ULCER.
The treatment of ulceration of the Anus is dealt with in the article on Anal Fissure on p. 46.
Gastric Ulcer is dealt with under its own heading on p. 3] S.
The treatment of Lupoid and Syphilitir ulcerations will be found detailed in the articles on Lupus and Syphilis, and Rodent Ulcer under its own title.
The treatment of Perforating Ulcer of the Foot will be found on p. 677, and that of Ulcers of the Mouth and Tongue under Stornatitis and Tongue Diseases. The form of Ulceration known as Bedsore will be found detailed under its own name.
The present article deals for the most part with the various phases of chronic ulceration which commonly appear on the leg, generally about its lower third. Owing to the frequency with which syphilis enters into the causation of these ulcers, it is advisable to submit the patient's blood to the Wassermann test before commencing treatment. They have been classified so minutely in former times under a variety of confusing and often misleading names that any description of the treatment of each as a separate entity is fraught with considerable difficulty.
This difficulty will, however, disappear if we consider the pathology of the affection and regard the common leg ulcer as usually due to some imperfection in the venous circulation of the blood in the lower part of the limb, which has led to molecular death of the superficial structures. The character taken on by the open sore will vary with the local conditions present, as friction, microbic infection, excessive muscular action, etc., which may convert the simple ulcer into the so-called irritable or inflamed ulcer, or owing to the presence of constitutional dyscrasia into the weak, sloughing and indolent conditions which have given their names to sores in this region.
When the ulcer has long been neglected, exposed to infective organisms, and the healing process retarded for want of rest, its margins become thickened, and in this condition it has been designated the callous ulcer. When the complication of visibly enlarged veins or an eczematous con dition is present, the sore is styled a varicose or eczematous ulcer.
Each name may he therefore taken to represent some condition grafted upon the simple healing sore, and not to indicate any real difference in the nature of the ulceration. Theoretically, a sore may pass through such
vicissitudes that at a given stage of its existence it may be either inflamed, irritable, sloughing, phagethcnic, eczematous, weak, indolent, callous, etc., or all these in turn. The treatment of the primary and most frequently met with form will be first considered.
The Simple Healing Sore or Ulcer.-11 the underlying cause of the molecular death of the superficial tissues be removed, the natural tendency of the simple sore to spontaneous healing will manifest itself speedily. Absolute rest to the part with elevation of the limb so as to aid the local circulation will be quite sufficient to insure healing as the venous stasis disappears, and gives place to a freer supply of arterial nourishment.
The patient must take to bed for this rest and the limb should he elevated on a pillow, or blocks may be placed under the foot of the bed. The granulating surface is to be dressed by covering it over with a solution or ointment containing any weak, unirritating antiseptic substance to prevent infection by microbic organisms. When a watery solution is employed, it is usually applied on lint and covered over with oiled the lint being changed at least twice a day, and the granulations cleansed by a gentle stream of sterilised normal serum, or of the antiseptic solution used for saturating the lint, before the dressing is reapplied.
Some surgeons after irrigating the surface apply a piece of perforated oiled silk protective directly to the granulations; on the top of this a double ply of lint saturated with the antiseptic solution is laid on, and the whole covered over with a thick pad of gauze tissue under a bandage, in order to absorb any secretion which oozes from the granulating surface. If an ointment or fatty base be it is not as a rule desirable to cover it in with any form of impervious but sometimes when the unaffected skin is tender it may be smeared with Lanoline or Vaseline all round the ulcer which is being treated by the aqueous antiseptic solution under oiled silk.