ULCERS 427 



Weak Ulcers. " The simple ulcer or the healing sore is very apt to 

 become a weak ulcer as the result of defective blood-supply, either from 

 too small a quantity of blood being sent to the part, as in cases where 

 the vessels are diseased, or from deficient quality of blood, for example, 

 during the progress of some constitutional disease. In this form of ulcer 

 the granulations become smooth and somewhat yellowish, the secretion 

 thin and small in amount, and very apt to scab, and the edges pale and 

 flat. In other cases of weak ulcer the granulations become cedematous, 

 and this is more especially the case where there is some general cause 

 of oedema or some local interference with the circulation, such as com- 

 pression of veins from the contraction of the sore, &c. Or again, we 

 have another form of weak ulcer, where the granulations show excessive 

 growth. This is chiefly the case where the ulceration is due to inability 

 of the sore to contract. In such cases the granulations become promi- 

 nent, vascular, soft, and bleed readily, and we have the condition which is 

 popularly spoken of as ' proud flesh '. 



" These simple ulcers again may become attacked with some septic 

 virus which leads to what is called the phagedsenic ulcer. In the latter 

 case the ulcer becomes covered with grayish pulpy material, which rapidly 

 infiltrates the surrounding skin and cellular tissue, and extends both super- 

 ficially and deeply at the bottom of the sore, leading to extensive and very 

 rapid destruction of the part, and not uncommonly to the death of the 

 patient. "--Watson Cheyne. 



Treatment. In the treatment of ulcers, as in the treatment of 

 wounds, it is desirable to remove all causes of irritation, and especially 

 the septic discharge with which they are usually covered. In this 

 connection the antiseptic method applied to wounds must be resorted 

 to here. The hair must be removed from around the ulcer, and the skin 

 cleansed and rendered aseptic. The ulcer must then be disinfected. 

 This may be accomplished either by the application of a solution of 

 chloride of zinc (40 grains to the ounce), or by touching the surface with 

 nitrate of silver, or by scraping away the septic granulations and sub- 

 sequently applying undiluted carbolic acid. Following this, the wound 

 should be dressed every day with boracic-acid ointment, half 'strength, and 

 covered with three or four layers of boracic-acid lint. In some cases of 

 callous ulcer, gentle pressure will be found of service where bandages 

 can be applied, or a mild blister to the edges of the wound may hasten 

 the healing process. In long-standing cases, the actual cautery may be 

 lightly applied to the surface of the sore with good result, followed by the 

 application of boric-acid dressings. 



Specific Infective Ulcers are the result of the action of pathogenic 



