A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    128/878 (page 104)
    ULCERATION. unhealthy action continues, but towards the latter stages nature seems just as determined to heal them up again. At first, ulceration is present; latterly, the process of healthy granulation: there is a sore or ulcer, but instead of any excavation, such as is seen in ulceration' there is actually an effusion of lymph on the surface,—a kind of addition caused by nature, instead of a loss. Hitherto it has been the custom to account for the loss of substance in such cases by what Hunter termed the ulcerative absorption, but it is supposed by more modern pathologists that the destruction of parts isi chiefly .the result of disorganization and softening of portions of the fomfdi t|1SSUeS: t^ie so c^anged being swept away in the puri- The term ulcer is usually applied to a healthy granulating surface, such as that which is present in a wound healing by the second in- tention,—a stump, for example, treated in the Continental fashion, without bringing the surfaces into apposition at first; yet here, it may be remarked, the process of ulceration will, in all likelihood, never be present at any period, from the infliction of the wound until cicatriza- tion is complete. In most instances of ulceration there seems to be a deposit of lymph between the affected surface and the parts immediately underneath, and hence, when vessels of moderate size are destroyed by this pro- cess, there is a security against hemorrhage. Sometimes, however, this effusion does not occur, and then the ulceration is most danger- ous; and sometimes the ulcerative process removes the lymph that may have effused: of both of which examples the secondary hemor- rhages which occur after amputations and operations for aneurism give too frequent proof. 6 Ulceration may go on in any texture and in any part of the body. Un the skm and on the mucous membranes it is seen in a variety of forms; and it occurs frequently in articular surfaces, cartilages, bones, and blood-vessels. Generally it is attended with a secretion of pus, although there are instances in which it seems to occur without this accompaniment. Where pus is present it is usually small in quantity, thin and watery, of a pale colour, though occasionally tinged with blood, especially in the early stages of the disease. The matter will vary in aspect and in amount according to the condition of the sore and the nature of the dressings; and there is no better test of the improvement of an ulcer than the approach of this fluid to the sem- blance of “ laudable pus.” The management of particular kinds of this disease will be best exemplified in after parts of the volume, but here it may be stated generally to consist in such measures as are supposed to arrest its progress and bring on a healing action. The usual treatment for inflammation, constitutional as well as local, seems most applicable, whether the ulcerative process is going on externally or internally. When all the symptoms of inflammation are well marked, as most frequently they are, abstraction of blood, locally in particular fomen-