An ulcer is a wounded or raw surface which shows no tendency to heal. It generally starts from inflammation. An irritable ulcer is one which is red, sensitive, protrudes, and bleeds freely. The little red points, or granulations, are painful to the touch. A fungous ulcer is one in which the granulations are considerably elevated by exuberant growth, commonly termed proud flesh. Callous ulcers are those which have thick and hardened margins. These ulcers are generally very inactive, are quite deep, and have rounded edges and a glazed surface.

The Treatment of Ulcers

Irritable ulcers should bo treated by the application of nitrato of silver, or of a hot iron, by means of which the irritable surface will be destroyed. They should afterward be compressed by means of strips of adhesive plaster. If this treatment cannot be em ployed, carbolic acid ointment and other mild ointments should be used. Sprinkling the surface with powdered iodoform will often relieve the pain of irritable ulcers. Iodoform may also be used in the form of on ointment, two to four drams to the ounce of vaseline.

Fungous Ulcers require the application of remedies for the purpose of destroying the fungous granulations. Nitrate of silver, or a hot iron, may be used for this purpose, or the parts may be washed with a decoction of oak-bark, or dusted with powdered alum. After the proud flesh has been removed, pressure should be applied by means of narrow strips of adhesive plaster.

Callous or Inactive Ulcers require remedies to destroy the calloused margins, and to increase the circulation. The hardened edges may be touched with solid nitrate of silver, or with a strong solution of the same. To stimulate the circulation, one of the most efficacious remedies is continuous immersion of the part in warm water. The same effect, to a considerable degree, may be obtained by the employment of the alternate hot and cold spray, two or three times a day. Hot fomentations may also be advantageously employed. The use of electricity is frequently followed by excellent results. The application may be made in the usual way, by means of sponges, or by the simple method recommended for bed-sores.

Large ulcers which are in a healthy condition for healing, large surfaces which have been deprived of the skin by accident, as burns, etc., afford a good opportunity for the employment of skin grafting, which consists in applying to the granulations small portions of healthy skin taken from some other parts of the body or from some other individual. The grafts of skin should be very small, and care should be taken to place them upon the raw surface with the proper side downward. After the application, the entire part should be carefully covered with gutta-percha tissue, which should be kept in place without removal for two or three days. Great care should be taken in dressing that the newly formed portions of skin are not rudely brushed away.

At the end of a week or ten days, little points of the newly forming skin may be seen making their appearance where the grafts were applied. This measure in some cases is very important, as sores so large as to be otherwise incurable may be healed by means of it By the aid of this remarkable discovery, cases have occurred in which re covery has taken place when the whole scalp has been tom off by the hair becoming entangled in machinery, the new scalp being formed by the growth of hundreds of little grafts placed upon the denuded surface.