ULCERS (derived from the Latin uleus, a wound) may be arranged either according to the constitutional or specific disease from which they are derived, or according to the characters which they present. According to the first system, we speak of ulcers as healthy, inflammatory, strumous, etc.; while, according to the second, they are named irritable, chronic, sloughing, etc. In this article, we shall adopt the former of these arrangements, as being, upon the whole, the most satisfactory, although each possesses its own advantages.
A common, simple or healthy ulcer is such as is left after the separation of an accidental slough in a healthy person, and is merely a healthy granulatiug surface, tending to Cie* triZati011. Its edges shelve gently down to the base, and are scarcely harder than the adjacent healthy skin. Their surface near the border is of a purplish blue tint where the young epidermis modifies the color of the healing granulations; and within this, the granulations have a deeper hue than those at the center, being most vascular where the cuticle is being chiefly developed. The discharge from such an ulcer is healthy or " laud able " pus. The only treatment required is a little dry lint, if there is much discharge: or the water-dressing, if the sore is comparatively dry. When the !granulations are too luxuriant, they must be touched with nitrate of silver, and dressed with dry lint. Inflammatory ulcers differ less than most kinds from the above-described common or healthy ulcers. They commonly arise from some trifling injury, such as a blow or slight abrasion of the skin, which, to a healthy person, would have done no harm. Their most common seat is ou the lower half of the leg or shin. The surface is red, and bleeds eas ily; the discharge is thin and watery•, the edges irregular or shreddy; and the sur rounding skin shows a red tinge, and is the seat of a hot and aching sensation. This ulcer most commonly occurs in the infirm and old, the ill-fed and overworked. Hence constitutional treatment, good diet, and complete rest (with elevation of the limb) are here demanded, in addition to water•dressing or lead-lotion applied warm. Senile ulcers usually present very little discharge, exhibit granulations of a rusty red tint, and are surrounded by a dusky red area. Nourishing food, wine, bark and the mineral acids are here required, and opium in small repeated doses is often ser viceable. The local treatment must be of a stimulating nature; and in bad cases sir J. Paget recommends strapping the leg daily with a mixture of resin ointment and Peruvian balsam spread on strips of lint. Strumous or scrofulous 'ulcers usually mem as the consequence of scrofulous inflammation in the subcutaneous tissue or lymphatis glands. They most commonly occur in the neck, groins, cheeks, scalp, and the neighborhood of the larger joints. The discharge is thin, and of a greenish-yellow tint. These ulcers are seldom very sensitive or painful. The general treatment must be that i recommended for constitutional scrofula (q.v.). Iodine, some form or other, is the best local application. A poultice of bruised and warmed sea-weed is a very populai remedy; but there is probably nothing so efficacious as tincture of iodine diluted with water till it causes only a slight discomfort, and applied three or four times a day.
(About 30 drops of the tincture may be added to an ounce of water to begin with.) Of the numerous other species distinguished by sir J. Paget, we shall briefly *etiee the ,aricose, indolent, and sloughing ulcer. Varicose ulcers are connected with an enlarged or varicose stale of the veins of the lower extremity, which weakens the parts, and renders them especially liable to ulceration. See VARICOSE VErics. The chrome, indolent, or callous 'ulcer, beyond all doubt, gives more trouble to the poor-law medical officer and the workhouse surgeon than any other half-dozen surgical affections. It is usually seated in the lower half of the leg, and is most commonly of an oval form, with its long axis parallel to that of the leg. "Its base lies deep, and is flat, pale, or tawny and dusky, with very minute or no visible granulations. The margin is usually abrupt, or unequally shelving, and iu its most characteristic form, strictly overlaid with opaque, white, dense epidermis."—Paget, op. cit., p. 217. Many volumes have been written on the proper means of treating this form of ulcer. The distinguished surgeon from whose memoir we have so largely quoted, especially recommends opium, regulated pressure, and blister ing. A grain of opium night and morning is usually sufficient. The pressure is. applied with straps of adhesive or lead plaster on linen. The object of blistering is not only to stimulate the ulcer, but to soften its callous edges by causing absorption of part of the exudation with which they are infiltrated, and cresquamation of the cuticle which_ covers them. The expediency of healing old ulcers of this kind has often been called in question, inasmuch as apoplexy, palsy, mania, and other serious diseases are said to have the healing of such ulcers. In the following cases it may be decided that a CUM should not be attempted. (1) If the ulcer be affected by the gout, having regular attacks of pain, returning at stated periods, and similar to what the patient has expe rienced from gout in other parts. (2) If an ulcer habitually occur whenever the consti tution is disordered. (3) If the patient be very infirm and old; for under these circum stances the removal of a habitual source of irritation, or the diversion of a habitual ef flux of blood may prove fatal; and especially as very old ulcers have been known to heal spontaneously a short time before death. To these cases, specified by sir E. Home, Dr. Drilla adds (4) that of ulcers on the legs of stout women about the critical period of life, and displaying a tendency to discharge profusely as the menstrual discharge dimin ishes. Ta counteract these dangerous tendencies, the bowels should be freely purged during, and for some time after, the mire of an old ulcer; and if there any symptoms of congestion in the head, a setou should be inserted in the back of the neck.
For the treatment of sloughing ulcers, we must refer to the article SYPHILIS.