ULCER, a word derived from the Latin tams, a "wound." Ulcers may be ar ranged either according to the constitu tional or specific disease from which they are derived, or according to the charac ters which they present. According to the first system ulcers are spoken of as healthy, inflammatory, strumous, etc.; while according to the second they are named irritable, chronic, sloughing, etc. In this article the former of these ar rangements is adopted as being, on the whole, the most satisfactory, though each possesses its own advantages. A com mon, simple, or healthy ulcer is such as is left after the separation of an acci dental slough in a healthy person, and is merely a healthy granulating surface tending to cicatrization. Its edges shelve gently down to the base, and are scarcely harder than the adjacent healthy skin. Their surface near the borders is of a pur plish blue tint where the young epidermis modifies the color of the healing granu lations 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 "laudable" pus. The only treatment required is a little dry lint, if there is much discharge, or the water dressing; if 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 com mon 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 on the lower half of the leg or shin. The surface is red and bleeds easily; the discharge is thin and watery; the edges irregular or shreddy, and the surround ing 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 re quired, and opium in small repeated doses is often serviceable. The local treatment must be of a stimulating nature, and in bad cases Sir J. Paget recommends strap ping the leg daily with a mixture of re sin ointment and Peruvian balsam spread on strips of lint. Strumous or scrofulous ulcers usually occur as the consequence of scrofulous inflammation in the sub cutaneous tissue or lymphatic glands. They most commonly occur in the neck, groins, cheeks, scalp, and the neighbor hood 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 recommended for constitutional scrofula. Iodine in some form or other is the best local application. A poultice of bruised and warmed sea weed is a very popular remedy; but there is prob ably 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).