THE IRRITABLE ULCER is painful and tender, the slightest injury causing it to bleed. It is of a dark purplish hue, and filled with spongy, sensitive granulations. It discharges a thin, bloody matter which is sometimes very fetid and acrid, and excoriates the tissues if it comes in contact with them. The edges of this species of ulcer are shelf-like and ragged, and turn inward. The adjacent structures are red and swollen. Very often they are attended by severe constitutional disturbances, such as chills, fever, and great nervous prostration and irritability.
IN THE INDOLENT ULCER the edges are not undermined, but turned outward, and are rounded, thick, glossy, and regular. The granulations are broad, flat, pale, insensible, and covered with a grayish, tenacious matter.
The surrounding parts are not very sensitive, but the limb on which it is located is apt to be swollen. This is the commonest form of ulcer, and often remains for years.
VARICOSE ULCER. This species of ulcer occasions a swollen or enlarged condition of the neighboring veins, which are very much enfeebled. It almost invariably appears below the knee, and may be either indolent or irritable. It is generally sensitive to the touch, and sometimes excessively painful. Knots of superficial veins may often be seen beneath the skin.
As we have before remarked, these various species of ulcers are merely modifications of one form of chronic sore. The patient may assert that he enjoys excellent health, but if we question him closely, we find that the sore irritates him, and that there is sufficient constitutional disturbance to prevent the healing powers of nature from effecting a cure.
TREATMENT. The cure of these sores is necessarily slow, and who ever expects to obtain _immediate_ relief will be disappointed.
Constitutional treatment is of the utmost importance, and should, therefore, be thoroughly and persistently applied. The nutritive system, especially the absorbents, should be kept active, as these are the channels by which the broken-down tissue surrounding the sore is replaced by that of a higher grade of vitality. For this purpose, the best alteratives or blood cleansing remedies are required. If secretion and excretion are not normally performed, the blood becomes poisoned by the absorption of unhealthy "matter" from the sore, and various constitutional disturbances occur. If, at any time during treatment, constitutional disturbances are manifested by fullness or disagreeable sensations in the head, nausea, pain, cough, chills, or fever, a thorough cathartic should be given. If the patient be robust, a repetition of the same once a week will be very beneficial. Dr. Pierce's Golden Medical Discovery, and "Pellets" will be productive of the best results.
The local treatment should depend upon the character of the ulcer. If the sore be _irritable_ or painful, soothing applications, such as warm poultices or steaming in a vapor of bitter herbs, as hops, boneset or smart-weed or water pepper, will be found highly beneficial. A poultice of powdered slippery elm is also very soothing, and hence well adapted to this purpose. If the ulcer be _indolent_, a stimulating application is necessary. The hardened, callous state of the edges should be removed by alkaline applications. A strong solution of saleratus, or even a caustic, prepared by boiling the lye from hard-wood ashes to the consistence of syrup, will prove of great utility. One or two applications of the latter are generally sufficient.
The foregoing course of treatment is intended to put the open sore or ulcer in what is known to surgeons as a healthy condition--a condition most favorable for the healing process.
But the open surface of the sore needs something more. It needs the cleansing or antiseptic and soothing influence of such a dressing as is found in Dr. Pierce's All-Healing Salve. If your dealer in medicines does not have this Salve in stock, 25 cents in stamps sent to World's Dispensary Medical Association, Buffalo, N.Y., will secure a box of this unequaled dressing. It will be sent to your address by return post.
Therefore, do not allow the dealer to put you off with some inferior preparation. If he has not the All-Healing Salve in stock you can easily obtain it by sending to us as above directed.
No matter how good the local dressing applied to the open sore, or ulcer, do not discontinue the internal use of the "Golden Medical Discovery" until the affected parts are completely healed.
FEVER-SORE. (NECROSIS.)
By the term _necrosis_ we mean mortification, or the state of a bone when it is deprived of life. Dunglison says: "This condition is to the bone what _gangrene_ is to the soft parts." It is popularly known as _fever-sore_, there being no distinction made between this species of sore and those ulcers which affect only the soft tissues of the body.
When any part of a bone becomes _necrosed_, it is treated as a foreign body. Nature makes an effort for its removal, and at the same time attempts to replace it with new and healthy materials. In consequence of this process, the dead portion is often inclosed in a case of new, sound bone, termed the _involucrum_; when this is the case the dead portion is termed the _sequestrum_. If, however, it be superficial, and separate from the parts beneath, it is called an _exfoliation_. This healing process, by which the involucrum is formed, cannot be completed while the dead portion remains. Hence, numerous openings are made through the involucrum, to permit the escape of the sequestrum. When a surgical operation is performed for the removal of the necrosed bone it is called _sequestrotomy_. The instruments which our specialists usually employ for this practice are represented in Figs. 3, 4, and 5.
[Illustration: Fig. 3.
Hand drill for boring bone. ]
[Illustration: Fig. 4.
The osteotrite, for enlarging openings and cutting carious bone.]
[Illustration: Fig. 5.
Gouge forceps for excavating bone.]
CAUSES. Fever-sore may be due to inflammation, injuries, working in phosphorus, or from the inordinate and protracted use of mercury.
SYMPTOMS. The pain frequently commences in the night, and all the different stages succeed, until, finally, the result is frequently mortification or death. The entire bone, or only a part of it, may be affected; the parts become swollen, "matter" forms, and unless it be artificially evacuated, it will in time work its way out through a fistulous opening. As the disease progresses, the adjacent tissues become thickened and numerous openings are formed, which communicate with the bone, and often with each other, so that a probe may be passed from one to another, as represented in Fig. 6, copied from a drawing by Dr. Howe. The discharge from fever-sores varies in character, and usually has a fetid odor. The surgeon can readily distinguish between healthy and unhealthy bone by the use of a probe. The pus discharged in necrosis contains minute particles of bone, which may be felt by rubbing it between the fingers. Sometimes large pieces present themselves at the openings. The general health is seriously impaired, and the patient becomes debilitated, anaemic, and hectic.
[Illustration: Fig. 6.
Necrosis of the tibia. A common probe is passed through the sinuses, or openings.]
TREATMENT. The process of repair is necessarily tedious, and nature should be assisted to remove the old bone and promote the formation of the new. An alterative course of treatment is indicated and must be persistently followed. Give Dr. Pierce's Golden Medical Discovery and Pleasant Pellets in sufficient doses to keep the bowels regular.
However, all efforts to heal the sores, as long as dead bone remains, will prove fruitless. The sores should he throughly cleansed with injections of an alkaline solution, after which bandages, moistened with glycerine, may be applied. If they emit a fetid odor, add a few drops of carbolic acid to the glycerine. The dead bone can be but slowly removed by suppuration, therefore time, and, indeed, sometimes life itself, may be saved by removing it with surgical instruments. In the operation of sequestrotomy, the surgeon must exercise great judgment. Carelessness may prolong the disease and subsequently necessitate another operation, or, perhaps, an amputation.
Usually the dead bone is easily removed by the skilled specialist surgeon, and, when thoroughly taken out, the parts readily heal and the patient rapidly recovers. The removal, therefore, of the dead bone which is a constant source of irritation, and the cause of protracted suffering, should not be delayed, for very rarely indeed can it be removed at all without the assistance of the surgeon. Besides, delay often results in the loss of the limb, and not unfrequently occasions the death of the patient. Under the influence of a reliable local _anaesthetic_, carefully applied, the operation of removing the decayed and offensive bone is speedily and painlessly performed, the use of chloroform or ether not generally being required.
TESTIMONIALS.
If the following letters had been written by your best known and most esteemed neighbors they could be no more worthy of your confidence than they now are, coming, as they do, from well known, intelligent and trustworthy citizens, who, in their several neighborhoods, enjoy the fullest confidence and respect of all who know them.
Out of thousands of similar letters received from former patrons, we have selected these few at random, and have to regret that we can find room only for this comparatively small number in this volume.
BLOOD DISEASE.
RAW SORES FROM KNEE TO ANKLE.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
[Illustration: Master Amasa Peck]
_Dear Sirs_--My little boy, Amasa Claude Peck, was severely stricken with what the doctors called erysipelas. We had employed two doctors for months without any effect, until he commenced taking your Dr. Pierce's Golden Medical Discovery. Two bottles effected a cure. His leg was raw from his knee to his ankle; it has never broken since, which has been several years. The same medicine also did great things for my now deceased husband in a case of erysipelas of long standing. Respectfully yours,
MRS. A.B. PECK, Ranger, Eastland Co., Texas.
My daughter Mrs. Jennie Rice, was cured of catarrh in her head by using the "Discovery" with Dr. Sage's Catarrh Remedy. She derived great benefit from your medicines and gives the privilege of using her name.
A.B.P.
ANaeMIA--IMPOVERISHED BLOOD.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, NO. 663 Main St.. Buffalo, N.Y.:
[Illustration: Mrs. Knight.]
_Dear Sirs_--Ten or twelve years ago I had a combination of diseases.
Our family physician said I was bloodless and there was no hopes of my recovering. My mother advised me to consult you, which I did. After one month's treatment I was on foot again; it was truly astonishing how speedily I found relief after taking your preparations. I have also used your "Favorite Prescription" and "Golden Medical Discovery," which proved very beneficial.
MRS. ADDIE R. KNIGHT, Carapeake, Gates Ce., North Carolina.
ERYSIPELAS.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
[Illustration: J. Smith, Esq.]
_Gentlemen_--I am glad to say that the use of your medicine has saved me many doctors' bills, as I have for the past eleven years been using it for the erysipelas and also for chronic diarrhea, and am glad to say that it has never failed. I have also recommended it to many of my neighbors, as it is a medicine worth recommending.
I give you the privilege of using my name