Ulcers vary much in disposition and appearance, follow wounds,
abscesses, sloughing, eruptions, &c., and often occur without any
previous læsion of the surface. Those most generally met with are
comprehended in the following classes:—1. The simple purulent ulcer,
or healthy or healing sore. 2. The weak or sluggish ulcer,—a sore
with undermined integuments and an unhealthy state of the cellular
tissue. 3. The indolent ulcer,—a sore with hard elevated edges, and
presenting little or no appearance of reparation. 4. The irritable
ulcer,—a sore with over-action, and generally affecting only the mere
surface of the true skin. Besides these, there are sores connected with
diseases of the bones, and others arising from specific action; some
are complicated with a varicose state of the veins: the former have
been already treated of; the latter are reserved for consideration.
Ulcers change their characters, as from simple to irritable, and from
indolent to inflamed; the change depends on situation, on the state of
the constitution, and on the treatment which they receive.
I. The appearances of the first class were described when the healing
of wounds by granulations was considered, p. 173. They heal more
readily on the upper extremities, on the face, neck, and trunk, than
on the lower limbs; for in the former parts the circulation is more
vigorous, the natural processes of cure proceed more easily, and are
less liable to interruption. The sore only requires rest, a clean
condition of the surrounding parts, mild and light dressings, and
moderate support; dry lint or lotions are preferable to ointments,
since the latter are apt to irritate by their rancidity. When the sore
is of considerable size, and there is a tendency in the granulations to
rise above the level of the surrounding skin or cicatrix, the edges may
be protected by very narrow slips of fine old linen or cambric, spread
with fresh spermaceti ointment or cold cream; a pledget of dry lint is
then laid on, and retained by a roller. The dressings thus arranged
do not adhere, and the tender cicatrix is not ruffled and disturbed;
or a piece of pierced linen spread thinly with unirritating ointment
may be placed over the sore, and above that dry lint. When the sore
has contracted to a small size, and some powder, as starch or calamine
stone, or a piece of dry lint, may be applied, so as to allow a scab
to form for the protection of the subjacent surface; but this will,
in most cases, be better accomplished by touching the surface lightly
with lunar caustic or blue stone; the fluids on the part are thereby
immediately coagulated, a crust is quickly formed, and by covering it
with charpie, it is retained in its situation, whilst the process of
cicatrisation proceeds beneath it: if a small quantity of matter should
be secreted, it readily escapes by the sides of the crust, without
disturbing either it or its covering; the limb should be raised above
the level of the trunk.
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