Of local applications the formulae are without end; the following are frequently employed, the first four of which meet every ordinary require ment: Carbolic Lotion (i in 4o), Spirit Lotion (r in 4), Saturated Boric solution, Chlorate of Potassium (4 grs. to i oz.), Chloride of Zinc (2 grs. to i oz.), Sulphate of Zinc (2 grs.), of Copper (r gr.), Nitrate of Silver (5 grs. per oz.), Black or Yellow lotion, Perchloride of Mercury (1 gr. per oz.), Liquor Plumbi Dil. and Chloral Hydrate (3 grs. per oz.).
Of ointments the official preparations, save those of Zinc Oxide and Zinc Oleate, are all too concentrated for continuous application to the simple sore. Those of Creosote, Carbolic and Boric Acids, Resin and Calomel should be diluted with at least 3 times their weight of Vaseline. Iodoform, Lead Carbonate, and Hamamelis ointments may be used diluted with equal parts of Vaseline. When an unguent is selected for use, which should only be the case if aqueous solutions are not comfortably borne, the granulating surface will require cleansing by gently swabbing it with soft gauze before renewing the lint, on which the ointment should be evenly spread.
The healing of the simple sore may often be accelerated by employing a thin layer of sheet lead (such as is used for lining tea chests) instead of oiled silk.
Under the above method of rest treatment new skin is formed and complete cicatrisation effected in a few weeks, when the sore is small and healthy looking. Large ulcers with great breaches of surface should be dealt with by skin-grafting in order to save time and give a more resistant cicatrix.
As few busy sufferers will consent to lie up for the necessary period, and as all hospitals except the Poor Law Institutions refuse to fill their wards with patients suffering from simple ulcer of the leg, other means must be resorted to which will enable the victim to pursue his ordinary avoca tion during treatment.
Two plans of dealing with the chronic simple sore have been devised to meet these requirements. These are based upon the principle of mechani cally aiding the weakened local circulation, and affording a degree of mild pressure or support to the granulations which produce the same effect as prolonged rest.
The first of these and the simplest is the elastic or rubber bandage. Martin's appliance consists of a thin bandage of pure rubber, which is also procurable with numerous small perforations in its substance. Even with these openings there is great risk of the retained secretion and perspiration fretting the healthy skin and producing a sodden condition or a general dermatitis over the entire leg. Some surgeons apply the Martin bandage direct to the limb and sore without any intervening dressing, but this is not a desirable method. In all cases a better result will be obtainable by the following routine: Cut out with scissors a double ply of lint or gauze of the size and shape of the ulcer, and a single layer of oiled silk about half an inch larger. The lint is soaked in ordinary Carbolic lotion (1 in 4o), laid upon the sore, and covered with the oiled silk. Where there is any tendency to eczema, the skin around the edges of the ulcer, where in contact with the oiled silk, may be smeared over with a little Lard, Vaseline, or any stiff emollient ointment. This prevents irritation by the retained secretion under the oiled silk. Over the lint and oiled silk a woven rubber bandage, about 31 inches wide (such a bandage as is used for Esmarch's bloodless operation), is applied evenly from the toes up to the knee. This bandage is manu factured in the same way as the elastic spring-sides of ordinary boots, and it is known as " elastic webbing." It should be taken off when the patient retires to bed, and put on before lie gets up in the morning, any ordinary bandage being used to keep the dressing in its place during the night.
This bandage as ordinarily procurable is stiffened by some form of dressing used in its manufacture. It should, before being applied to the limb, be soaked in tepid water, and after drying should be stretched, bent and kneaded by the fingers to produce suppleness and flexibility, so that it may more easily adapt itself to the contour of the limb.
The second method is also a most efficient one, and in many cases gives better results than the elastic bandage. Both plans are very suitable for the treatment of ulcers when associated with the presence of varicose veins.