22 



SURGERY. 



membrane. The surrounding integument is swollen, hard, and ofa 

 dusky red colour. 



It has little sensibility, and the patient is apt to let it go unnoticed, 

 unless by accident, exposure, or over-exertion, it inflames and be- 

 comes painful. 



Treatment. — At first a poultice will be serviceable by cleansing 

 the sore and diminishing the inflammation and pain which usually 

 precedes the application for relief, which a purge and rest will assist 

 in producing. The surface should be lightly touched with nitrate of 

 silver or nitric acid, in order that healthy granulations should sprout ; 

 or, pressure may be employed to produce the same effect by means 

 of strips of adhesive plaster and bandages. Small doses of opium 

 are also useful in maintaining the capillary circulation. 



Irritable Ulcer. — This has been defined as possessing an ex- 

 cess of organizing action, with a deficiency of organizable material. 

 It is superficial, having an unequal surface of a dark hue, and often 

 covered with tenacious fibrin. It occurs most frequently near the 

 ankle. The edges are thin, serrated, and everted. The discharge 

 is thin, acrid, and bloody. It is very sensitive, attended with great 

 pain, and produces often peevishness of disposition. 



Treatment. — Rest, elevation, and relaxation of the part. Nitrate 

 of silver produces a sedative and antiphlogistic effect. This should 

 be followed by a light poultice, or warm- water dressing, or, if there 

 is great pain, fomentations of the infusion of opium, conium, or 

 belladonna. 



Phagedenic Ulcer. — This is of an irregular form, with ragged, 

 abrupt edges, and uneven brown surface, looking as if gnawed by 

 the teeth of an animal. It is- attended with burning pain, and great 

 constitutional disturbance. 



It frequently assumes a sloughing form, as in hospital gangrene, 

 and cancrum oris, where the discharge is extremely fetid. 



Treatment. — Should be both constitutional and local. Fresh air 

 and good diet are all-important ; the secretions must be corrected 

 and a Dover's powder given at night. Locally, there should be ap- 

 plied active escharotics, such as nitric acid, nitrate of mercury, &c., 

 followed by warm poultices ; these may be superseded by warm so- 

 lutions of the chloride of lime or soda. Mercury must never be 

 given, especially in cases of a venereal taint. 



Varicose Ulcer. — This is dependent upon a varicose condition 

 of the veins, and usually occurs in the leg, just above the ankle. 

 They are oval and superficial, and attended with deep-seated, aching 

 pain. They are indolent, and usually moist upon the surface. 



Treatment, — The cure must depend upon removing the disease of 

 the veins. Great relief will be found in the constant use of cold 

 water, rest, regular bandaging, or laced stockings. 



Certain ulcers are not to he healed, for example, when an ulcer 



