Chapter 17 - Surgical Diseases
Modern Surgery
Suppuration and Abscess
Ulceration and Ulcers
Malignant Pustule
Burns and Scalds
Frost Bite
Septic Wounds
Incised Wounds
Rules for Examining and Dressing Wounds
Antiseptic Dressings
Way Wounds Unite
Punctured Wounds
Lacerated Wounds
Granulation and Scarification
Gunshot Wounds
Poisoned Wounds
Way Broken Bones Unite
Different Diseases of Bones
White Swelling
Stiff Joint
Water in the Scrotum
Blood in the Scrotum
Varicose Veins
Deformities and Irritations of the Spine
Wry Neck
Foreign Bodies in the Eye
Inflammation of the Edge of the Eyelids
Disorder of the Lashes
Chronic Inflammation of the Lachrymal Sac
Inflammation of the Cornea
Inflammation of the Iris
Weakness of Sight
Imperfect Vision
Short and Long Sight
Affections of the Ear
Inflammation of the Meatus
Wax in the Ear
Inflammation of the Tympanum, Deafness
Bleeding from the Nose
Ingrowing Toe Nail
Chafing and Excoriation
Foreign Substances
Bleeding from Wounds
Proud Flesh
Compression of Arteries to Stop the Flow of Blood
Care of the Teeth
Rotting of the Teeth
Filling Teeth
The First Teeth
Cleaning the Teeth
Ulcer of the Stomach
Riggs' Disease

17.6 Ulceration and Ulcers

Ulcerations and Ulcers.

WHEN the small particles composing the body have been used a while, they wear out, and become useless. Over the whole body are distributed a multitude of small vessels, called absorbents, whose business it is to pick up these worn and loosened particles, and carry them away.
There is another class of small vessels, having just the opposite duty, namely, to bring new particles of matter, and put in the places of those taken away. These are arteries. They are the natural artisans, who construct our bodies. The absorbents are the demolishers who pull them down. Under these two forces, our existence is, for a time, a drawn game between life and death. The absorbents, like myriads of hungry insects, eat us up, the constructing arteries, like faithful builders, reconstruct us. The work of the absorbents, is called absorption; that of the constructing arteries nutrition.
When nutrition partially ceases, and absorption continues unabated, we grow thin, or lose flesh. This happens in consumption. If nutrition should stop altogether, absorption going on as usual our bodies would be quickly destroyed. We should be wholly devoured by these little absorbent vessels. This would be ulceration applied to the whole body. But it does not appear in so general a form. It confines itself to particular parts.
When nutrition entirely ceases in any portion of the body, the absorbents devour all the skin, flesh, and vessels of the part, leaving an open cavity. The process of taking away the flesh, etc., is ulceration, the cavity left is an ulcer or sore.

Natural Surgery. Ulceration sometimes acts the part of a natural surgeon. When a part dies from mortification, it is necessary to have it removed; so nature sets up, directly around it, an acute inflammation, in which all nutrition stops, and absorption goes on rapidly. In this way, a complete dike is in a short time made around the dead mass, and it is as handsomely amputated, or cut off, as any Surgeon could do it.

When the ulceration is going on, and the blood vessels are being cut off by it, the blood coagulates or curdles in them for a short distance back from the breach, which prevents bleeding. This is as good as tying the arteries.
Some textures ulcerate more easily than others, the skin and raucous membranes most easily of all.
Ulcers are divided into healthy, unhealthy, and specific.

A Healthy ulcer is a simple sore, not showing any bad symptoms, but rather a kindly disposition to heal. It is generally small in size, of a florid red color, and has upon its surface little elevations, pointed like cones, called granulations, which are not so apt as in the case of unhealthy ulcers, to rise above the level of the surrounding skin.

Unhealthy Ulcers comprise those called irritable, indolent, phagedenic, etc.

Indolent Ulcers are numerous. The edges of the skin around them are generally thick, prominent, and rounded. The granulations are pale, smooth, large, and flabby, with a peculiar gloss upon them. These ulcers form most often on the leg; and the nearer they are to the ankle, the harder they are to cure.
Phagedenic Ulcers are those which look as though they literally eat away the parts. Their surface has a livid appearance. The matter formed is small in quantity, and is frequently tinged with blood.

Specific Ulcers embrace scrofulous, cancerous, venereal, scorbutic, and others. They are called specific because they are produced by particular diseases and states of the system.

Treatment. The first thing to be done is to remove the exciting cause. A venereal, or a scrofulous, or a scorbutic ulcer, cannot be cured, unless we first lessen the force of the disease in the general system. If the continuance of a sore depends on bad digestion, we cannot expect to cure it till we put the stomach right.
Healthy ulcers need no treatment, except some simple dressing, such as oxide of zinc ointment. It is well, in some cases, to touch the granulations near the surface with lunar caustic.
Ulcers upon the legs and ankles do not heal well if the patient walks about much, or even allows the legs to hang down a great deal. The patient must be put to bed and the leg bandaged, especially if the ulcers are the result of the breaking clown of varicose veins, which are so common a cause of leg ulcers.
Indolent ulcers are to be touched by lunar caustic, or by diluted nitric acid. The diluted ointment of the nitrate of mercury is also often used with benefit. So is the compound tincture of benzoin, the basilicon ointment, etc. Or, apply a bread and milk poultice to the ulcer, and keep the patient twenty four hours in bed. Then apply the lunar caustic to the whole sore, and to the skin around it. Afterwards cover the ulcer with sticking plaster, and a bandage.
The following is the best plan. Lay upon the sore a number of pieces of lint, soaked in the nitric acid lotion (314), and cover them with a bread and milk poultice. Change these applications twice a day, and continue them till the discharge looks healthy, and the granulations begin to appear.
If there is inflammation about the sore, give some of the preparations of salts to purge the bowels, and confine the patient to bed. When the parts begin to look healthy, lay some pieces of lint upon the sore, wet with nitric acid lotion (214), or zinc lotion (215); and then apply strips of adhesive plaster, one and one half inches wide, two thirds round the limb, and extending an inch below the ulcer and an inch above it, at the same time drawing the edges of the sore together with a gentle force, and retaining them there with the plaster. Put a compress of soft linen over the plaster, and apply a bandage over the whole, making it tighter below and a little looser above, and extending to the knee. (Fig, 154.)

Surgeons frequently snip out little pieces of healthy skin from some adjacent part and graft onto the ulcer, thus shortening the process of healing. A dressing of bovinine and water in equal parts hastens the growth of the flesh part. Whenever the flesh is even with the skin it should be kept at this level by some mild caustic, as stated above. Then comes the time for transplanting skin. The varicosities of the veins must be cured, or at least improved before the ulcers will remain healed, Avoid the use of pork or lard.

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