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Ulcer of the

leg, skin, treatment, unconsciousness, movements, usually and ulcers

ULCER OF THE LEG.—Ulcers are found rather fre quently on the leg ; not in connection with any general disease, but conditioned by disturbances of the circulation of the blood. These disturbances are caused either by varicose veins or by a sluggish flow of blood in the veins, owing to much standing or walking. They may be caused also by repeated inflammation of the leg, arising from uncleanliness, from slight wounds, or from wounds that have not been properly cared for. In a leg with varicose veins, the blood-vessels, which appear bluish as seen through the skin, gradually come nearer and nearer to the surface, and occasionally burst, either spontaneously or as the result of some slight wound. In consequence of a poor nutrition of the skin, and insuffi cient care of the leg, these small wounds do not heal ; on the contrary, they generally grow larger, at the expense of the surrounding skin, which has but little power of resistance. They usually cause much annoyance and pain.

The treatment involves great care as well as much technical experience. Treatment is best carried on in bed, with the leg in an elevated position, and with applications of moist bandages or salves, according to the extent of the ulcer. The most disturbing feature is the fact that they often reappear after having been cured, until the fundamental cause (the varicocities) has been removed. The injurious effects are mitigated by enveloping the leg from the toes to the thigh with flannel, rubber, or tricot bandages. The last named are the best. Entire removal of the ulcer can be effected only by operation.

Ulcers not caused by varicocities appear mostly on the lower third of the leg (see Fig. 427), and are characterised especially by their wide-spread and rapid extension, and by the reddened, inflammatory condition of the adjacent parts. The skin is usually brownish-red in colour, and is compact and hard. The longer these ulcers are neglected, and the less care the patient takes of himself, the more the margins of the ulcers spread, and the more difficult it becomes to heal them. The removal of an ulcer necessi tates a more or less prolonged rest of the leg, in bed if necessary. Careful nursing, and cleansing of the surface of the ulcer, are likewise important.

Bandaging the leg, as described in the foregoing, is very serviceable in these cases also.

UNCONSCIOUSNESS.—The complete abolition of cerebral activity pro duces a condition of unconsciousness which may last for a brief period of time (faint) or be considerably prolonged (apparent death). The affected individual neither sees, feels, nor hears ; he lies still, without making any movements, and the limbs are completely relaxed. The pulsations of the heart and the movements of the chest are the only indications that life exists. The condition may result from a sudden anemia of the brain, from cerebral concussion or disease, from convulsions, and from intoxications. Among intoxications may. be included also the comatose conditions associated with diabetes and inflammation of the kidneys, in which diseases the system itself produces the toxic substances. Patients suffering from a high fever are not usually unconscious, hut merely benumbed : their consciousness is not abolished, but merely obscured. They answer when loudly called, and may perform voluntary movements.

Since the most varied kinds of illness may produce unconsciousness, there is no one method of treatment. The latter depends entirely on the original disease, which the physician must first recognise before any remedia 1 measures can be instituted.

If a layman is called upon to render assistance in a case of unconscious ness, he should immediately loosen all constricting parts of the patient's dress, and place the head low if the face is pale, or elevate it if the face is red and flushed. If vomiting occurs, the head should be turned to one side, so that the vomited material may not get into the windpipe, and thence into the lungs. If the unconsciousness is due to an epileptic fit, which is characterised by twitching of the limbs and the appearance of froth at the mouth, the patient should be left alone, a pillow or some other soft object being placed under his head so that no injury may take place. When respiration has ceased in an unconscious person, ARTIFICIAL RESPIRATION, as described under that heading, should at once be applied.