Ulcer

“ From what has been said you can see that in general the prognosis of ulcer of the stomach is good, that with proper avoidance of all irritation, the ulcer has a tendency to heal of itself. This tendency has been observed even in large ulcers, where death was perhaps the result of some intercurrent disease. ”

“ A wise physician, with any regard to his own reputation, should abandon a patient laid up with an ulcer which appears to have been dusted over with a sort of pulverised crust, or who has been suffering from one accompanied by loss of flesh and strength, cough, difficult respiration and aversion to food. An ulcer, which occurring at any of the vital parts of the body secretes a copious quantity of pus and blood, and refuses to be healed even after a course of proper and persistent medical treatment, is sure to have a fatal termination. ”

“ In cases of peptic ulcer, you will find that the pain is in direct relation to the amount and quality of food taken; that the patient has little or no pain when the stomach is at rest; that coarse foods as well as acids cause or aggravate the pain, and that indifferent foods, such as milk, do not bring it about, though they may sometimes cause a sense of fullness or oppression. Some patients with ulcer will tell you that the position of their body has an influence on their pain. ”

“ The best clinical example of an inflamed ulcer is the venereal soft sore. The base of the ulcer becomes red and angry-looking, the granulations disappear, and a copious discharge of thin yellow pus, mixed with blood, escapes. Sloughs of granulation tissue or of connective tissue may form. The edges become red, ragged, and everted, and the ulcer increases in size by spreading into the inflamed and oedematous surrounding tissues. Such ulcers are frequently multiple. Pain is a constant symptom, and is often severe, and there is usually some constitutional disturbance. ”

“ When the ulcer is spreading, the discharge is fetid, black, attended with great pains, and other symptoms of inflammation; irritation is produced by relaxing medicines, and relief by the opposite class. When the ulcer is clean, the fluid is small in quantity, consistent, without smell, thick, white, with an agreeable sensation. When the ulcer is inflamed, we must use those things recommended for inflammations. When it is foul, we must inject the juice of ptisan with honey, or basilicon ointment with the oil called Susinum ”

“ The chronic and intractable character of the ulcer is due to interference with the trophic nerve-supply of the parts, and to the fact that the epithelium of the skin grows in and lines the track leading down to the deepest part of the ulcer and so prevents closure. While they are commonest on the sole of the foot and other parts subjected to pressure, perforating ulcers are met with on the sides and dorsum of the foot and toes, on the hands, and on other parts where no pressure has been exerted. ”

“ Such an ulcer has an elevated border, sharply cut edges, an indurated base, and exudes a scanty serous discharge; its surface is at first occupied by yellow necrosed tissue, but in time this is replaced by smooth, pale-pink granulation tissue; finally, epithelium may spread over the surface, and the ulcer heals. As a rule, the patient suffers little discomfort, and may even be ignorant of the existence of the lesion, unless, as a result of exposure to mechanical or septic irritation, ulceration ensues, and the sore becomes painful and tender, and yields a purulent discharge. ”

“ A lint, properly saturated with a medicinal plaster and rightly inserted into the cavity of an ulcer, leads to its speedy healing. All secreting measures in connection with an ulcer should be continued or stopped according to its condition, whereby the nature and shape of the bandage should be determined as well. An ulcer, due either to the deranged condition of blood or the Pittam, should be dressed and bandaged once a day which may be extended to a number of times in the case of an ulcer brought about by the deranged Kapham and Vayu. ”

“ When epitheliomatous degeneration occurs in a chronic ulcer, it first begins to get hard about the edges, which become everted and gradually bound down to the deeper tissues. The granulations about the margins become large, red, nodular, hard and bleed very readily. This condition spreads over the entire ulcer, which assumes a sloughing and foul character. The diagnosis is confirmed by the microscopic examination of a section cut from the edge of the ulcer.
Treatment. Malignant ulcer can be cured only by the destruction or removal of the new growth. ”

“ In the case of an ulcer, it is not expedient to stand; more especially if the ulcer be situated in the leg; but neither, also, is it proper to sit or walk. But quiet and rest are particularly expedient. Recent ulcers, both the ulcers themselves and the surrounding parts, will be least exposed to inflammation, if one shall bring them to a suppuration as expeditiously as possible, and if the matter is not prevented from escaping by the mouth of the sore ”

“ Ulcers which are not cleansed, are not disposed to unite if brought together, nor do the lips thereof approximate of their own accord. When the points adjoining to an ulcer are inflamed, the ulcer is not disposed to heal until the inflammation subside, nor when the surrounding parts are blackened by mortification, nor when a varix occasions an overflow of blood in the part, is the ulcer disposed to heal, unless you bring the surrounding parts into a healthy condition. ”

“ When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be healed with safety. When ulcers either accompany chronical diseases, or come in their stead, they must be cautiously healed. If an ulcer conduces to the patient’s health, from whatever cause it proceeds, it ought not to be healed; but if, on the contrary, it wastes the strength, and consumes the patient by a slow fever, it should be healed as soon as possible. ”

“ An ulcer is a circumscribed area of necrosis occurring on the skin or mucous membrane and covered with granulation tissue. It is a process of destruction, and when this process is going on faster than regeneration can take place, we have a gnawing, or eating, ulcer. When such an ulcer increases rapidly in size it is termed a phagedenic ulcer. A fungoid ulcer is one in which the bottom of the ulcer projects beyond the edge of the skin. These ulcers secrete milky or bloody-white liquid called ichor. ”

“ In addition, the offensive odour of many ulcers renders the patient a source of annoyance and discomfort to others. The primary object of treatment in any ulcer is to bring it into the condition of a healing sore. When this has been effected, nature will do the rest, provided extraneous sources of irritation are excluded. ”

“ As the state of the system has a considerable influence on the condition of an ulcer, so also has the state of the ulcerative action an effect on the constitution. A healthy ulcer, unless very extensive, has little effect on the system; but, unhealthy ulcers, or those which are very large, although the action may be sufficiently perfect, produce a greater or less degree of the general diseased formative action, or what is called hectic. ”

“ We have seen that the appearance of blood in the stools is not very frequent: that the most extensive ulceration may and commonly does exist without it; still when blood does appear it is generally found in combination with an ulceration which is not only extensive, but which has penetrated deep into the coats of the intestine. But although this be the general fact, yet it must be borne in mind that blood may be poured out in large quantities without the existence of a single ulcer. ”

“ Secretions from ulcers:—Now we shall describe the characteristic secretions from all types of ulcers. Secretions from a contused or lacerated skin, as well as from an ulcer confined only to it) , whether spontaneously bursting or surgically opened, are thin and watery in their consistency. They are characterised by a raw (fleshy) smell and a yellowish colour. An ulcer, affecting the flesh, exudes a slimy, thick and white secretion like clarified-butter. ”

“ An ulcer is an open wound or sore in which there are present certain conditions tending to prevent it undergoing the natural process of repair. Of these, one of the most important is the presence of pathogenic bacteria, which by their action not only prevent healing, but so irritate and destroy the tissues as to lead to an actual increase in the size of the sore. Interference with the nutrition of a part by œdema or chronic venous congestion may impede healing; as may also induration of the surrounding area, by preventing the contraction which is such an important factor in repair. ”

“ When erysipelas supervenes upon any sore, you must purge the body, in the way most suitable to the ulcer, either upward or downward. When swelling arises around an. ulcer, and if the ulcer remain free from inflammation, there will be a deposit of matter in process of time. ”

“ It is the indolent ulcer, occasioned by the gradual breaking down of the tissues, that produces the grave constitutional disturbances and death. It is the small, round, or oval ulcer, with elevated, hardened edges, that produces the many and various reflex nervous symptoms, which are misleading and troublesome. ”

“ But the ulcers may give rise to no marked symptoms, and there have been instances where fatal perforation suddenly took place, and where post-mortem examination revealed the existence of long-standing ulcers which had given rise to no suggestive symptoms. While gastric ulcer is to be regarded as dangerous, its termination, in the great majority of cases, is in recovery. It frequently, however, leaves the stomach in a delicate condition, necessitating the utmost care as regards diet. ”

“ The secretions from an ulcer, affecting any vital part of the body, need not be separately described, as such a part naturally involves the organic principles of skin, flesh, etc.; and hence an ulcer, invading it, must necessarily exude a secretion, which is peculiar to any of the aforesaid bodily principles (skin, flesh, etc.) that has become affected. ”

“ The Arabians treat of these ulcers very fully. Avicenna in particular gives very proper directions for the constitutional treatment. When the state of the ulcer is occasioned by an intemperament, it is to be corrected, and if the blood is deficient in quantity or quality, this is to be remedied by a proper diet; and when on the contrary it is connected with plethora, venesection is to be had recourse to, and if the veins leading to it are varicose, it may be proper to open them. When the sore is kept from healing by a spiculum of bone, we are to cut down and remove it. ”

“ When the irritation is further down the intestine, as when an ulcer is situated in the rectum, there is a constant desire to go to stool, but the only results of the expulsive efforts involved in its gratification are exhaustion of the patient and aggravation of the ulcerated condition. ”

“ As has already been indicated, constitutional treatment should be principally relied upon to cure ulceration of the neck of the womb. Put the system in perfect order and the local ulceration cannot fail to heal. If you have a sore or ulcer upon the leg you very naturally reason that there is a fault in the system at large or in the blood. You do not apply caustics to the sore, but you go to work to restore the blood and system to a normal or healthy condition and as soon as this is accomplished the open and rebellious sore, or ulcer, heals of its own accord. ”

“ An Ulcer is a Rupture of the Natural Union of the Parts made a long while ago, which is maintain'd by the Sanies that runs out of its Cavity; or an Ulcer takes its Rise from a Wound that cou'd not be well cur'd in its proper time, by reason of the ill quality of its Pus or corrupt Matter.
What difference is there between a Wound and an Ulcer?
It is this, that a Wound always proceeds from an external Cause, and an Ulcer from an internal, such as Humours that fall upon a Part; or else a Wound in growing inveterate degenerates into an Ulcer.
Whence is the difference of Ulcers deriv'd? ”

“ But, it is expedient, after the flow of the blood, to bind over the ulcer a thick and soft piece of sponge, rather dry than wet, and to place above the sponge some slender leaves. Oil, and all things of an emollient and oily nature, disagree with such ulcers, unless they are getting nearly well. Neither does oil agree with wounds which have been recently inflicted, nor yet do medicines formed with oil or suet, more especially if the ulcer stands in need of more cleansing. ”

“ Thus the patient shall lie in comfortable posture, attended upon by his sweet-talking friends and relations. Metrical Text:—The friends and relations of a patient shall alleviate , the pain of his ulcer with pleasant and interesting topics, and by solacing him with the prospect of a speedy recovery. An ulcer-patient should not sleep in the day time, as it tends to aggravate the pain, swelling and redness of the ulcer, increases its exudations, and gives rise to itching and heaviness of the limbs. ”

“ Some cases of ulcer of the stomach present the queerest symptoms. For instance: they complain of pain after drinking milk, or even after taking a morphine powder, while they can eat the coarsest food without any harm. Others run along without presenting any symptoms at all, until they, as well as their physicians, are surprised by the perforation of a gastric ulcer. ”