Licence: Public Domain Mark
Credit: A manual of pathological anatomy (Volume 3-4). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![black, &c. With the changes last described, are connected marked collapse of the body, lividity of the integuments (especially of the exan- thematous part), and of the muscles, red transudations into the serous cavities and into the tissues, and particularly the escape of blood into the parenchyma of membranous expansions, in the form of ecchymoses, petechia, suffusions, &c, especially on the skin. As the exanthematous, especially the acute cxanthematous processes are allied in their nature to the exudative, I must here refer to yet one septic exudative process which takes place upon skin deprived of its epi- dermis, and which is closely analogous to sloughing croup1 (Bretonneau's Dyphtheritis): it is that which is named hospital gangrene. 3. Ulcerative processes.—The ulcerative processes are, for the most part, results of inflammations already described; and they are especially liable to occur when those inflammations, having been raised to unusual intensity by some unfavorable external influences, either continue intense or repeatedly become so; or when they are called forth by some internal constitutional cause (dyscrasia); or when running their course under such constitutional influence, they give rise to a special product by which the tissues are in a peculiar manner consumed (dissolved). As the in- flammations, especially the various exanthematous forms of inflammations present numerous characters, which more or less distinctly manifest the nature of the constitutional affection, so also, and still more, are these characters usually stamped upon the ulcer. Again, many ulcerations of the skin are produced by the metamor- phosis of known adventitious growths in the skin itself or in the tissues beneath it; others are secondary stages of various changes in the texture of the cutis, with which we are not as yet acquainted. Of this kind the following are examples, although most of them still require minuter anatomico-physical investigation : All ulcers connected with disorder of normal, or what have become normal excretions: all those which originate in a congenital or hereditary, or in an acquired dyscrasia, whether the latter be simple, or combined and modified: all menstrual, hemorrhoidal, and urinary ulcers, as they are called, are therefore of this .kind; so also are the abdominal, the gouty, and the scorbutic ulcers, those which exist in psoriasis, the syphilitic and syphi- loid, the leprous, scrofulous (tubercular) and cancerous, and the numer- ous cancroid ulcers. They present many more or less characteristic differences in site and in form, i. e. in the state of their margins and bases, in their disposition to extend superficially or deeply, and in the amount, and especially in the quality of their product: hence the known divisions of ulcers into round, oval, and sinuous; into callous and fun- gous ; into moist and dry, &c. As the ulcer presents various characteristic peculiarities, so also does the cicatrix. It is important and interesting to observe the relation subsisting be- tween inflamed and ulcerating integuments and certain subcutaneous struc- tures, especially periosteum and bone: it is seen, for instance, on the cranium and shins, and prevails chiefly in the inflammation and ulcer arising from constitutional causes. 1 [ Gangrenous stomatitis ?—Ed.]](https://iiif.wellcomecollection.org/image/b21151106_0082.jp2/full/800%2C/0/default.jpg)
