4. Ulcers failing to heal from peculiarity of action are of various kinds. They may be due to syphilis, scurvy, scrofula, &c., and as a rule their treatment consists of treatment of the constitutional condition which maintains them, which it is the business of a surgeon to detect. Belonging to this class also are ulcers caused by dilated veins, occurring commonly on the legs. Anything that supports the veins will help the ulcer, notably a well-adjusted elastic stocking.
Ulcers prevented from healing by some con stitutional state are often sloughing ulcers, whose edges rapidly break down, are very ir regular and undermined. It is to be noted that in the simple suggestions for treatment given here no mention is made of the use of blue stone or caustic. These are sometimes used by surgeons, and if used judiciously may often be of great value, but should never be taken into the hands of anyone else.
It is not to be assumed that one or other of the methods noted will be sure to heal any ulcer. Many ulcers are extremely obstinate, and baffle even skilful surgeons. But what it is desirable to insist on is that, if people must treat ulcers on themselves or others without medical advice, such simple means as are men tioned are the only safe methods. In all cases, if after a few days trial the person fails to produce an improvement in the sore, he should seek advice whenever possible.
Herpes is the name given to an eruption characterized by groups of small sacs (vesicles) filled with a clear fluid. An itching or burn ing sensation announces the approach of the eruption, and the same sensation accompanies it. The part of the skin attacked is swollen and inflamed before the vesicles form. Two or three days after the eruption is fully formed the clear fluid becomes turbid, and finally dries up into a crust. It lasts not more than 7 or 8 days. The eruption may occur on the lips, on the lining membrane of the mouth and tonsils, and rarely the tongue, and on various other parts of the body. It may occur on the private parts. Iu all its forms it is accompanied by some slight disturbance of general health, fever, headache, &c.
Perhaps the commonest form is that which occurs on either the upper or lower lip during an ordinary cold, and called herpes labialis, herpes of the lip. It is familiarly known to everyone as one of the signs of a cold. When they occur on the throat they form little ulcers by the bursting of the vesicles.
Another form is apt to occur in young people at particular times of the year in the shape of clusters of the small blisters about the elbows and knees and other parts.
Treatment.—Painting the part, when the tingling sensation begins, with tincture of cam phor may check the eruption ; but once it is formed it should be left alone.
Shingles (Herpes Lotter) is an eruption of the same kind as that just described. It is, however, much more extensive, and it attacks in particular certain well-defined parts of the body. It seems to have a nervous origin, for it follows the course of some particular nerve. Thus it is common on one side of the chest, from the middle line of the back round to the middle line in front, but not crossing that line. This is the course of one of the nerves running between the ribs. It may occur on both sides, not by extending itself, but because it attacks two different nerves. This, however, is rare. It may occur over the belly in the same semi circular way, also over the cheeks and nose, or over the forehead from the inner corner of the eyelid, following the line of one of the sensory nerves of the face; and in other localities.
It is preceded by stinging neuralgic pains for 24 or 48 hours, then the eruption comes out in numerous groups (Plate XXV.) over the in flamed skin, and is attended by intense irri&a tion. The eruption goes through the same stages as already noted of ordinary herpes, and yellow crusts form. The vesicles attain their full development in 5 or 6 days, and in 8 or 10 days usually the eruption has disappeared. Some times successive crops delay the disappearance. Often, especially in the aged, the pain does not cease with the disappearance, but may continue for weeks and months. It does not recur.
Treatment. —No known treatment is of any use to check the disease. It must be allowed to run its course. All that should be done is to diminish the irritation as much as possible by dusting the part with powder, and covering it with cotton-wool, held in position by a band age, to prevent rubbing with the clothes. Ap plication of the lysol dressing in the manner described for ulcer will be found very soothing. Sometimes the pain is so great that it is neces sary to give doses of opium to relieve it and to procure sleep. When the neuralgic pain con tinues, quinine, iron, and arsenic tonics are valuable. (See PRE•CRIPTIONS—TONICS.) Pemphigus is a disease of the skin attended by the formation of blebs (blithe). These are like blisters, larger than vesicles, varying in size between a millet-seed and an apple, and are filled with a clear yellowish or muddy fluid. The skin on which they rest is slightly inflamed. They come out in successive crops over various parts of the body, except the head, palms of the hands, and soles of the feet. The fluid of the blebs may be absorbed, and the skin over the collapsed sac becomes dry and separates, or the bleb may burst and leave an exposed surface.