VARICOSE ULCER OF THE LEG

HOWARD JONES, M.D.

CIRCLEVILLE, 0.

I N 1876, at the DemiIt Dispensary in New York City, I had to dress numer- ous cases of varicose uIcer of the Ieg

every day for many months. The disease occurred for the most part in middIe-aged and eIderIy women and the uIcer was often Iarge, deep and very painfu1. The pIan in use at the time was to scrub the Ieg and uIcer with soap and water, pack the uIcer with Iint saturated with baIsam of Peru and over this stretch diagonaIIy strips, about x inch wide, of moIeskin pIaster reaching two-thirds around the Ieg. This treatment did much good, but I do not recaI1 any case that was cured.

In 1878 my attention was directed to a method of treatment of varicose uIcer of the Ieg devised and practiced in my home town by Dr. S. D. Turney with uniform success. About this date he pubIished an account of his treatment in the Ohio Medical Journal, and, since then, I have contributed severa times articIes to different medica journaIs on his pIan, which I have from time to time sIightIy modified. As the method is so successfu1 I have aIways feIt that it shouId have greater pubIicity than it has received.

Hundreds of cases of varicose uIcer of the Ieg have been treated by me, in more than fifty years of active practice, with practicaIIy no faiIures and no return of the uIcers if instructions were foIIowed. The pIan is as foIIows:

In very severe and painfu1 cases with sweIIing of the Iegs (often there is one or more uIcers on each Ieg) the patient is put to bed for a week or two, seIdom more than a week. The majority of patients, however, are ambuIatory without much sweIIing, and can be treated without interfering with their reguIar work.

Whether an ambuIatory case or not the diseased Iimb is first washed with soap and water, we11 Iathered with suds, and, after being rinsed with cIean water, dried. The uIcer is then swabbed with I :IOOO soIution of bichIoride of mercury, appIied thoroughIy but gentIy. If the uIcer is deep and the edges undercut, a piece of fine mesh gauze, cut to fit over the uIcer within the area of the destroyed skin, dampened with the bichIoride soIution is appIied. Over this is Iaid a pad of severa thicknesses of gauze heId in pIace by a few narrow strips of zinc oxide pIaster. This is done at bedtime. ImmediateIy foIIowing this the Iimb is tightIy wrapped from toes to the knee with a 255 inch para rubber Esmarch bandage. This shouId be tight enough to drive a11 the bIood from the vesseIs and shouId remain on from five to ten minutes, but not Iong enough to produce discomfort. When the time is up this bandage is suddenIy Ioosened above and rapidIy unwound. By this means the stagnant bIood in the veins is driven out and its pIace suppIied by an onrush of fresh bIood which furnishes stimuIation to the starving ceIIs of the uIcer. The bichIoride dressing is Ieft on unti1 morning, when the process is repeated. If the Iimb is edematous the patient is kept in bed and the process described repeated night and morning unti1 the sweIIing has subsided suffIcientIy for meas- uring for a Iight weight or medium weight eIastic stocking. This stocking must be made to order to fit the Ieg. Trade stock- ings seIdom answer the purpose because they do not make even pressure, and one that does not fit wiII be worse than useIess. There must be equa1 eIastic pressure on every part of the Ieg; especiaIIy, it shouId never be tighter at the top than eIsewhere.

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Nrw SERIES VOL. XXI, No. 3 Jones-Varicose UIcer Anlerican Journal of Surgery 407

As soon as the stocking comes from the factory, generaIIy four or five days, it is put on in the morning after the treatment with the Esmarch bandage, and taken off at night before the treatment and Ieft off until morning. GranuIations start in a few days, secretion from the uIcer becomes Iess and Iess and soon a white Iine of new skin begins to show around the edge of the uIcer. At this stage it is best to cover the granuIations for a few days with fine gauze spread with zinc oxide ointment.

In cases without sweIIing the treatment is not begun unti1 the eIastic stocking arrives, then the same course is pursued as described except that the patient is not confined to bed. The Iength of time for the heaIing of the uIcer of course depends somewhat on the genera1 condition of the patient and the amount of skin invoIved. Often a Wassermann reaction of three or four pIus is found; in this event appropriate specific treatment is given. In days before tests for syphiIis were in use there were no faiIures_ in heaIing the uIcer aIthough some must have been

syphihtic in character. After the uIcer is heaIed, which is accompIished in a few weeks’ time, according to its severity, the patient must continue to wear a properIy fitted eIastic stocking. With this treatment the veins seem to become smaIIer, and after severa years the eIastic stocking may be dispensed with for months at a time. The injection method of curing varicose veins of the Ieg can, after the uIcer is heaIed, be used in seIected cases to great advantage. The treatment de- scribed is so uniformIy successfu1, so simpIe, cIeanIy and comfortabIe in its resuIts, that I know of no other procedure that compares with it for satisfaction to patient and physician.

The applications to the uIcer can be varied to suit the case or the convenience of the physician. UndoubtedIy it is best at first to use some strong germicida1 soIution to the uIcer, it shouId not be forgotten that air and dryness are essentia1 to rapid heaIing, consequentIy, the sooner a11 ointments and irritating antiseptics can be dispensed with the better.