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.
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].
[49] The circumstance of one part of an ulcer being more affected than another, will be more fully noticed in considering the next genus, in which it is of more practical consequence. Ulcers generally belong to this species, before they assume the characters of the second (for they frequently change from one species, or genus, to another; in which case, the treatment must also be changed).
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.
[50] The cause why these granulations rise, even this trifling height, above the level of the skin, is the indolence of the action, which prevents a cuticle from being formed in due time.