es. 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.

The _phagedaenic condition_ is the result of an ulcer being infected with
specially virulent bacteria. It occurs in syphilitic ulcers, and rapidly
leads to a widespread destruction of tissue. It is also met with in the
throat in some cases of scarlet fever, and may give rise to fatal
haemorrhage by ulcerating into large blood vessels. All the local and
constitutional signs of a severe septic infection are present.

#Treatment of Ulcers.#--An ulcer is not only an immediate cause of
suffering to the patient, crippling and incapacitating him for his work,
but is a distinct and constant menace to his health: the prolonged
discharge reduces his strength; the open sore is a possible source of
infection by the organisms of suppuration, erysipelas, or other specific
diseases; phlebitis, with formation of septic emboli, leading to pyaemia,
is liable to occur; and in old persons it is not uncommon for ulcers of
long standing to become the seat of cancer. 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.

Steps must be taken to facilitate the venous return from the ulcerated
part, and to ensure that a sufficient supply of fresh, healthy blood
reaches it. The septic element must be eliminated by disinfecting the
ulcer and its surroundings, and any other sources of irritation must be
removed.

If the patient's health is below par, good nourishing food, tonics, and
general hygienic treatment are indicated.

_Management of a Healing Sore._--Perhaps the best dressing for a healing
sore is a layer of Lister's perforated oiled-silk protective, which is
made to cover the raw surface and the skin for about a quarter of an
inch beyond the margins of the sore. Over this three or four thicknesses
of sterilised gauze, wrung out of eusol, creolin, or sterilised water,
are applied, and covered by a pad of absorbent wool. As far