ULCERS. 21 



tions are small, pointed, florid, sensitive, and vascular. When they 

 reach the level of the skin, cicatrization commences. The edge 

 swells a little, and then is covered with a white pellicle of lymph, 

 which is converted into cuticle. 



Treatment. — -The plan of the treatment is simply protective. Pus 

 is the natural protection to these granulations ; if, however, it collects, 

 it becomes a source of injury, increasing ulceration. The air acts 

 as a stimulus, and may cause too great inflammation. Hence the 

 propriety of dressing. It should be lint dipped in tepid water or 

 some simple cerate ; water dressings are now preferred. The dress- 

 ing should only be removed for the sake of cleanliness and removing 

 the fluid pus ; but care should be taken not to wash the surface too 

 freely, else the progress of cicatrization is delayed by the removal 

 of lymph which may be mistaken for pus. 



Weak TJlcer. — If the granulations are too luxuriant, becoming 

 pale and flabby and long, they should be treated by an astringent 

 wash, such as a solution of sulphate of zinc or copper ; or they may 

 require an escharotic, such as solid sulphate of copper or nitrate of 

 silver ; or a scab may be formed by exposure to the air, or spreading 

 fine lint upon the surface ; at the same time a generous diet will be 

 beneficial. 



Scrofulous Ulcers. — These occur, in debilitated constitutions, 

 and usually in clusters ; most frequently upon the neck and joints. 

 They originate in the cellular tissue, beneath the skin. At first, 

 there is hardening, without pain, then swelling, followed by imper- 

 fect and slow suppuration ; the skin becomes blue and thin, and the 

 aperture for the discharge has ragged edges, revealing a dirty gray 

 surface, with no granulations ; the integument is soon undermined, and 

 the ulcers communicate. The pain is slight, and the discharge is thin 

 and serous. The system sympathises and the result may be hectic. 



Treatment. — Constitutional remedies should be steadily perse- 

 vered in. Active measures must be taken to get rid of the soft infil- 

 trated tissue surrounding, by escharotics ; caustic potash must first 

 be freely applied, and then a poultice ; upon its removal a slough 

 will be found to have separated, and the surface to be firm and vas- 

 cular, covered with healthy granulations. The sore may then be 

 treated as a healthy one, unless a relapse occur, when the applica- 

 tion should be repeated. The constitution must be sustained, and 

 the cicatrix supported by a bandage ; otherwise it may ulcerate, es- 

 pecially if it is blue, soft, spongy, and elevated. 



Indolent Ulcer. — This is the most common of all ulcers, and 

 occurs most frequently in the lower extremity and in old persons. It 

 is owing frequently to a healthy sore having been neglected or badly 

 treated. Its surface is smooth, glassy, concave, and pale. The 

 discharge is thin and serous. Its margin is elevated, round, white, 

 and callous, resembling a cartilaginous ring surrounding a mucous 



