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.
[51] Indolence of the action does not imply that the quantity of a discharge should be lessened, but only that its nature should be changed. In this species, the discharge is much the same in quantity as in a healthy ulcer of the same size, but its perfection is greatly less.
[52] Sometimes the granulating action and the cicatrizing one seems to be confounded, the surface exhibiting a fibrous fleshy appearance. This I have seen most frequently in the calf of the leg; but it may occur in other parts.
These appearances vary in degree from the soft pale surface, and thin whitish purulent discharge, with slightly thickened edges, to the state now described. The pain, when compared to the size of the ulcer, is not considerable.
This genus may occur, in a slight degree, in recent sores, from neglect, &c.; but it is chiefly after ulcers have been of long standing, that they assume these appearances in the greatest degree. They may then be said to have become chronic, or habitual; and, in many instances, it is absolutely impossible to restore the action to its natural state, and produce recovery[53].
[53] These ulcers, after long continuance, frequently induce a disease in the bones or muscles seated below them, as will afterwards be mentioned.
The second species is distinguished by the paleness and imperfection of the granulations, whilst the discharge is tolerably good; but it never can be equal to that of the healthy ulcer; because, when one part of the action is affected, the other is also more or less affected. This species does not require any more particular observation or remark, because it is to be treated exactly as the first, of which it is often just a slighter degree, or a forerunner; for it is frequently the first change which takes place in a healthy ulcer. When it becomes diseased, it does not continue long; for both parts soon come to suffer in the same proportion; in which case, the ulcer belongs to the first species. For this reason, we never find old ulcers belonging to this species.