"THE BAD LEG."

Auckland Star, Volume LVIII, Issue 78, 2 April 1927, Page 29

"THE BAD LEG."

AMBULANCE AND REST TREATMENTS. MORE HASTE LESS SPEED, j (By PERITUS.) ,\ doctor, speaking before the British Medical Association in England recently, i B aid tiiat the amateur journalist may J be known by his frequent reference to j himself and his experience, that a bad journalist may be a good doctor, and that a good doctor is generally a bad journalist. This is all a matter o: opinion, but I have been much comforted thereby. because, in passing on such knowledge as I nave to you, whilst proving myself "bad" as a journalist, I must (according to tne above) have won your conndence as a "good" doctor. I have never bad to experiment in "bad leg" treatment because, for very many years, 1 acted as assistant to a number of surgeons and physicians, thus being a-ble to benefit by the successes and be warned by the lailures of other men. The chief difficulty one has to contend ■with is the fact that most bad leg cases occur in men and women hard pressed ]}•' ci r cumstanee, and unwilling or unable to obey instructions given by the doctor. (Six weeks' absolute rest in bed with careful and frequent dressing of an ulcer is * prescription containing so large a dose of impossibility that patients gasp, shudder, and refuse to accept or follow it. It is, however, most important to realise that a reduction in pressure of blood in the ailected limb is the most effectual method of assisting the hea!THg process, particularly if a few skin grafts have been planted upon the raw surface of a once-suppurating wound. The light elastic pressure of a ■bandage is next in value to the recumbent posture with the limb raised in a cradle or upon a cushion above the level of the body, and if there is enough reparative energy in the patient slow healing may result. It is not natural or normal for a scratched pimple upon the ankle, or a minute chip out of the eurface over the shin bone, to start a spreading and discharging wound. Healthy men and women may contract infection so, and sutler from local or general poisoning, but the wound will sometimes heal before the poisoning is efficiently evident to produce delinite illness, enlarged glands, or abscess (the latter perhaps remote from the site of injury). It is the under or over-fed, the overworked, the patient with impure blood, or weakened by disease, who provides the site and setting of a superficial ulcer. A Curious Superstition. There is a euperstition that a "running sore" is a vent or safety valve for some impurity of the system, and ignorant persons will suffer, and carry a discharging wound to the grave, rather than , face the risk of having this vent "sealed up." Short skirts and thin stockings may cause many a "bad leg" to be taken for treatment, but I have seen the outline of a leg bandage showing through more than one dainty stocking, and have not been able to avoid wondering what was beneath. The skin over the sharp-edged bone of the shin ie but ill-supplied with blood, and responds slowly to invitations to heal when broken. There is a surgical mode of treatment most successful in young subjects. Under a general anaesthetic the wound is thoroughly scraped, and disinfected by picric acid solution, then covered by sterile waterproof dressing extending beyond the ulcer into air-tight contact with the healthy skin, firmly bound with a light cotton webbing bandage, and left untouched (except keeping bandage firm) for several weeks. In a reasonably healthy youthful patient a few ekin grafts (taken from the sterile eurface or the upper arm) will grow upon a wound so prepared, but when this is done more frequent inspection is necessary. It seeme certain that the. ordinary treatment by moist dressing (kept moist by an oiled-silk protective covering) is the best all-round remedy, provided that the dressing is never allowed to become adherent. Even if gently bathed and permitted to drop off the fact of the dressing once having stuck to the wound disturbs the delicate granulations of new ■kin forming. When healing from the margins only, .-quarter of an inch in a Sn g S^nh? haSJoUm^eXpeCtin

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