A. L. CLARK, A. M., M. D., ELGIN, ILLINOIS
Varicose ulcers occur most frequently among the poor—among those of bad hygienic surroundings, and who are much on foot, and for these reasons are more difficult to treat. First: there is a condition of enlarged veins, then some injury, cold, etc., determines the formation of an ulcer. These may be curable or incurable, but are usually curable. For success, the treatment should be both local and constitutional, but if only one course is to be followed, constitutional treatment should always be given the preference.
In certain cases a watery discharge will keep up so long as no other vent exists. The patient should keep off the feet and should raise the foot if necessary. In any case some other outlet for the fluids of the body should be provided, and the general health should have careful attention.
The first is a cardinal principle in the management of these cases, and is to be accomplished by the use of the saline cathartics. Most of these exercise some influence on the kidneys. The white liquid physic of the early Eclectics, or something of that nature, should be given to produce about two healthy watery discharges daily, then some of the alteratives—pulverized yellow dock, pulverized spikenard and jalap have been used in this connection. Iodide of potash usually is not beneficial. If the patient is anemic iron tonics may be given.
Locally we have an indolent ulcer, manifestly needing stimulation. Convert it into an elliptical sore, as granulations form at the edges and are more easily approximated in this form. Put over this sore a pledget of cotton, and draw the edges together with adhesive strips. Apply something of a drying nature, as bismuth, carbonate of magnesia, etc. These have a tendency to dry up and form a scab with granulations underneath. Some very irritable cases are overcome by incising the edges, others by touching with nitrate of silver. Bandaging from the toes to the knee is almost a necessity, especially if much on foot. This brings the affected part into a condition of rest.
In smarting, burning and painful cases the aqueous extract of opium may be found of service. Watch the granulations and gradually approximate the edges. Internal treatment should be given as before indicated.
As a dressing for these ulcers I can hardly speak too highly of plain bovinine. Poured directly upon and into the sore every day the results produced seem sometimes marvelous. With two weeks rest in the recumbent position and with the medication already indicated, I have seen wonderful results follow the use of bovinine. It seems to act as a food for the debilitated wound, healthy granulations spring up in a few days and cure is complete.