the granulations share in the œdema, and there is an abundant serous
discharge.

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.

[Illustration: FIG. 18.--Callous Ulcer, showing thickened edges and
indurated swelling of surrounding parts.]

_The Callous Condition._--This condition is usually met with in ulcers
on the lower third of the leg, and is often associated with the presence
of varicose veins. It is chiefly met with in hospital practice. The want
of healing is mainly due to impeded venous return and to œdema and
induration of the surrounding skin and cellular tissues (Fig. 18). 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. The discharge is usually watery, and cakes in the dressing.
When from neglect and want of cleanliness the ulcer becomes inflamed,
there is considerable pain, and the discharge is purulent and often
offensive.

The prolonged hyperæmia of the tissues in relation to a callous ulcer of
the leg often leads to changes in the underlying bones. The periosteum
is abnormally thick and vascular, the superficial layers of the bone