method he has defcribed, and of nine cafes of carious ulcers.

"I with it," he fays, in conclufion, "to be particularly obferved, that all the patients whofe cafes are here related, were permitted during the whole time of their cure, to walk about, and to follow their refpective callings; not excepting even thofe of the moft laborious kind. To have mentioned this and other circumftances in every cafe, would have fwelled the work to an unnecessary fize; a fault which I have endeavoured to avoid, by drawing up the cafes as concifely as poffible. It may likewife not be improper to remark," he adds, "that about rza of the patients are now living, and perfectly well. About twenty of the remaining number are dead; and twenty-feven are removed to fresh places of abode,"

The manner in which the cafes are related, leaves no doubt of their authenticity, and we cannot help regarding them as honourable teftimonies of the author's merit, in reviving an improvement in the treatment of ulcers of the legs; the fimplicity and greater fecurity of Mr. Baynton's method of apply ing preffure, muft however give it a preference in general practice. The volume, we might add, is elegantly printed, on a fine wove paper, and decorated with a neat coloured engraving, delineating portions of difeafed bones, which the author had extracted from the legs of fome of the patients, whose cafes are here detailed. We mention not, however, this circumftance of the elegance of the volume as a recommendation, on the contrary, we think it detracts fomewhat from its utility; as all practical works fhould be printed in fuch a form as to be acceffible to every member of the profeflion, for which they are published. We must not omit to inform our readers, that the profits of this publication are humanely dedicated by the author to the improvement of the fund of the fociety, for the relief of the widows and orphans of medical men in London and its vicinity.

ART,