ULCER is a suppurating soreproduced by the destruction of some part of the living structure, leaving a hollow from which matter is discharged. Ulcers may be either internal cr external. They may be arranged either ac cording to the constitutional or specific disease from which they are derived or according to the characters 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 irri table, chronic, sloughing, etc. 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 granu lating 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 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 centre, being most vas cular where the cuticle is being chiefly devel oped. 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 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 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 irregu lar or shreddy; and the surrounding 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 a water dressing or lead lotion applied warm. Senile ulcers usually present very little discharge, exhibit granulations of a rusty red tint and are sur rounded 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 strapping the leg daily with a mixture of resin ointment and Peruvian balsam spread on strips of lint is recommended. Strumous or scrofu lous ulcers usually occur as the consequence of scrofulous inflammation in the subcutaneous tissue or lymphatic glands. They most com monly 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 pain ful. The general treatment must be that rec ommended for constitutional scrofula. Iodine in some form or other is the best local appli cation. A poultice of bruised and warmed sea weed is a very popular 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. Consult Adams, E., of Chronic Leg Ulcers' (New York 1914); Da Costa, C Modern Surgery' (7th ed., Philadelphia 1914); Foote, E. M., of Minor Surgery' (New York 1914).