Secondary abscesses must be aspirated or opened and drained whenever possible.

The general treatment is conducted on the same lines as on other forms of pyogenic infection.

CHAPTER V

ULCERATION AND ULCERS

Definitions—­Clinical examination of an ulcer—­The healing
    sore.—­Classification of ulcers—­A.  According to cause: 
    Traumatism, Imperfect circulation, Imperfect nerve-supply,
    Constitutional causes—­B.  According to condition:  Healing,
    Stationary, Spreading.—­Treatment.

The process of ulceration may be defined as the molecular or cellular death of tissue taking place on a free surface.  It is essentially of the same nature as the process of suppuration, only that the purulent discharge, instead of collecting in a closed cavity and forming an abscess, at once escapes on the surface.

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 oedema 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.  Defective innervation, such as occurs in injuries and diseases of the spinal cord, also plays an important part in delaying repair.  In certain constitutional conditions, too—­for example, Bright’s disease, diabetes, or syphilis—­the vitiated state of the tissues is an impediment to repair.  Mechanical causes, such as unsuitable dressings or ill-fitting appliances, may also act in the same direction.

#Clinical Examination of an Ulcer.#—­In examining any ulcer, we observe—­(1) Its base or floor, noting the presence or absence of granulations, their disposition, size, colour, vascularity, and whether they are depressed or elevated in relation to the surrounding parts. (2) The discharge as to quantity, consistence, colour, composition, and odour. (3) The edges, noting particularly whether or not the marginal epithelium is attempting to grow over the surface; also their shape, regularity, thickness, and whether undermined or overlapping, everted or depressed. (4) The surrounding tissues, as to whether they are congested, oedematous, inflamed, indurated, or otherwise. (5) Whether or not there is pain or tenderness in the raw surface or its surroundings. (6) The part of the body on which it occurs, because certain ulcers have special seats of election—­for example, the varicose ulcer in the lower third of the leg, the perforating ulcer on the sole of the foot, and so on.