III. Indolent ulcers, which have long existed, are frequently met
with on the lower limbs. Their margins are thick and insensible—their
surfaces smooth, hollow, and of a pale colour—the discharge is
scanty, and adheres to the surface. A sore, having been long open and
neglected, degenerates into this state. Poultices are to be applied for
a day or two, to clean the surface, promote the discharge, and soften
the callous margins. This is the more necessary, if, as is often the
case, the sore, or the surrounding integuments, are inflamed when the
patient applies for relief. Afterwards, the applications must be of
such a nature as to moderate the discharge and keep the granulations
firm and healthy. In such cases only is adhesive plaster applicable,
and in them it produces the most beneficial results. Supposing the
ulcer to be situated on the fore and middle part of the leg, a bandage
should first be firmly applied from the toes to a little below the
sore; the ulcerated part of the limb is then encircled by narrow
strips of adhesive plaster, tightly drawn, and with the extremities
of each strip crossing immediately over the ulcer. A pledget of tow
is placed on the plasters to absorb the discharge, and the bandage is
brought over dressings, and continued for some way upward. By this
application, the margins of the sore, it is supposed, are brought
nearer to each other, and the ulcerated surface diminished; the
sluggish granulations and the subjacent parts are stimulated, and a
more vigorous action being excited, the process of reparation proceeds
speedily and effectually; the surrounding parts, previously turgid
and œdematous, are by the pressure brought to the same level with the
newly-secreted matter, and new skin is quickly formed. In the previous
state of matters, the old skin was much elevated, and an action was in
progress, causing a continuance of that elevation; by the compression,
the whole limb is properly supported, serous effusion prevented,
absorption excited, and œdema removed; the livid swelling of the lower
part of the limb, which might arise from the tightness of the adhesive
plaster, is obviated by the bandage being first applied. A feeling of
uneasiness in the limb sometimes follows such dressing, but is of short
duration; should it increase, so as to amount to pain, the elevation of
the limb and the pouring of cold water occasionally over the dressings
will soon restore the parts to comfort. Or the adhesive plaster may
be slit up behind, immediately after its application; indentation of
the limb being thereby avoided, and sufficient pressure at the same
time kept up on the sore. If possible, the dressings ought not to be
removed before the second day, as much irritation will be produced
by their frequent renewal. The benefits arising from this mode of
treatment are truly surprising; the slow and indolent ulcer is speedily
converted into the simple purulent sore; the white and recent cutaneous
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