VARIETIES AND TREATMENT OF ULCERS. 55 



Bloughing. In some cases many points of "ulceration form in 

 the neighbourhood of each other, the ulceration taking place 

 around several central sloughs ; these by enlargement coalesce, 

 and ultimately form one large ulcer, embracing, as in some 

 cases of " carbuncle of the coronary band," a space of several 

 inches. The treatment of this variety is a matter of great 

 urgency and importance, but not always satisfactory. 



Treatment. — Free scarifications of the part, to relieve con- 

 gestion ; the removal of all sources of irritation, and the appli- 

 cation of emollient and antiseptic poultices or fomentations, 

 constitute the best local treatment. If the ulceration continues 

 to spread, I have seen benefit arise from the gentle application 

 of nitrate of silver to the edges. The constitutional derange- 

 ment must be treated by purgatives, anodynes, or sedatives, 

 succeeded by tonics ; and the diet regulated according to the 

 stage and variety of the accompanying symptoms. 



Specific ulcers will be described with the diseases of which 

 they are symptomatic. 



MORTIFICATION, OR DEATH OF A PART. 



, This is of two kinds, complete and incomplete. In the soft 

 structures, the first is called sphacelus, and the second gangrene ; 

 whilst mortification of the blood is termed necrgemia, and that 

 of the hard structures, as the bones, necrosis. When the dead 

 tissue is visible to the naked eye, it is called a slough ; when it 

 is soft, the process is called sloughing, which means the pro- 

 gressive death of the part as well as the process by which the 

 slough is separated; the same meaning is applied to exfoliation, 

 or the process of separating a sequestrum or dead piece of bone. 

 But so long as the dead particles of tissue ejected in the 

 ulcerative process are in the form of minute particles, visible 

 only with the microscope, the disease is spoken of as ulceration, 

 not mortification or sloughing. 



Degeneration of a part may be distinguished from its death 

 by the fact that the degenerated part never putrifies, and that 

 no process (sloughing) ensues for its separation or isolation, such 

 as can be seen in the case of a dead part. " However degenerate 

 a tissue may be, it either remains in continuity with those 

 around it, or it is absorbed. If the samo tissue were dead. 



