The old Lead and Opium lotion applied on lint under oiled silk is a favourite local remedy, but it is doubtful if the laudanum contained in it has any analgesic action. Chloral Hydrate (r in 200) may be applied on lint, or the ulcer may be sprinkled with finely powdered Todoform or lodol, or smeared over with lchthyol. Persistent and intractable pain can only be effectually relieved by a complete excision of the entire ulcer area and the application of skin grafts.
The II eak Ulcer is often due to a general anaemic condition, and is therefore sometimes styled an anemic ulcer. Iron by the mouth, alone or in combination with Arsenic, should be freely administered. The urine should be examined for albumin and sugar; if found present, the agents suitable for the treatment of chronic Bright's disease and Diabetes are indicated.
Local measures should be the direct opposite of those employed for the painful and inflamed condition of the sore which, in the present case, will require the application of a stimulant and not of a sedative. The best routine method is to rub over the granulating surface with a large smooth crystal of Sulphate of Copper, and cover it with a double ply of dry lint or gauze. Solid Nitrate of Silver is much more painful, and upon the whole less satisfactory. Lotions and all liquid preparations under oiled silk should give place to dry dressings and desiccating powders. If the flabby granulations do not yield to these measures, the ulcer may be thoroughly scraped or curetted, or the exuberent granulations may be conveniently and painlessly clipped off with scissors, and the raw surface dusted over with Airol or dressed with Chinosol gauze. The steady pressure exerted by a layer of thin sheet lead under a firm elastic bandage has often a most stimulating effect upon the flabby exuberant granulations. Ungt. Resinw makes a good stimulating dressing, or fresh-blood supply may be determined by the application of a cupping glass.
The Indolent Ulcer is a vaguely defined condition which is often regarded as identical with the callous or with the weak sore. The term should be restricted to very chronic ulcers which, without showing any tendency to heal, remain in a lifeless condition without necessarily exhibiting any great degree of callous margin or flabby granulation.
Rest in bed with warmth applied to the limb and tonic constitutional treatment will be necessary. The ordinary gelatin or elastic bandage will in time promote healing, but the process is very slow and the cicatrix is liable to break down.
Electricity, when continuously applied, is the best local stimulant to growth for this condition, and the writer has found excellent results follow the employment of Bird's plan for treating bedsores in paralytic patients.
Any working jeweller can easily prepare two discs, one of silver of the size of the ulcer, and the other of zinc about the dimensions of a crown piece. These are connected by a piece of stout copper wire 4 to 6 inches long. The silver disc being laid in direct contact with the sore, the zinc plate is placed on the skin•at some distance from the ulcer over a layer of wash leather soaked in vinegar. The method may be modified by placing a weak solution of a zinc salt on lint under the silver disc, which will induce a weak cataphoresis.
Stoker's plan of stimulating the growth of indolent ulcers by exposure to a small jet of Oxygen is a valuable method of treatment, giving a healthy and resistant cicatrix, and similar results may be obtained in syphilitic subjects by the local application of Calomel vapour generated in the apparatus for giving a hot-air bath in Bright's disease.
As in the treatment of the flabby exuberant granulations of the weak ulcer, the typically indolent sore may be stimulated by the application of Copper Sulphate, Lunar Caustic, solution of Corrosive Sublimate, &c., or of any dry dressing after dusting the sore with Iodoform, Airol, &c. The surface of the indolent sore may be painted over with Blistering Fluid, which should also overlap the neighbouring sound skin.
The Callous Ulcer with its edges often of cartilaginous hardness is always most indolent, and healing can never occur as long as the in duration is permitted to remain.
Pressure should have a trial before resorting to surgical measures, and sometimes healing rapidly follows after the hardened margins have become softened or absorbed by the steady pressure of the pure rubber bandage of Martin, which should be applied directly to the face of the sore without any intermediate dressing, and the effect is expedited by permitting the patient to take a fair amount of muscular exercise. The patient should apply it himself every morning before leaving bed, and he soon gets to feel the requisite amount of tension, which increases as he assumes the vertical position. The bandage is kept on all day and not removed until the patient is flat in bed. It is then washed in a basin of water containing a trace of some antiseptic. The ulcer is to he likewise carefully cleansed, and a thick pad of lint soaked in Spirit or Carbolic lotion placed over it till morning under a plain calico or stocking web bandage.