ulatory Treatment._--When the circumstances of the patient forbid
his lying up in bed, the healing of the ulcer is much delayed. He should
be instructed to take every possible opportunity of placing the limb in
an elevated position, and must constantly wear a firm bandage of
_elastic webbing_. This webbing is porous and admits of evaporation of
the skin and wound secretions--an advantage it has over Martin's rubber
bandage. The bandage should extend from the toes to well above the knee,
and should always be applied while the patient is in the recumbent
position with the leg elevated, preferably before getting out of bed in
the morning. Additional support is given to the veins if the bandage is
applied as a figure of eight.

We have found the following method satisfactory in out-patient
practice. The patient lying on a couch, the limb is raised about
eighteen inches and kept in this position for five minutes--till the
excess of blood has left it. With the limb still raised, the ulcer with
the surrounding skin is covered with a layer, about half an inch thick,
of finely powdered boracic acid, and the leg, from foot to knee,
excluding the sole, is enveloped in a thick layer of wood-wool wadding.
This is held in position by ordinary cotton bandages, painted over with
liquid starch; while the starch is drying the limb is kept elevated.
With this appliance the patient may continue to work, and the dressing
does not require to be changed oftener than once in three or four weeks
(W. G. Richardson).

When an ulcer becomes acutely _inflamed_ as a result of superadded
infection, antiseptic measures are employed to overcome the infection,
and ichthyol or other soothing applications may be used to allay the
pain.

The _phagedaenic ulcer_ calls for more energetic means of disinfection;
the whole of the affected surface is touched with the actual cautery at
a white heat, or is painted with pure carbolic acid. Relays of charcoal
poultices are then applied until the spread of the disease is arrested.

For the _irritable ulcer_ the most satisfactory treatment is complete
excision and subsequent skin-grafting.

CHAPTER VI

GANGRENE

Definition--Types: _Dry_, _Moist_--Varieties--Gangrene primarily due to
interference with circulation: _Senile gangrene_; _Embolic
gangrene_; _Gangrene following ligation of arteries_; _Gangrene
from mechanical causes_; _Gangrene from heat, chemical agents, and
cold_; _Diabetic