PERFORATING ULCER OF THE FOOT.
The primary disease, which is usually either locomotor ataxia, spina bifida,peripheral neuritis, diabetes or leprosy, should receive due attention.
Mild cases may be made to heal completely by a persevering use of the continuous or galvanic current; this is best applied by dropping one electrode into a warm foot-bath whilst the other is placed over the sciatic region. A large corn-plaster with the perforation over the sinus of the ulcer should he worn and the foot should be rested.
The thickened margins of the ulcer should be pared, and any flabby granulations scraped away, after which the sinus may be filled with Bismuth jelly or injected with Friar's Balsam and the sore dressed with any stimulating ointment, as the Unguentum Resinze, or by very weak Nitric Acid, Perchloride of Mercury solution or Spirit lotion by means of a piece of lint covered with tinfoil or thin sheet-lead. Rest during the slow
healing process is essential. Stretching the posterior tibial and plantar nerves has given excellent results in many cases.
Diseased bone should be removed by the gouge or forceps, and if the wound is very sluggish it may be occasionally brushed over with a strong solution of Nitrate of Silver, or touched with strongest Nitric Acid, or Acid Nitrate of Mercury Solution, or even brought into light contact with the thernio-cautery, or ,..raped tlioroughly with a Volkmann's spoon, and the thickened cuticle round the edge of the ulcer should be frequently pared by a sharp scalpel or corn knife. When all these measures fail and the sinuses refuse to heal, a Syme's or a Teale's amputation may then be seriously considered, but the incisions must he made above the level of any anesthesia which may he present.