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Ulcers (General)

Bryan Applications, U

A sore that involves the true skin is described as an ulcer. It is kept open and extends by the death of minute particles of tissue which are liquefied and removed in a discharge. A similar process may affect a mucous membrane and cause an ulcer there. Many different types of ulcer are described, but each consists of an area more or less depressed below the general surface of the skin or mucous membrane, which is known as its floor, and around this margin, or edge. From the surface of the ulcer there exudes a discharge which may be purulent or watery and profuse or scanty; sometimes it is mixed with blood.

The body is instant in its attempts to repair breaches in the continuity of its tissues and repair of an ulcer takes place by the floor becoming filled up and covered with a layer of granulation tissue, which gives the surface of the ulcer a pink, granular appearance. At the same time new epithelium grows in from the edges over the surface of the granulations and can be readily seen as a thin blue margin. The discharge is scanty and is of a watery, or serous, character. When healing has been completed a scar remains.

Subdivisions based on causation:

As regards causation, ulcers fall into three main groups, namely, those due to mechanical, chemical or septic irritation, those due to specific microorganisms, such as the tubercle bacillus and the spironema of syphilis, and those due to malignant new growths.

In the causation of an ulcer belonging to the first group the nutrition of the affected skin or mucous membrane may be compromised, and this may be a predominant factor in keeping an ulcer going. The explanation of this nutritional defect may be found in some local disturbance such as varicose veins or Raynaud’s disease (after the French physician, Maurice Raynaud), or it may have to be sought for in some constitutional disorder such as anemia, diabetes, chronic Blight’s disease, or locomotor ataxia.

An inflamed ulcer discharges, freely and there is redness and swelling of the skin around the ulcer. If considerable portions of dead tissue appear on the ulcer it is called a sloughing or phagedenic ulcer. An irritable ulcer is one in which a nerve is included in the floor of the ulcer, a circumstance that gives rise to great pain.

A callous, or indolent, ulcer is a chronic ulcer with a thickened, rounded edge, the floor being pale. The discharge is scanty as a rule, but may be offensive.

This kind of ulcer is most common on the leg and in elderly people who suffer from varicose veins. A trophic, or perforating, ulcer is one that occurs in locomotor ataxia, diabetes, or some other condition in which there is disease of nerves. An ulcer of this kind is quite painless. The most frequent site is on the ball of the great toe.

Ulcers due to microorganisms:

A tuberculosis ulcer has a ragged, irregular margin, which is undermined and its floor is covered with pale granulations among which tiny yellow tubercles may be visible. Ulceration occurs in the first and second stages of syphilis, but when one speaks of a syphilitic ulcer what is generally meant is the sore that is left when a gumma, a swelling that forms in the tertiary stage, softens and ruptures, discharging its contents. The margin of the ulcer is sharply cut and steep, and the floor has the appearance of wash-leather.

Ulcers that are caused by the growth of a malignant tumor are represented by the rodent ulcer, by epitheliomata, and by the sores produced by malignant tumors, in structures like the breast, breaking through the skin.

Ulcers belonging to all the three groups which have been mentioned occur on the lining of the various cavities and hollow organs of the body and are discussed in connection with these.

The treatment of an ulcer depends on its cause. In this should be malignant disease, an attempt should at once be made by operation to remove all the diseased tissues and any glands which may possibly be infected. A tuberculosis ulcer may be removed by operation or treated by artificial sunlight, while the general treatment of tuberculosis is carried out. A syphilitic ulcer requires in the first place general anti-syphilitic treatment, and so for any specific infection, while local treatment is used to keep the ulcer clean.

In the treatment of ulcers belonging to the first group the main considerations are rest and cleanliness and, where necessary, the removal of any constitutional factor in so far as this is at all possible. Satisfactory healing of an ulcer can hardly be expected, for example, if anemia is allowed to persist, or diabetes is untreated. Rest can be secured for a lower limb only by the patient lying up, though it may be sufficient to support an upper limb on a sling.

If the floor of an ulcer is sloughy or very dirty it may be necessary for a doctor to treat it with a strong antiseptic, such as pure carbolic acid, or to scrape it. Commonly, however, an ulcer can be cleaned up by applying boracic fomentations. The fomentation is made by wringing a double thickness of boracic lint lightly out of hot water, applying it and covering with gutta-percha tissue so as to overlap the lint at least half an inch all round. At the beginning it may be necessary to renew the fomentations three or four times daily, and each time the fomentation is taken off the ulcer should be washed with an antiseptic lotion.

Special dressings to prevent adhesion:

When the ulcer is clean treatment may be continued with the moistened lint with-out the gutta-percha tissue, but if the lint adheres it may injure the delicate epithelium that is growing in to cover the ulcer, and to this a piece of oiled silk perforated with a number of openings to let out the discharge may be applied beneath the lint. The silk is first of all left for a short time in an antiseptic lotion.

An alternative treatment is to apply lint smeared with a thickish layer of boracic ointment. When the area of ulceration is considerable skin-grafting will hasten healing very considerably, but this can be carried out only when the surface of the ulcer is thoroughly clean. An irritable ulcer is treated by cutting across its floor so as to divide the nerve and then proceeding as above described. Incisions may also be required in order to start the healing of a callous ulcer.

When the granulations are exuberant, forming what is called proud flesh, they may usefully be rubbed over lightly with blue stone. If on the other hand they are forming but slowly it will be well to bathe them with a stimulating lotion. To obtain healing of varicose ulcers it is necessary to support the limb by applying a bandage. When the ulcer has healed it may be desirable to operate for the cure of the varicose veins. See: Antiseptic Duodenum.,

Application and treatment:

The location of the ulcer will determine the course of action. If it is internal, use the application for that area as listed, or, if it is external, electrode pad placement as appropriate, with one pad on either side of the area, switching polarity for 30 to 60 minutes per session, and it should be remembered that toxic reactions will occur in those who are inexperienced. Therefore it is necessary to follow sessions with detox frequencies.

Ulcers, Duodenum:

A loss of substance on a cutaneous or mucous surface, causing gradual disintegration and death of cells or groups of cells that are in contact with living tissue. To relieve general symptoms, see (Cramps). Duodenal Ulcer is often called stomach neuralgia, and spasmodic attacks of pain may be mild or so sudden and painful that fainting occurs.

Ulcers (General)

A person may also experience chills, sweating fits, and attacks of nausea. Cramps may be brought on by duodenal ulcer, by spoiled or indigestible foods, gallstones, disorders of the pylorus, brain and spinal conditions, or female troubles.

To aid in removal of the ulcer use positive polarity for 10 minutes over the stomach area with 727, 787, and 880 Hertz for 3 minutes each at very low output settings to devitalize vims, bacteria, worms and fungi that may be the underlying causative agent. Place the positive on the stomach and the negative on the sacral plexus centers in the back of the sacrum.