Though the local treatment of the indolent ulcer is most important, little advance can be made unless constitutional measures be closely attended to. This is true also as regards all forms of chronic sore. Healing may be impossible till good food in abundance, and tonics, pure air and every means by which the nutrition of the body can be improved, have got a fair trial.
The Varicose Ulcer.—The treatment of this condition is that of the simple healing sore when complicated with the presence of varicose veins. Excision of the dilated venous trunk may be required in some cases, but as a rule the constant application of the woven rubber or the gelatin bandage meets all requirements. It allows the ulcer to heal, and the prevention of future recurrence can then be safely undertaken on an aseptic field by removal of the veins. The method described on a previous page as practised by Jamieson and Low is the best procedure.
The Eczematous Ulcer is usually associated with the last-mentioned condition, and generally the pure rubber bandage is badly borne. The best plan is to start the treatment of the eczema whilst the patient remains in bed by the application of a suitable ointment containing Liq. Carb. Detergens with White Precipitate and Lead. After a time he may be permitted to go about with this application on lint covered in by a woven elastic bandage. Aqueous lotions under oiled silk often tend to spread the eczema over the entire limb. When the discharge is profuse, drying powders like Zinc Oxide, Fuller's Earth, Bismuth and Starch may be freely dusted on under the woven rubber bandage.
The Sloughing, or Phagedcenic Ulcer is seldom met with in the leg, and then only in patients debilitated by alcoholic excesses or those suffering from some profound blood dyscrasia as renal disease or diabetes. As the condition is due to infection with sonic virulent strain of microbe in addition to active constitutional remedies, energetic disinfectant, com bined with Vaccine, treatment must be promptly resorted to.
The limb should be enveloped by frequently changed Charcoal poultices till the surface of the sore has been cleansed from superficial sloughs; Peroxide of Hydrogen is freely swabbed over the ulcer, which may then be exposed to the thermo-cautery, and any deep sloughs removed by the aid of the knife, and the whole thoroughly painted by liquefied Carbolic Acid.
By keeping the leg constantly immersed in a trough containing warm solution of Permanganate of Potassium the stench may be controlled and new action encouraged. In chronic cases an autogenous Vaccine may be employed with advantage.
The ulcers which arise from the condition recognised as Bazin's Disease (see under Erythema) are frequently found on the posterior surface of the leg over the calf. Whilst they are best treated on the above lines by scraping, pressure and local antiseptics,constitutional treatment is of more importance, and generally speaking this should be such as is indicated in tuberculosis. Not infrequently these patients show a positive Wasser mann reaction.
URZEMIA—see Bright's Disease.