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INFLAMMATION. 139

or an "open sore," spreads more or less rapidly, and the sur-
rounding integument is hot and swollen, and the disintegrated
tissue is thrown off as extraneous matter. It originates from an
excess in action of the retrograde changes over such as induce
repair. Ulcers also originate from pustules that fail to heal after
the pus escapes, but spread and maintain an acute inflammatory
character. An ulcer may be circular, crescentic, irregular, in
the form of a shallow or deep ring, or it may be tubular, forming
a fistula.
The edges of an ulcer are either low or raised, hard (callous),
soft, jagged, vertical, everted, or undermined, etc. Ulcers aris-
ing from persistent local irritation, as those of the oral mucous
membrane, usually heal as soon as the affected parts are placed
under favorable external circumstances. As long as the epi-
thelium is preserved, the superficial inflammatory process in
mucous membranes may be called catarrh. When suppuration
of mucous membranes proceeds so far as to expose the substantia
propria or corium, the diseased surface is known as an ulcer.
The surface of an ulcer is covered with coarse granulations of a
dark red color, while healthy granulations are cherry red in color.
The ulcer granulations bleed readily. Age, sex, and occupation,
are important factors in the etrology of ulcers, as age is charac-
terized by diminished physical power and vital resistance, and
retrogressive tissue changes. Ulcers are three times as prevalent
among men as among women : they are also more prevalent
among the laboring classes, owing to a greater degree of ex-
posure to injuries, and also to a greater neglect of personal clean-
liness. Ulcers are classified accordino- to their origin, such as
the non-infectious and the infectious. The non-infectious com-
prise those caused by friction, pressure, or other mechanical
injuries, chemical irritation, enervation, impaired nutrition, and
obstructed local circulation.
Ulcers are also classified as inflamed, irritable, fungous, hem-
orrhagic, torpid, callous, corroding, perforating, phagedenic, and
malignant. An inflamed ulcer is characterized by swollen edges,
surrounding skin very tender, dense and shining, and the base and
surrounding parts more or less acutely inflamed. The irritable