Sores on the lower limbs are always difficult
to manage. The reparative process is tedious, on account of their
situation; the parts are at a distance from the centre of circulation,
their action is weak, the return of blood is tardy, and the same
facility is not afforded of restraining the motions of the part as in
the upper extremities. In persons of a good constitution, however,
the simple purulent sore often heals speedily, even in the lower
limbs. Before cicatrisation can take place, it is essential that the
granulating surface should be on a level with the sound surface around;
this soon takes place when a favourable position is observed, and the
part is kept at rest; but by neglect, the new matter is often absorbed.
Again, the healing process cannot advance where the granulations are
exuberant, large, and flabby, and have risen above the proper level:
they must be kept in check by due compression, and by astringent
lotions, containing salts of zinc, copper, &c. The constant meddling
with sores, the touching them with this, that, or the other caustic, is
much to be reprobated. Should it be necessary to destroy granulations,
and bring them down to the surrounding surface, one good rubbing with
the blue stone will generally suffice. If the ulcer is large, the
granulations close to the cicatrix should only be destroyed, leaving
the centre to be dealt with as the cure advances.
During the cure, the patient must be a good deal confined to the
recumbent posture; when erect, a bandage or laced stocking must be
applied to the limb; thus the return of blood is assisted, swelling
is prevented, and the affected parts placed in a state of comparative
rest. Much pressure ought to be avoided, as it is apt to produce
bad effects upon the sore, causing absorption of the granulations,
thin bloody discharge, and great tenderness of the surface. After
cicatrisation, the scars may be absorbed, and sores reproduced, by
external injuries, or an unhealthy state of the body; and so much does
the state of a sore depend upon that of the general health, that the
one is a good index of the other.
Public-domain text, read in full here on John Shaqi.
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