CHAPTER V. 
ULCERATION. SINUSES AND FISTULA. BURNS AND SCALDS. 
An ulcer is an open sore of some superficial structure, whether 
skin or mucous membrane. 
Causes. — Ordinary pus forming organisms of specific disease, 
neglect of abrasions or wounds, malnutrition. 
An ulcer is brought about in the same manner as an abscess, 
with this difference, that in an abscess the dead material is retained 
in the tissues, whereas in an ulcer dead cells are thrown off almost 
immediately. In the case of a wound which degenerates into an 
ulcer, it should be remembered that the natural tendency of all 
tissues is to heal, but neglect or severe injury to the tissues so 
lessens their vitality as to allow pus-forming organisms to gain the 
upper hand, with the result that the w^ound instead of healing 
becomes an ulcer and tends to enlarge. 
Characters of an ulcer. — Ulcers may be classified into three 
main groups — 
1. Ulcers which are granulating. 
2. Ulcers which are spreading. 
3. Ulcers which are stationary. 
I . Ulcers which are granulating may be quite healthy, in which 
case we find the base of the ulcer covered with an even layer of 
small red uniform granulations with sharp points which do not bleed 
readily if lightly touched, the edges neither everted nor inverted and 
with a glistening mother-of-pearl-like appearance, showing that it is 
commencing to heal over. The discharge is small in amount, 
yellowish in colour, contains little pus and is inodorous. 
Treatment. — Consists chiefly in cleansing the sore by irrigation 
with some such lotion as carbolic acid, phenyle (i — 80), perchlo- 
ride of mercury (i — 2000, i.e.^ grs. v to the pint), potassium per- 
manganate (grs. iv — XX to one pint), thymol (grs. x to one pint). 
It may then be dusted with boracic acid powder, equal parts of 
iodoform, zinc oxide and starch, or equal parts of iodoform and 
starch [see Part III, Formulae 64 to 69). 
A granulating ulcer is said to be w^eak when its base is covered 
with an uneven layer of granulations which are irregular in shape, 
flabby and with more or less rounded points and discharging a thin 
unhealthy-looking pus. 
