ULCER (from Lat. tacos, Gk. helkos, sore, ulcer, wound). An open sore; a super ficial solution in the continuity of the soft parts. The tendency of an ulcer is toward continued dis solution of the tissues in which it exists, rather than toward healing, as in the case of an or dinary open granulating wound, the latter being less frequently (though properly) called an ulcer. Ulcers are usually classified according to their character and mode of origin into two classes: simple and specific or infective ulcers. In fective ulcers may result from such infective dis eases as syphilis, tubercle, leprosy. and glanders. Among the simple ulcers may be mentioned a number of varieties, such as the traumatic or inflammatory, the varicose or chronic, the ere thritic or irritable, the perforating or trophie, the callous or indolent ulcer, the hemorrhagic, the phagedenie, and the fungous ulcer.
The structures to which ulceration is usually limited are the skin and mucous membranes. Upon the surface of an ulcer a layer of inflam matory exudate is found, mingled with fragments of broken-down tissue or tissue in a state of co agulative necrosis. Beneath this tissue lies a layer of what is known as granulation tissue, which is composed of polynuclear leucocytes and epitlielioid cells, with relatively little inter cellular substance, but richly supplied with a network of capillary blood vessels, and forming the base of the ulcer. Below this there is usually found some of the fibrous tissue of the deeper layers of the skin. The edges of the ulcer con
sist of the surrounding skin, which has been more or less altered by inflammatory changes. The margins of an ulcer are occasionally undermined by the ulcerative process. or they may become firmly adhesive to the periosteum of bone or other subjacent structures. The varicose ulcer, the form most commonly seen by the surgeon, is situated usually on the front of the leg, above its lower third. Around it are generally seen the numerous dilated and congested veins whoso condition is responsible for the ulcerative process. Passive hyperaemia and its resultant enfeebled nutrition are the fundamental causes of ulcera tion in this locality.
The treatment of ulceration in general may be regarded as constitutional and local. Constitu tional treatment consists in fresh air, nourishing diet, proper hygienic surroundings, the adminis tration of iron where anaania exists, and the ap propriate medication for any specific constitu tional disease that may be present. Local treatment consists in rest and elevation of the part, antiseptic measures, and the application of special local forms of treatment adapted to the conditions present at the site of ulceration. Bandaging, strapping, and the application of various stimulating substances are the measures generally employed. Consult Morris, flaw We Treat Wounds (New York and London, 2d ed., 1886).