The doctor at home and nurse's guidebook / edited by George Black.

Date:
1909
Catalogue details

Licence: In copyright

Credit: The doctor at home and nurse's guidebook / edited by George Black. Source: Wellcome Collection.

    625/684 (page 575)
    the indolent and the irritable ; but as these conditions of the sore are very frequently observed in the same case at different periods, induced by irregularities in the habits of the patient, or superin- duced upon the accession of some general constitutional disease, all ulcers, such as are likely to come under cognisance, will be treated under one head, with notice, how- ever, of such peculiarities as require a difference in their mode of man- agement. ULCERS, TREATMENT OF i. Ulcer on Leg.—In the case of an ulcer on the leg, if on examina- i tion it is found to be covered with I thick, healthy-looking matter, if i the edges are regular, not much or at all elevated and the granulations or new growths are small, conical and firm and not disposed to bleed upon slight pressure, and particularly if a delicate white film is seen around the edge of the sore and on the tips of the little conical granulations, these may be taken as signs that this ulcer is in a healthy condition and that some impropriety in the man- agement must have interfered with and retarded its healing. The fol- lowing is the most approved method of dressing such an ulcer. Apply first a pledget of dry lint of the size of the ulcer (for Nature, in the pro- duction of healthy pus, furnishes the sore with what is better than any salve) and apply over the dry lint a large pledget spread with simple cerate, to prevent evapora- tion and the consequent stiffening of the under-dressing. The evil to be dreaded from the dry pus and hardened lint is the removal of the fine film, before alluded to, from the edges of the sore and from the tips of the granulations, this delicate film being the matrix of the new skin. For the same reason do not wipe or wash the sore, the matter being the most sanative dressing and the new skin, or rather its embryo, be- ing very easily detached. Over the large pledget it is advisable to apply a compress of linen rag and over this a calico roller, to keep all in place and to defend the sore from external violence. This healthy ulcer need not be dressed oftener than once in two days. 2. Cup-shaped Ulcer.—Let us now suppose the case of an ulcer that is cup-shaped, with hard ele- vated edges, the sore itself smooth, dry and not very sensitive when touched ; the patient is in all prob- ability past the meridian of life and very likely the veins of the leg will be found to be swollen, or varicose in many places. Such an ulcer, if its history be inquired into, is of long standing, has probably appeared more than once to be nearly healed, the hollow having been filled up with granulations, but it has suddenly altered in its condition, the granu- lations, which were soft and flabby, having been speedily reabsorbed and the size of the sore having as suddenly been enlarged. Such a change is likely to occur again unless the patient is guarded against irregu- larities in his habits and unless the local treatment of the sore is prop- erly conducted. If the patient is out of health, this circumstance must be attended to and every excess in diet or drink, habitual or occa- sional, must be carefully avoided. 3. Local Treatment.—The local treatment of this cup-shaped ulcer in its present state consists in stimu- lating the surface of the sore and in the proper application of bandages. If the hollow of the ulcer be dry and glossy, sprinkle the surface with red precipitate in fine powder and fill up the hollow with either dry lint,