Surgery; its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Surgery; its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    50/848 (page 48)
    The inflammatory and inflamed ulcer.^—These terms are applied to ulcers in which the inflammator}' phenomena are the most marked feature. The inflammation may depend on some consti- tutional disturbance consequent upon alcoholism, poor living, and the like ; or it may be the result of local irritation applied to any ulcer, whatever its previous character. For the purpose of dis- tinction, the term inflammatory is applied to the former con- dition, whilst the term inflamed is generally restricted to ulcers of the latter class. Inflammatory ulcers have generally an irregu- lar shape, the edges are ragged and shreddy, or abrupt or sharp- cut ; the surrounding skin is red and oedematous, and the base void of granulations, dry, livid-red, or covered with a serous or sanious discharge mixed with tissue-debris, and if the inflamma- tion is very acute, with yellow sloughs. When inflammation attacks a previously granulating ulcer, the granulations become florid and swollen, and generally slough, whilst the surrounding parts present the ordinary inflammatory phenomena. The treat- ment should consist of rest, the elevation of the part, the removal of all local irritation, the application of warm antiseptic lotions, as boracic acid, on lint, attention to the constitutional state, and regulation of the secretions. The sloughing ulcer.—This is merely a severer degree of the former, and it differs from it in that the inflammatory process is more intense and of a spreading character. It is seldom met with except in connection with venereal disease. The micro- organisms at work in this and the next form of ulcer are probably only the ordinary pyogenic micrococci found in all ulcers, but here acting with greater intensity in a vitiated constitution. The ulcer spreads with great rapidity, the edges are undermined, in- verted, and dusky red, and the base is covered by an ash-grey or black slough. I'here is commonly much pain and severe consti- tutional fever. The treatment is similar to that of the inflamed variety. Antiseptics should be freely used if the ulcer is foul, and opium given if there is much pain. When due to syphilis, the proper remedies for that affection should, of course, be given ; but mercury should be used cautiously, or be altogether withheld till the sloughing has ceased. The phagedcEnic tilcer, owing to improved sanitation and hygiene, and the more scientific treatment of wounds, is seldom seen at the present day, except in connection with venereal disease in persons whose constitution is thoroughly broken down by intemperance, poor living, and general neglect. The edges of the ulcer are irregular, swollen, and undermined, and the skin around is of a dark, ])urplish, and dusky-red color. The surface is devoid of granulations and covered with a dark, blood-stained