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The ulcer continued spreading near a week, during which time the child continued ill, when it increased to a size nearly as large as a shilling. It began now to discharge pus; granulations sprang up, and it healed. This child had before been of a remarkably sickly constitution, but is now in very high health.
The shadow of the dead bone is seen in the position of the original shaft which it represents; it is of the same shape and density as the original shaft, while its margins present an irregular contour from the erosion concerned in its separation. The sequestrum is separated from the living bone by a clear zone which corresponds to the layer of granulations lining the cavity in which it lies.
In any case it is necessary to disinfect the track, and, it may be, to remove the unhealthy granulations lining it, by means of the sharp spoon, or to excise it bodily. To encourage healing from the bottom the cavity should be packed with bismuth or iodoform gauze.
It is sometimes advisable to protect the granulating surface against irritation by dusting it over with a non-irritating antiseptic powder, or applying a mixture of carbolic acid one part and glycerine twelve parts. After the wound shows healthy granulations longer intervals should lapse between treatments.
The excessive use of moist dressings leads to a third variety of weak ulcer namely, one in which the granulations become large, soft, pale, and flabby, projecting beyond the level of the skin and overlapping the edges, which become pale and sodden. The term "proud flesh" is popularly applied to such redundant granulations.
Thence we proceeded to Namptwich, an old town: from the inn, I saw scarcely any but black timber houses. I tasted the brine water, which contains much more salt than the sea water. By slow evaporation, they make large crystals of salt; by quick boiling, small granulations. It seemed to have no other preparation. At evening we came to Combermere , so called from a wide lake. We went upon the Mere.
Don’t believe in what is called “proud flesh.” The granulations of new flesh are always called so, and burnt off as fast as they grow by corrosive sublimate or “oils as’ll cut a broomstick in two.”
The induration results from coagulation and partial organisation of the inflammatory effusion, and prevents the necessary contraction of the sore. The base of a callous ulcer lies at some distance below the level of the swollen, thickened, and white edges, and presents a glazed appearance, such granulations as are present being unhealthy and irregular.
When the gummatous tissue is first exposed by the destruction of the skin or mucous membrane covering it, it appears as a tough greyish slough, compared to "wash leather," which slowly separates and leaves a more or less circular, deep, punched-out gap which shows a few feeble unhealthy granulations and small sloughs on its floor.
The ramifications are lost in the periphery amid fine granulations that resemble spores. We might say that we here had to do with numerous mycelia moulded in a slightly colored resin. Preparations made from New South Wales and Autun boghead presented the same aspect.
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