Licence: Public Domain Mark
Credit: Surgery / by John Allan Wyeth. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![vessels by mechanical means, or relieving the overpressure bj^ position. For the former the elastic stocking, properly adjusted, is invaluable. Martin's elastic band- age is an excellent apparatus, but requires considerable care in its even and skillful application. 'When neither of these methods is available, pressure may be successfully employed by means of flannel or muslin bandages. An elevated position of the foot and leg should be maintained in all ulcers of the lower extremities. An indolent ulcer demands stimulation. This may be effected by irrigation from a fountain syringe sufficiently elevated to give strong pressure, with normal salt solution at 120° F., for ten or fifteen minutes twice daily. A wet gauze dressing and tight roller should be ap- \ j plied. Supporting the edges of the sore with well-adjusted \ J strips of diachylon plaster is also a commendable practice. | \^ ] The strips should be cut about three fourths of an inch wide, | ^ ^J and crossed in a spiral manner (Fig. 808). Irritable iileers require rest and soothing applications. One of the most satisfactory preparations for the treatment of all forms of ulcers, granulating surfaces, incised accumu- lations of pus, septic wounds of all kinds, burns, etc., where absorption of moisture is desired, is the halsam-oil mixture first employed by Prof. W. W. Van Arsdale in 188-t. It forms an excellent, slightly astringent, and unirritating dressing. For ordinary use it suffices to cover the surface with a mat of absorbent gauze, painting it over thickly with a brush. Enough gauze should be used to absorb the quan- tity of exudate for the time it is to be left on. Over the absorbent gauze, cotton batting is laid, over this rubber tis- sue or oil-silk protective, and a light bandage over all. When it can be obtained, the sterile preparation should be used. It is made by submitting castor oil for at least two hours to a temperature of 160° C. (320° F.). A special chemical thermometer is necessary for this purpose. The sterilized oil should then be jDoured into bottles taken out of boiling ■water, immediately corked with rubber stoppers similarly sterilized. The sterile oil will sutBce without the addition of the Peruvian l^alsam, but I usually prefer to add this, and this must be done as the oil is poured out at the time of using. Balsam cannot be heated 'svithout destroying its value. Twenty minims of balsam to the ounce of castor oil is the proportion. For infected wounds, while the aseptic Fig. sus. preparation is ahvays to be preferred, 3'et, when it cannot be obtained, the ordinary cold-pressed castor oil can be used, and the balsam added in the same proportion as given. The constitutional treatment of all patients suffering from ulcers is of first importance. Ulcers wdiich have destroyed large areas of integument cannot be cured without the transplantation of skin. Gangrene is death of a part of the body from the gradual or sudden arrest of its nutrition. The term is usually applied to the process of mortification in the softer structures. The analogous condition of bone is called necrosis. Animal tissues have two modes of dying—the one is molecular, or death by granular meta- morphosis, in which no trace of the anatomical or histological properties of the tissues remains; the other is death in httlh, in which, although the tissues deprived of life undergo rapid decomposition and ultimate disintegration, they retain for a time something of their original form. It is to denote this last variety of tissue death that the term gangrene is employed. There are three varieties—namely, the acute, or moist; the chronic, senile, or dry; and the contagions, phagedenic, or hospital gangrene. Acute Gangrene.—The chief cause of moist gangrene is the sudden obstruction of the afferent or efl^erent vessels of a part. AVhether the artery is alone occluded, as by an embolus, the ligature, or an accidental solution of its continuity; or](https://iiif.wellcomecollection.org/image/b21203647_0793.jp2/full/800%2C/0/default.jpg)
