Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    313/1274 (page 281)
    surrounding skiu is eczematous. A paste, which differs slightly from the original formula, is prepared by heatiug together gelatine, If) parts, glycerine, oO parts, oxide of zinc, 10 parts, and water, 45 parts. This paste, melted by heat, is thickly painted over the affected portion of the limb, and covered by a firmly applied gauze bandage, which Unna suggests should be double-headed, and crossed backwards and forwards round the part. A fresh layer of the paste may be painted over each layer of the bandage. The dressing can be left undisturbed for several days. Excellent results have followed this mode of treatment. Another mode of treating chronic ulcers is that which was recommended by 8yme, consisting iu the application of a blister to the indurated edges and the surface of the sore, after which some simple dressing is used. This is often efficient, but if the sore be of any considerable size, it is possible that the patient may absorb sufficient cantharidin to cause symptoms of poisoning. If the edges of the ulcer are so indurated that the contraction necessary for heahng is impossible, Volkmann recommends that an incision should be made through the indurated tissues completely around the ulcer, and at a short distance from its margin. Further, it must be mentioned that Thiersch's method of skin-grafting (p. 278') has been successfully applied to the treatment of callous ulcers. In cases of extensive intractable ulcers, which resist every method of treatment, amputation is occasionally required. Irritable Ulcer.—This is met with mostly after the middle period of life. It is usually of small size, and situated behind one or other malleolus. It is frequently a consequence of varicose veins. The surroundincj sldn is usually pui-ple, slightly indurated and sometimes pigmented ; the edges are slightly raised, very irregular in outline, and present no signs of healing. The surface is but slightly below the level of the skin ; it is either dark purplish-red in colour or covered with a thin slough. The lase is but slightly indurated. The discharge is scanty and thin. The pam is the principal characteristic ; it is exceedingly great, and usually worse at night, thus preventing sleep and seriously disturbing the general health. In fact, such an ulcer, if unrelieved, may bring the patient into so exhausted a condition that death may occur from some apparently slight ailment, such as an attack of bronchitis. Hilton pointed out that if the surface of the sore be carefully touched all over with the point of a probe, one or more spots will be found most acutely tender. This is due to the exposure of a nerve-ending on the surface of the sore. In the Treatment of this ulcer, sedatives at bedtime are often necessary to procure rest. If opium be used, the constipation must be relieved by saline purgatives in the morning. The local treatment which I have found most successful, is to brush the surface of the sore and the surrounding parts from time to time with a strong solution of nitrate of silver (gr. x. to 3].), and then to keep sedative remedies, such as lead and opium lotions, applied to it. If this does not succeed, the surface of the sore may be rubbed with solid nitrate of silver until a distinct slough is formed. The treatment may be rendered painless by the previous application of a 10 per cent, solution of cocaine ; the smarting, if there be any, soon ceases, and the patient will often enjoy after it the first good night's rest he has had for months. Hilton