A
REPORT
ULCERS
ON
OCCURRING
AMONGST
OE
LEG
THE
THE
MEN
OF
THE 39TH NATIVE INFANTRY. By Surgeon A. R. W. Sedgekikld, m. b., i si
the
During very
large
Regiment, the
cases
Native did
a
of 1881
seasons cases
Infantry,
and
of ulcer of the
in the
treatment
ity presented of
rainy
number of
under my
C. I. Horse.
Regt.
at
and
not run the same course,
leg
a
came
of the
Hospital Morar,
1882,
39th although all
yet the majoras to admit
such uniform characteristics
general description being applicable. characters.?The ulcer occurred
Anatomical
exclusively on the ankle, dorsum of the foot showing a very marked preference for the inner malleolus?the part most exposed to friction The ulcer begins as a slightly swollen boggy patch, the almost
or
the skin,
skin
spot has a sodden appearance, and is of red colour: there is considerable tenderness on
at the
dusky
pressure. centre
formed
The skin then
of the a
discharge,
patch,
small
quantity
of
often mixed with
It is in this stage that the
point in the opening so tenacious yellowish
gives way through
and
a a
men
at a
the
little blood, escapes. generally come to hos-
pital. If
a
will be
probe be found
now
that it
the detached skin to
passed can
some
in at the
opening,
it
be moved freely under extent in all directions.
The loosened skin then
sloughs away, leaving a y2 an inch to 3 inhctie in diameter, covered with a sticky greyish yellow exudation, and bounded by somewhat overhanging ragcred edges and an areola of low cedematous inflamsomewhat circular ulcer from
mation. In this state the ulcer may remain for
some
weeks
either
slowly or, in some few cases spread usually however, after remaining very rapidly; few for a days, it begins to heal. stationary is Healing always preceded by a return to the natural state of the cedematous ring of inflammation round the ulcer, and is usually rapid. A flat shiny scar is left after healing. or
it may
The average duration of each
three weeks, and
they mostly
case was a ran
a
little
over
very uniform
course.
Varieties.?The ulcer is one, and in
only
an
essentially a superficial inappreciable minority of the cases
below the subcutaneous cellular and in all these the men were much below par. did it
pierce
tissue,
THE INDIAN MEDICAL GAZETTE.
254
Some of the ulcers
presented the appearance due
of
being
great amount of very deep ; cedema in the subcutaneous cellular tissue raising the level of the skin,and not to penetration of desp tissues. but this
pain
The amount of cases
there
there
was
was
was
little
was
or none.
to a
in most
very variable, In the worst cases, where
cedema, great pain was complained of night, and in all these there was some
much
especially
at
febrile disturbance. Constitutional state.?The state of general health of the men attacked was conspicuously not at all
and except in the men attacked
uniform,
worst cases, I do
think that the
by
compare unfavourably with those who Some of the
men
attacked
good health, and, indeed, and healthy men suffered
not
the disease would
to be in very
exceptionally strong others were obviously in
many ;
poor health, and these furnished the worst cases ; others again shewed the blue line on the gums, supposed to indicate deficient vegetable feeding but quite as often
seen
in malarial cachexia.
tous, large and
painful, a state of debility, with nervous excitement, slight feverishrtess, and rapid loss of strength and flesh, would come on ; as soon, however, the low inflammation round the ulcer subsided,
rapid healing and complete The disease running a distinct
recovery would
ensue.
was
Race
and
caste.?The
cases
were thus
had
distributed
among the different castes:
Brahmins and Chatries
Jats Ahirs
F Co.
i8'5
per cent.
...
...
C
,,
17
...
...
D
?
15-8
?
2
,,
Hillmen
...
...
H
?
14-5
,,
Sikhs
...
...
A
?
14-5
?
...
B
,,
io'o
?
...
G
?
6-5
?
...
E
,,
4*0
,,
"
All
races
Chumars, &c.
Mihtars, Inferior
and creeds"
caste
It will be
seen
Hindus
that the low
caste
Hindus,
who feed
best, have suffered least. Time of
fluence
on
were seen,
year?Has had the disease.
but
a very important inIn the hot weather no cases
at the time of
maximum prevalence of during September, October and
malarial fever, namely, November, the great majority of the
this disease have
of
?
constitution?in
some
some cases.
cases
2.
occurred.
Enfeebled
3. Influence of climate
cases.
?after the rains.
Exciting.? Irritation of the skin or abrasion. The natives say the hardness of the water is I do not consider that
following
disease occurred
the
principally vegetables are most abundant; of vegetables are sold in the bazaar, had
a cause.
scorbutic taint has had
a
much to do with it for the
at
reasons. season a
The
of year
large quantity
and
fresh limes
obvious curative effect.
no
Malaria has
no
doubt been
disease occurred almost
important factor : the
an
at the
entirely
malarial time
of year. The type of the ulcer
before
was
of
character I have
a
although many cases were those of the ulcer of debility,?flabby, indolent, and not attended with any marked heat, swelling or pain, and slow to heal?in many others the ulcer spread rapidly, and was attended with much heat, swelling, and pain and some constitutional disturbance, and was further characterized by healing very rapidly as soon as the oedema had subsided, running a course resembling that of an acute abscess. met
with,
regular course, specific or special very The
following
1.
...
considerations it
above
causes
for
Treatment.?As the disease is
course.
observed that very few of the men suffered from fever lately who had the ulcers. It
the
Predisposing. i. Underfeeding?in
not
It was a very noticeable feature in the disease that, in the bad cases, the men would often look in very fair health on admission, and as the ulcer became (Edema-
as
Causation.?From would appear that the been as follows :?
when
escaped.
appeared
[September, 1884.
might
as
treatment
means were
one
have been was
used
which
runs a
expected,
no
found serviceable.
:?
Local.?
bed, strapping, splints, elevation of the limb ; caustic, astringent, and stimulating dressings 5 poultices and sedative applications ; iodoform ; several preparations of opium. Rest in
2.
Constitutional.?
Opium ; feeding stimulants, limes. The
up ; iron tonics ;
most successful
Poultices
local
quinine, arsenic,
applications by
far were?
containing laudanum ; solution of nitrate 10 to t?) ; solution of chloride of lime (gr. 20 to ?i). All strong caustic applications were very decidedly injurious, and after a week's trial I entirely abandoned them. As soon as the ulcer began to heal the following treatment was of use :?Resin ointment dressing and once in 3 days application of solution of nitrate of silver. of silver
(gr.
UIXERS OF LEG AMONGST SEPOYS.
September, 1884.] Skin-grafting
used in
was
a
few
Of the constitutional treatment, were
decidedly
and milk
given
to
were
the
cases
feeding
successfully.
and stimulants
best, quinine benefited
given
to all the
those whose ulcers
some
?,
rum
bad cases; were
opium was painful at night,
and with much benefit. All of
the
cases
recovered, though had
long duration ; two they were both hillmen.
to
be
sent
some on
few
were
sick leave
/
>
255
REPORT
ULCERS
ON
OCCURRING
AMONGST
OE
LEG
THE
THE
MEN
OF
THE 39TH NATIVE INFANTRY. By Surgeon A. R. W. Sedgekikld, m. b., i si
the
During very
large
Regiment, the
cases
Native did
a
of 1881
seasons cases
Infantry,
and
of ulcer of the
in the
treatment
ity presented of
rainy
number of
under my
C. I. Horse.
Regt.
at
and
not run the same course,
leg
a
came
of the
Hospital Morar,
1882,
39th although all
yet the majoras to admit
such uniform characteristics
general description being applicable. characters.?The ulcer occurred
Anatomical
exclusively on the ankle, dorsum of the foot showing a very marked preference for the inner malleolus?the part most exposed to friction The ulcer begins as a slightly swollen boggy patch, the almost
or
the skin,
skin
spot has a sodden appearance, and is of red colour: there is considerable tenderness on
at the
dusky
pressure. centre
formed
The skin then
of the a
discharge,
patch,
small
quantity
of
often mixed with
It is in this stage that the
point in the opening so tenacious yellowish
gives way through
and
a a
men
at a
the
little blood, escapes. generally come to hos-
pital. If
a
will be
probe be found
now
that it
the detached skin to
passed can
some
in at the
opening,
it
be moved freely under extent in all directions.
The loosened skin then
sloughs away, leaving a y2 an inch to 3 inhctie in diameter, covered with a sticky greyish yellow exudation, and bounded by somewhat overhanging ragcred edges and an areola of low cedematous inflamsomewhat circular ulcer from
mation. In this state the ulcer may remain for
some
weeks
either
slowly or, in some few cases spread usually however, after remaining very rapidly; few for a days, it begins to heal. stationary is Healing always preceded by a return to the natural state of the cedematous ring of inflammation round the ulcer, and is usually rapid. A flat shiny scar is left after healing. or
it may
The average duration of each
three weeks, and
they mostly
case was a ran
a
little
over
very uniform
course.
Varieties.?The ulcer is one, and in
only
an
essentially a superficial inappreciable minority of the cases
below the subcutaneous cellular and in all these the men were much below par. did it
pierce
tissue,
THE INDIAN MEDICAL GAZETTE.
254
Some of the ulcers
presented the appearance due
of
being
great amount of very deep ; cedema in the subcutaneous cellular tissue raising the level of the skin,and not to penetration of desp tissues. but this
pain
The amount of cases
there
there
was
was
was
little
was
or none.
to a
in most
very variable, In the worst cases, where
cedema, great pain was complained of night, and in all these there was some
much
especially
at
febrile disturbance. Constitutional state.?The state of general health of the men attacked was conspicuously not at all
and except in the men attacked
uniform,
worst cases, I do
think that the
by
compare unfavourably with those who Some of the
men
attacked
good health, and, indeed, and healthy men suffered
not
the disease would
to be in very
exceptionally strong others were obviously in
many ;
poor health, and these furnished the worst cases ; others again shewed the blue line on the gums, supposed to indicate deficient vegetable feeding but quite as often
seen
in malarial cachexia.
tous, large and
painful, a state of debility, with nervous excitement, slight feverishrtess, and rapid loss of strength and flesh, would come on ; as soon, however, the low inflammation round the ulcer subsided,
rapid healing and complete The disease running a distinct
recovery would
ensue.
was
Race
and
caste.?The
cases
were thus
had
distributed
among the different castes:
Brahmins and Chatries
Jats Ahirs
F Co.
i8'5
per cent.
...
...
C
,,
17
...
...
D
?
15-8
?
2
,,
Hillmen
...
...
H
?
14-5
,,
Sikhs
...
...
A
?
14-5
?
...
B
,,
io'o
?
...
G
?
6-5
?
...
E
,,
4*0
,,
"
All
races
Chumars, &c.
Mihtars, Inferior
and creeds"
caste
It will be
seen
Hindus
that the low
caste
Hindus,
who feed
best, have suffered least. Time of
fluence
on
were seen,
year?Has had the disease.
but
a very important inIn the hot weather no cases
at the time of
maximum prevalence of during September, October and
malarial fever, namely, November, the great majority of the
this disease have
of
?
constitution?in
some
some cases.
cases
2.
occurred.
Enfeebled
3. Influence of climate
cases.
?after the rains.
Exciting.? Irritation of the skin or abrasion. The natives say the hardness of the water is I do not consider that
following
disease occurred
the
principally vegetables are most abundant; of vegetables are sold in the bazaar, had
a cause.
scorbutic taint has had
a
much to do with it for the
at
reasons. season a
The
of year
large quantity
and
fresh limes
obvious curative effect.
no
Malaria has
no
doubt been
disease occurred almost
important factor : the
an
at the
entirely
malarial time
of year. The type of the ulcer
before
was
of
character I have
a
although many cases were those of the ulcer of debility,?flabby, indolent, and not attended with any marked heat, swelling or pain, and slow to heal?in many others the ulcer spread rapidly, and was attended with much heat, swelling, and pain and some constitutional disturbance, and was further characterized by healing very rapidly as soon as the oedema had subsided, running a course resembling that of an acute abscess. met
with,
regular course, specific or special very The
following
1.
...
considerations it
above
causes
for
Treatment.?As the disease is
course.
observed that very few of the men suffered from fever lately who had the ulcers. It
the
Predisposing. i. Underfeeding?in
not
It was a very noticeable feature in the disease that, in the bad cases, the men would often look in very fair health on admission, and as the ulcer became (Edema-
as
Causation.?From would appear that the been as follows :?
when
escaped.
appeared
[September, 1884.
might
as
treatment
means were
one
have been was
used
which
runs a
expected,
no
found serviceable.
:?
Local.?
bed, strapping, splints, elevation of the limb ; caustic, astringent, and stimulating dressings 5 poultices and sedative applications ; iodoform ; several preparations of opium. Rest in
2.
Constitutional.?
Opium ; feeding stimulants, limes. The
up ; iron tonics ;
most successful
Poultices
local
quinine, arsenic,
applications by
far were?
containing laudanum ; solution of nitrate 10 to t?) ; solution of chloride of lime (gr. 20 to ?i). All strong caustic applications were very decidedly injurious, and after a week's trial I entirely abandoned them. As soon as the ulcer began to heal the following treatment was of use :?Resin ointment dressing and once in 3 days application of solution of nitrate of silver. of silver
(gr.
UIXERS OF LEG AMONGST SEPOYS.
September, 1884.] Skin-grafting
used in
was
a
few
Of the constitutional treatment, were
decidedly
and milk
given
to
were
the
cases
feeding
successfully.
and stimulants
best, quinine benefited
given
to all the
those whose ulcers
some
?,
rum
bad cases; were
opium was painful at night,
and with much benefit. All of
the
cases
recovered, though had
long duration ; two they were both hillmen.
to
be
sent
some on
few
were
sick leave
/
>
255
