Second, When the action has, at any one period, been diseased, or too low, but has been restored to a proper state, we must of necessity continue gentle pressure, and treat the sore as if the action were stationary, although it may not be so.
GENUS II.
Of the Indolent Ulcer.
In this genus, the action is diminished, and, consequently, rendered imperfect and diseased.
Indolent ulcers, like those of the next genus, are divisible into two species: First, that in which both parts of the ulcerative action, namely, the granulating and purulent, are equally diseased, and equally imperfectly performed: Second, that in which one part is more affected than another[49].
The first species is distinguished by the following symptoms, which appear in greater or less degrees, according to the diminution and imperfection of the action.
The granulations are pale, and imperfectly formed, partaking less of the firmness and organisation of the healthy fleshy granulations in proportion to the affection of the action. They are obtuse, and scarcely at all elevated; and, therefore, the surface loses its doted, or red pointed appearance. The discharge is thin, and of a whitish colour, at the same time that we frequently observe isolated spots of lymph interwoven here and there with the imperfect granulations. Although these granulations are said not to be elevated, yet the surface often exhibits a species of fungus; but the individual granulations are not elevated, or pointed. This fungus never rises higher than the twentieth part of an inch above the level of the surrounding skin[50], and often appears only at particular parts of the surface. It is pale, and somewhat of a gelatinous appearance. The pain is trifling.
In more advanced cases, the whole disk is covered with a thin layer of lymphatic substance, which adheres firmly, and gives the idea of a thin pellicle being thrown over the granulations, which are seen imperfectly and irregularly through it. The discharge is generally thin, like serum, and considerable[51]. The edges are hard and tumefied, sometimes of a light purple colour, at other times white[52]. The surrounding integuments are also hard and thickened, at least in old ulcers, and the veins are generally more or less varicose.