Ulceration may find its starting-point in a cut, bruise, or wound of any kind.
Ulcers heal by what is called granulation. The broken surface is covered over by minute red elevations (the granulations) or hillocks of newly- formed tissue, which readily bleed. From the surface fluid oozes away, consisting partly of a clear fluid (serum) and partly of matter (pus). By the growth of the granula tions the loss of substance is gradually made up. Round the edge of the sore there is a slow encroachment of the upper layers of the sound skin, so that the extent of the sore gradually diminishes, and a thin covering of scarf-skin spreads over it. Ultimately the sore is entirely, covered over, but retains features distinguishing it from normal skin—its thin covering, not of true skin, and its pale trans parent appearance. In medical language a cicatrix or scar remains.
There are various kinds of ulcers. The late Professor Syme of Edinburgh classified them as-1. Healing ulcers, 2. Ulcers failing to heal front excess of action, 3. Ulcers failing to heal front defect of action, and 4. Ulcers failing to heal from peculiarity of action. It is often a nice point for a surgeon to decide what kind of ulcer he is dealing with, and what is the appro priate treatment. The probability is that an unskilled person, attempting to cure an ulcer, will only aggravate the sore. Here we shall only try to indicate what such a person may do, in the absence of proper surgical advice, without running such a risk.
1. The healthy ulcer is known by the small, firm, red elevations that cover it. They are sen sitive when touched and readily bleed. There is a slight discharge of healthy matter. The edges are level with the surface, and a thin blue line indicates the advancing layer of skin.
The treatment of this kind of ulcer consists simply in giving it fair-play. Let the part be kept at rest and raised—not hanging. Let the part be cleaned by allowing pure tepid water to flow over it from above, containing a tea 1 spoonful of lysol to every quart. Dry it by mopping it with pieces of perfectly clean absorb ent wool (ganigee), and then cover it by a layer of the dry absorbent wool, a gauze bandage retaining the whole. Renew the dressing every
second day, washing away, not tearing away, the old one. The person's general health should be maintained.
2. The ulcer failing to heal from excess of action has red, swollen, angry - looking edges, uneven surface, and thin offensive discharge, and there is aching or throbbing pain.
Treatment. — Raise the part affected and ensure rest. Let the person's bowels be opened by such medicine as seidlitz-powder, and let attention be given to the patient's health. To the ulcer itself apply the lysol dressing mentioned above, a piece of gamgee, the full thickness of the wool and the size of the ulcer, damp with the lotion, being applied after washing, and covered with oiled silk, overlapping the wool all round. If this is not sufficient, a lotion, made of ounce of solution of acetate of lead and the same quantity of glycerine to 5 or 6 ounces of water, may be applied, on lint covered with oiled silk. When the irritation has passed, the treatment for healthy ulcer is to be adopted. Irritable ulcers in full-blooded people, who live "not wisely but too well," will be greatly helped by the free use of seidlitz-powders, or mineral waters like Hunyadi Janos.
3. The ulcers failing to heal from defect of action have flabby, large granulations, to which the term "proud flesh" is applied. The dis charge is thin and watery, and the ulcer is painless. In other forms the surface is glazed, no granulations being present, and the edges are raised, hard, and irregular.
Treatment.—Those exhibiting "proud flesh" are best treated by firm pads placed on the surface and kept there by moderately-firm ban daging. Under the pads an astringent dressing may be applied. For that purpose a solution of 2 grains of chloride of zinc in an ounce of water may be used, diluted if found advisable. The same solution is valuable for the glazed ulcers. The patient should have nourishing diet and quinine and iron tonics.