Image from page 150 of "A system of surgery" (1895)
Title: A system of surgery
Authors: Treves, Frederick, Sir, 1853-1923
Publisher: Philadelphia : Lea Brothers
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School
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, from the dependentposition of the limb, oedema of thepart takes place, lymph is exudedinto the meshes of the cellular tissueand coagulates, and may even become organised, with the result thatthe parts surrounding the sore become hard and the arterioles arepressed upon, and the nutrition of the part is much interfered with.Hence the skin and tissues around a callous ulcer are much thick-ened and hard, and do not pit on pressure. The base of the ulcer isdepressed considerably below the surface of the skin owing to thisgreat thickening of the parts around. The base is also fixed andcontraction is impossible. The surface of the sore is pale and hasonly few and very imperfect granulations, and secretes a smallquantity of thin fluid. The margins of the sore are elevated,thickened, and white (Fig. 20). 7. In certain cases there is developed what is known as thehemorrhagic ulcer, which occurs more especially in patients whoare suffering from scurvy. In these cases the surface of the sore is
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Fig. 20.—Callous Ulcer, completely sur-rounding the Leg. The figure showsthe thickening of the surroundingtissues, the apparent depth of thesore, and the absence of any attemptat healing. This case was cured byskin grafting. 112 ULCERATION. swollen, red, and bleeds very readily, blood sometimes coagulating on,and adhering to, the surface, forming projecting clots. 8. Diabetic ulcer.—In patients who are affected with diabetesit is not uncommon for wounds resulting from scratches or cuts toextend rapidly, and lead to the formation of an ulcer, the resultpartly of the condition of endarteritis present in this disease, andpartly of the great proneness of the tissues to septic infection. Theseulcerations spread rapidly, the skin around is inflamed and red. andmost commonly, in addition to the ulceration, there are also visiblesloughs of the skin or subcutaneous tissues. 9. Ulcers the result of pressure.—Pressure ulcers especiallyoccur on the sole of the foot, and result from long-con
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