SURGICAL USES 
OTHER THAN HEMOSTATIC 
OF THE 
STRONG ELASTIC BANDAGE. 
BY 
IIENRY A. MARTIN, M.D., 
B REVET LIEUT.-COLONEL AND LATE SUROBON U.XffVWR* 
Reprinted from the 
Transactions of the American Medical Association for 1877. 
“ L’office du boa Medecin 
Est de guarir la maladie 
(duo s’il ne vient & ceste fln 
An moins faut-il qu’il la pallie.” 
Canons et Regies d’Ambroise 1’ark. 
B O 8 T (3 N : 
JAMES CAMPBELL. 
1878. SURGICAL USES 
OTHER THAN HAEMOSTATIC 
OF THE 
STRONG ELASTIC BANDAGE. 
BY 
HENRY A. MARTIN, M.D., 
BREVET LIEUT.-COLONEL AND LATE SURGEON U. S. VOLS. 
Reprinted from the 
Transactions of the American Medical Association for 1877 
“ L’office <lu bon Medecin 
Est dt) guarir la maladie 
due s’il ne vient & ceste fin 
Au moins faut-il qu’il la pallie.” 
Canons et Regies d’Ambeoise PaeIj. 
BOSTON: 
JAMES CAMPBELL. 
1878. SURGICAL USES OF THE STRONG ELASTIC BAND- 
AGE OTHER THAN HEMOSTATIC. 
Announced as above, I made somewhat extended remarks, 
on the third day of the late Convention of the American Medical 
Association at Chicago. 
So much interest, unusual and unexpected, was manifested in 
what I said, both at the time and ever since in very numerous 
letters of inquiry, that I gladly accede to the request contained 
in many of these, and also made by the Secretary of the Surgical 
Section, for a written abstract or resume of my remarks. 
The subject is one which has largely occupied my attention for 
a great many years. I have always been convinced of its im- 
portance, and always intended to communicate to the profession 
the results of my labor and observation in its investigation. In- 
deed it was because I considered the matter so very important 
that, although I have spoken of it freely to physicians, I have so 
long refrained from publishing anything about it. I did not 
wish to commit myself in print until I had accumulated such a 
mass of the results of experience and observation as should ena- 
ble me to speak with decision and without doubt on every point, 
and such accumulation cannot be rapidly made by a private 
practitioner without any of the great facilities of an hospital ap- 
pointment. 
I regret, on all accounts, that this paper has not, for its author, 
some man whose name commands the attention of the profession. 
“Truth is mighty, and will prevail,” I suppose, no matter who 
heralds her. It may be so perhaps, eventually, but I know from 
experience how slow even the enlightened world of the medical 
profession is to recognize Truth unless some great name announces 
her, and how, indeed, with such introduction, Folly and gross 
outrageous Error pass for her. 4 
THE STRONG ELASTIC BANDAGE. 
Tt is so very easy, however, for any one to test the truth of 
what I shall write—for the world is full of uncured ulcers and 
the other troubles for which I recommend a certain treatment— 
that I cannot help hoping, even against experience, that my 
readers, however eminent, will not criticize me unfavorably till 
they have fully tested, as they can so easily do, the method I 
shall describe. 
I call the bandage “the strong elastic bandage,” and not Es- 
march’s, which it much resembles, because I was making almost 
daily use of it very many years before Esmarch made the dis- 
covery and published the great improvement in practice which 
has immortalized an already illustrious name. I make no claim 
whatever to Esmarch’s discovery, although very many years ago 
I twice made suggestions to surgeons, about to amputate legs, 
which, if regarded, might have led to that discovery. The sug- 
gestions, however, were not regarded, I being at the time a 
“ young physician.” Indeed, I felt theoretically sure that such a 
bandage could not arrest the deep arterial circulation in a limb, 
so sure that I never took one of my bandages to try the simple 
experiment which would have developed the very important 
discovery that it easily can and does arrest it. The history of our 
art is largely a history of being satisfied with nice theories, and 
shirking the simple practical experiments which, when made, 
fill the world with wonder that they were not made long before.1 
1 I think that I am familiar with the uses hitherto made of India-rubber in sur- 
gery, and correct in supposing that most of the suggestions contained in this 
paper are original with myself. If mistaken, I am open to correction. The only 
publication of which I have knowledge in which strong rubber bandages are 
commended for the cure of ulcers of the leg, is a very brief paper in the London 
Practitioner for May, 1876, giving an account of the very rapid and satisfactory 
cure of six and probable cure of a seventh ulcer of the leg by the use of Esmarch’s 
bandage in a way quite different from mine. The writer is Dr. S. D. Turney, of 
Circleville, Ohio, and the paper a very interesting and important one, although 
so little noticed even by the editor of the Practitioner as to be entitled, by an 
absurd error or oversight, “ Use of blisters in chronic ulcers.” Dr. Turney’s 
method is to apply Esmarch’s bandage very tightly, “ as long as it could be 
borne” “ (about ten or fifteen minutes),” once a day, till cure is effected. His 
first case must have been a most unfavorable one, an old woman (85 years) with 
a “ chironian ulcer” on the ankle which had resisted the treatment, for fifteen 
years, of several physicians, Dr. Turney included. In less than four weeks she 
is reported as perfectly cured, cicatrization firm. The report of the case was pub- 
lished two years after the cure, during which the cicatrix had endured and 
“ resisted a severe attack of eczema.” Dr. Turney’s paper is in my estimation 
very important and suggestive. I take pleasure in calling attention to it. In a 5 
THE STRONG ELASTIC BANDAGE. 
I hope that the following papers may answer intelligibly the 
requirements of the profession. If any point seems obscure to 
any of my readers, or information is desired on any point not 
treated in it, I shall be most happy to clear up the obscurity or 
afford the desired information, if in my power, in answer to a 
request to that effect. 
Treatment of Ulcers of the Leg by the Strong Elastic Bandage.— 
For over twenty years I have, with unvarying success, treated 
all forms of ulcer of the leg by the application of a bandage of 
what is technically known as “pure rubber.” The length of this 
bandage is ten and a half feet, width three inches, and thickness 
of No. twenty-one of “ Stubs’ wire gauge.” Into one end, two or 
three inches of strong linen cloth is inserted, and to this is strong- 
ly sewed a stout double tape eighteen inches long. It is im- 
portant that the edges of the bandage should be perfectly even. 
If there is the slightest notch in them, the bandage will be very 
apt to tear at that point, and become useless. If, however, it 
be properly cut, it will bear almost any amount of continued 
traction. This even cutting of the bandage can only be done 
properly by machinery. When I began to experiment in this 
method of treatment I attempted to cut the bandages from the 
sheet rubber with strong sharp shears, but I found it impossible 
to cut them with sufficient accuracy. All my bandages are now, 
with the exception of attaching the tapes, made at the India rub- 
ber factory in my neighborhood. It is astonishing how long a 
properly made bandage will wear. Many of my patients are 
wearing them every day, and have done so for two, three, even 
four years, and I have cured several successive poor patients’ 
ulcers with a single bandage which is still perfectly serviceable. 
To insure this durability the material must be the best Para 
rubber, prepared with the minimum of sulphur and heat needed 
to effect that “curing” of the gum, without which it would very 
soon deteriorate and become worthless. The dimensions given 
are those which I have found most generally applicable. If a 
leg is very long and large, an addition of two or three feet in 
length, and of half an inch in width, may be desirable. In a few 
bad case of indolent hard-edged ulcer, I should certainly practise this method 
pari passu with my own, i. e., tight application of bandage for a few minutes each 
day, and gentle continued pressure for the rest of the twenty-four hours. 6 
THE STRONG ELASTIC BANDAGE. 
cases, where a varicose condition of the veins of the thigh accom- 
panies the ulcer or ulcers on the leg, I apply a bandage from the 
foot to the groin ; this must be from eighteen to twenty-one feet 
long, and, if the limb is very large, a width of three and a half or 
even three and three quarters inches may be requisite. If the 
leg is very slender, there will be somewhat more bandage than 
is necessary; this, however, can be wound round below the knee, 
or, of course, cut oft' to suit the exact requirements of the case. 
After being in use for a short time the bandages improve in 
appearance by getting rid of the sulphur which, to use a technical 
phrase, “sweats out” of the rubber. This sulphur is not at all 
objectionable except in appearance; indeed I think I am not 
fanciful in believing that, in certain conditions of the skin, it 
exercises a decidedly beneficial effect. The sulphur could be 
removed and a much nicer looking bandage produced, but this 
could only be done by certain chemicals which would probably 
injure the rubber. Now and then I use a bandage for a child 
or even infant, and, of course, a narrower and shorter but not 
thinner one is needed. For diseases and injuries of and about 
the joints, bandages of very varying length, and generally wider 
and of greater thickness, are required, according to the amount 
of support and resistance to the undue motion of the joint which 
is sought after. I have described the bandage rather minutely, 
perhaps, for so very simple a matter; but I am anxious that 
surgeons who test the merit of the practice I commend should do 
so fairly, and that there should be no room for mistake. One 
word more, the thickness is what I have found after many varia- 
tions and trials to be exactly right. If thinner, it would not 
fulfil desired ends, and if thicker it would be unnecessarily 
clumsy and heavy, and much more apt to slip down unless a 
degree of traction should be made and pressure applied to the 
leg beyond what is desirable. 
I need not detail the steps by which I arrived at the knowl- 
edge that no other application except of such a bandage is needed 
for the treatment of all ulcers of the leg of a non specific charac- 
ter which are at all in the category of curable by any method, 
while many not really curable by other treatment have been found 
to yield easily and perfectly to this. I first used the rubber band- 
age as a substitute for the “ roller,” usually applied over Bayn- 
ton’s strapping. I soon dropped the strapping and substituted 
various salves and lotions. At last I discovered that the baud- THE STRONG ELASTIC BANDAGE. 
7 
age alone is all that is requisite, and that without the slightest 
interruption of the patient’s business or way of life, without 
the necessity of an hour’s rest or change of position. Indeed, 
during the whole time that the patient wears the bandage till the 
complete cicatrization of the ulcer, he is much more comfortable 
and able to work or exercise than before its application. If not 
a means of cure, the strong elastic bandage would be very 
valuable as a palliative, particularly in that very large class of 
ulcers complicated with a varicose condition of the veins. 
When it is considered how very large a proportion of cases 
of ulcer of the leg occur among hard-working people, dependent 
on daily labor for daily bread, how impossible to successfully 
treat many of them without rest and recumbent position, and 
how out of the question it generally is for such patients to take 
the time needed for treat ment, it seems to me hatthe value of 
the simple method I propose cannot easily be overestimated. 
The form of ulcer wh ich yields most perfectly and readily to 
this treatment is that very common one connected with a vari- 
cose state of the superficial veins. It is well known how 
unsatisfactory all previous methods have been in this class of cases, 
how next to impossible to obtain firm sound cicatrization of such 
ulcers without a very long continuance of the horizontal posi- 
tion, and how extremely liable they are to return, at the 
slightest provocation, when the erect position is resumed. The 
ulcers found on old poorly nourished legs, where there is a defi- 
ciency in the quality or quantity (generally both) of the blood, 
a feeble heart, imperfect circulation, and, consequently, a wretch- 
edly nourished skin—those which were called chironian ulcers by 
the ancients, deemed by them incurable, or curable only by the 
Centaur Chiron, or one his professional equal; round or approach- 
ing round, with perpendicular sides, as if cut with a punch 
through the much thickened skin, with white, hard, almost 
cartilaginous edges—yield the least readily, but still are healed 
by this method more speedily and much more solidly and endur- 
ingly than by any other. 
I need occupy but little space in describing my way of using 
the bandage, lor nothing can well be simpler. The patient is 
directed to put it on the first thing in the morning, before the 
veins of the leg become distended by the impeded column of 
blood within them. The very best way is to apply it while still 
in bed. It should be applied with just snugness enough not to 8 
THE STRONG ELASTIC BANDAGE. 
slip down. The moment after the foot is put to the ground, the 
limb is so increased in bulk by the increase of blood in its veins, 
that the bandage becomes of precisely the proper degree of tight- 
ness, and, no matter how active the exercise or labor of the 
patient, it will remain in position all day. The bandage is ap- 
plied by winding one turn just above the malleoli, then one round 
the instep and sole, then up the leg, spirally, round and round, 
to the knee, each turn overlapping that below it, from one-half 
to three-quarters of an inch. If there is any redundant bandage, 
it can be wound round the leg below the knee, the tapes carried 
in different directions and firmly tied. When the patient un- 
dresses at night, the bandage is to be removed, and the limb 
wiped dry ; a piece of soft old linen moistened with olive oil, or 
some equally simple dressing, laid on the ulcer and retained 
in place by a few turns of an ordinary roller. The bandage 
should be sponged with water (cold will do, but warm is better), 
and hung over a line to dry, in readiness for the morning; or it 
can be wiped dry at once, and rolled up with the tapes in the 
centre. Such is the dressing for the night; in the morning the 
leg can be washed, but, whether it is or not, all traces of oil or 
cerate should be carefully wiped away, as contact with the band- 
age of anv fatty matter would tend gradually to injure the rubber. 
This is the whole treatment. Eubber bandage all day, with erect 
position and exercise. The simplest possible dressing (merely to 
protect the ulcer from injury), with the horizontal position and 
rest all night. When the bandage is removed at night, it and 
the leg will be found to be bathed in moisture. That part of the 
limb to which the bandage was applied has been all day kept 
warm, moist, and perfectly excluded from the air, in an atmos- 
phere and conditions the most favorable possible for the processes 
of granulation and cicatrization. In addition to this, a gentle, 
continually maintained, and even pressure has supported the dis- 
tended and weakened vascular coats, and prevented that venous 
turgescence which is the cause, in many ulcers, of mal-nutrition 
of the skin, the sole reason why nature’s ordinary processes of re- 
pair are impeded and prevented. In those cases where no vari- 
cose condition of the veins exists, but in which an imperfect and 
feeble nutrition of the skin is the raison d'etre of the ulcer, where 
nature is unable to heal the slightest scratch, and the most trivial 
contusion rapidly changes into an indolent ulcer, with white, 
elevated, leathery edges, the bandage, by the warmth and moist- THE STRONG ELASTIC BANDAGE. 
9 
ure induced by its application, favors the circulation in the 
capillary vessels, and a determination of blood to the surface. 
The constant pressure is at once a stimulus to the process of 
granulation, and to the rapid absorption of the hard edges, the 
removal of which, in some way, is a necessary antecedent to 
cicatrization. During the first week or two, and in a few cases 
for even nearly three weeks, an eruption appears under the band- 
age, sometimes of few, sometimes of many papules, running very 
rapidly into suppuration. Each of these indicates an obstruction 
in one of the cutaneous follicles. The bandage is their best pos- 
sible treatment, for the moisture softens the indurated secretion, 
washes it away, or favors the rapid suppuration by which nature 
accomplishes the same object, and, in a very short time, the skin 
of the leg, subjected to a daily and all-day Turkish bath, becomes 
entirely clear of all obstruction, and so continues, however long 
the bandage may be worn. Often, ulcerated legs evince other 
evidence of mal-nutrition of the skin. Without enumerating or 
classifying these, all I need say is, that all, however diversely 
named in the terminology of that great science of words, derma- 
tology, are more or less decidedly benefited by the bandage. 
I think what I have written will afford a sufficiently practical 
notion of the method of treatment by the strong elastic bandage. 
During the past twenty-five years, I must have treated at least 
from six to seven hundred cases of ulcers of the leg in this 
manner, and all, without exception, have been perfectly and 
absolutely cured. I do not include cases of syphilitic or scro- 
fulous ulceration. Although often a very useful adjunct to treat- 
ment in such cases, the bandage alone is not sufficient. Of course, 
now and then, some other treatment is advisable, if not absolutely 
necessary, as, for instance, measures to obviate constipation, 
washing with a strong suds of tar soap, bathing with more 
or less dilute carbolized washes when the skin is extremely 
itchy, etc. 
As I am writing for physicians I need not describe the general 
treatment of these cases. The great aggregate of cases which I 
have treated by this method during so many years includes every 
variety of ulcer commonly seen. In the first one to two hundred 
cases, I employed other treatment with the bandage, but, for the 
last fifteen years, I have constantly used the bandage alone in all 
ordinary non specific ulcers, and with the most gratifying and 
complete success. I repeat this, for I wish to impress the reader 10 
THE STRONG ELASTIC BANDAGE. 
with something of my own estimate of the value of the method. 
My custom is, when a patient comes from a distance, to apply the 
bandage, give the directions as indicated above, and tell him or 
her, if the ulcer is not well in one month, or evidently getting 
well very rapidly, to come again and get any further advice that 
may be necessary gratis. In not a single instance have I ever 
seen one of these patients again, as a patient ; now and then one 
returns with a friend to report himself well, and to bring his 
friend for treatment. In this way, and principally from the large 
manufacturing towns and cities, have I treated so large an aggre- 
gate of cases. Patients who stand all day at the loom become 
very liable, at and after mid age, to ulcer of the leg, very often a 
sequela of a long continued varicose condition of the veins, and, 
consequently, I have had a great many patients from the great 
woollen mills at Lawrence and elsewhere. 
An apprehension has often been expressed by physicians, of 
oedema of the foot, as a consequence of applying the elastic band- 
age as I have directed. Such apprehensions are needless. It is 
a fact, and illustrates the manner in which this method proves so 
efficient, that a properly applied bandage of this sort does not 
produce oedema of the foot. If oedema appears, it is because the 
bandage is on too tightly; applied with the degree of closeness I 
have indicated, it does not stop the circulation in the veins, but, 
by supporting the walls of the distended tortuous vessels, facili- 
tates the passage of the blood through them, and, in this way, not 
only does riot produce oedema, but rapidly removes that which 
often, to a certain degree, complicates ulcer of the leg. 
Another and very important point is that of wearing the band- 
age after an ulcer is quite well, as a preventive of its return ; 
many of my patients do this continually by preference, even 
when not directed to do so. I advise all whose occupation 
tends to aggravate a varicose condition of the leg to wear the 
bandage while standing, both for the palliation of the symp- 
toms of the varicose veins and as a preventive of the return 
of ulcer. Other patients are directed to wear the bandage when 
obliged to be much on the feet, or if there is the slightest irrita- 
bility or redness at the seat of former ulceration, indicating a 
possible tendency to breaking down of cicatricial tissue. This 
is a most important point. The surgeon must bear in mind the 
tendency of eicatrices to break down from slight causes, and, 
particularly, where there is a diseased condition of the veins; THE STRONG ELASTIC BANDAGE. 
11 
and instruct his patient to have his bandage always ready and in 
good order to be applied at once if needed. The cicatrization of 
ulcers under the rubber bandage is much iirmer and better than, 
as a rule, I have observed to result from other treatment, but, of 
course, is not exempt from tlie tendencies and infirmities of all 
such tissue. 
In conclusion of this part of my paper, and to illustrate what 
I have already written, I will briefly narrate four cases, one of 
pure varicose ulcer, one of hard-edged “chironian” ulcer, one 
ulcer complicated with phlebitis, a sequela (of twenty five years’ 
endurance) of typhus (“ship”) fever, and a fourth of unfavorable 
condition of a large incised wound following removal of tumor. 
Case I.—In the early davs of my practice, nearly thirty years 
since, I had a patient, a man of about thirty, very tall, and some- 
what corpulent. IIis business was to drive a wagon, with meat, 
to supply the poorer classes at their residences. This business 
kept him almost continually on his feet, and was particularly 
obnoxious to him, for he suffered from an extremely varicose 
condition of the veins of both legs. This was associated with one 
or more ulcers on each leg. lie would, from' time to time, be 
obliged to give up his business and submit to treatment. Over 
and over again he came under my care, and over and over again 
he went through the usual routine of Baynton’s straps, roller- 
bandage, horizontal position, iodine, arg. nit., etc. etc. At last 
he became a proficient in the application of the bandage, and so 
familiar with the treatment of ulcers of the leg that he took his 
case into his own charge and ceased to send for me. When I 
began to use the elastic bandage I tried to find this patient, but he 
had gone from my neighborhood and for many years I did not see 
him. Some fifteen years since he appeared at my office, exhibited 
his legs, their veins larger and more tortuous than ever—the 
saphena vein in each thigh being certainly three-quarters of an 
inch in diameter from the knee to the saphenous opening. The 
legs below the knee were scarred by very numerous cicatrices of 
old ulceration on one, and on the other two ulcers remained 
unhealed. I told him how glad I was to see him, and all about 
the bandages, and applied one three and three-quarter inches wide 
and twenty-one feet long to each limb, extending from the ankle 
to the groin. After these were applied, he walked about my 
office and expressed his satisfaction with the immediate effect 
in relieving an aching pain, and a hope that now he was to be 12 
THE STRONG ELASTIC BANDAGE. 
cured. In three or four days, however, he returned, bearing in his 
hand the two bandages, and saying, “It’s no use, Doctor, I can’t 
wear them.” I found that his was one of those rare cases (I have 
seen but three or four, and this was the only one of ulcer, the 
others were of trouble of the knee joint) in which the bandage 
irritated or “chafed” the skin, ,i. e., macerated and removed the 
outer layer of epidermis and left the sensitive surface of the true 
skin too slightly protected. I told him not to give up without 
another trial ; that if he could not use the bandages, there was 
nothing to do but to return to the strapping, etc., with which he 
was so familiar. He had attained perfect skill in applying linen 
bandages, one of which he then had on each leg. I simply applied 
the elastic bandages over these, and told him to persevere. In a 
week or so he came to my office and requested me to let him 
have two pairs more of the bandages. lie said nothing could be 
more satisfactory; the relief of pain was perfect, although he was 
daily and all day long on his feet. The ulcers were already giv- 
ing the most favorable indications of healing. I asked him why 
he need get four more bandages. I told him that those he had 
would last for three or four years with care, and he could always 
get new ones from me. He said, “ Something might happen to 
you, Doctor ; you might move away and I not be able to get them, 
and I would not be without them for ten thousand dollars.” I 
have never seen this man since as a patient, but from time to time 
have met him in the street. His legs are quite free from ulcera- 
tion, and have remained so since the elastic bandages were first 
applied. He wears them on both legs every day, as a means of 
palliation of the symptom from varicose.veins and of prevention 
of return of ulceration. 
Case II.—That of old indolent gristly edged ulcer was one of 
the very worst I ever saw. The man was prematurely old, poor, 
badly nourished. The ulcer was round and about one-half 
larger than a silver dollar. In every respect it was a typical 
specimen of the “ Chironian ulcer.” The patient had been, for 
over nine years, almost constantly under treatment, as out-patient 
of hospitals, dispensaries, and also of private practitioners. The 
ulcer had several times been nominally healed, but had invari- 
ably reopened in a very few weeks after he returned to labor. 
This was a perfect test case. I treated it with the bandage only. 
In four months the ulcer was firmly and perfectly cicatrized. I 
might undoubtedly have hurried on the cure of this case by THE STRONG ELASTIC BANDAGE. 
13 
removing the thickened edges by caustic or the knife, but pre- 
ferred to depend on the bandage alone. This patient was directed 
to wear cotton drawers, but as there was no disease of the veins, 
was told that he need not wear the bandage after the ulcer was 
closed unless there should be signs of approaching trouble at the 
site of the ulcer. He has now for almost five years continued 
perfectly well without resuming the bandage. 
Case III.—The third case I shall mention was a very marked 
one. The patient was a very intelligent man, an apothecary, with 
sufficient knowledge, the “ little learning” of the poet, to treat 
his own case. I had repeatedly urged him to use the bandage, 
but he was theoretically so sure that it would not “agree with 
his skin” that he never followed my recommendation. His ulcer 
resulted from disease of the superficial veins and capillaries about 
one ankle, consequent on phlebitis of the internal saphena vein, 
following, with much other serious trouble, a very severe attack 
of “ ship” fever some twenty-four or -five years before his ulcer 
came under my charge. It was in the very worst possible place 
for an ulcer to be, so near the joint that any unusual exercise 
excited inflammation, and a breaking down of cicatricial tissue. 
A space twice the area of a dollar piece was composed of the 
cicatrices of repeated limited ulcerations. Some of this was good 
firm cicatrix, but a large part of it looked as if a very slight 
degree of inflammatory action would result in its destruction, 
and such was its history for all those years, repeated reopening 
and repeated imperfect flimsy cicatrization, as a result of “ strap- 
ping,” application of argentic nitrate, iodine, and the linen band- 
age, which the patient had learned to apply with exquisite 
neatness and celerity. My directions to him had been, as he 
would not use my bandage, to keep the leg in a horizontal posi- 
tion, and use the plaster and bandage as soon as the slightest 
indication of trouble with the veins was manifested. At last, 
exigencies of business absolutely required his active exercise, in 
the way of walking, for over a fortnight after he was warned of 
trouble along the whole course of the saphena vein, and by a 
rapid reopening of the ulcer. When I was called to him the 
entire main trunk of the vein was corded and tender. The cica- 
trices of former ulcerations had all entirely disappeared; their 
place was occupied by an ulcer. I drew from my pocket a rub- 
ber bandage, and, in answer to his urgent and repeated assurances 
that he knew he could not bear it, told him that I would have 14 
THE STRONG ELASTIC BANDAGE. 
nothing to do with the case unless allowed to treat it as I saw fit, 
and also that if he wished the bandage taken off after twenty-four 
hours’ application, I would consent to its removal. I applied it, 
from the foot to the groin, with a view not only to the cure of 
the ulcer, but also of the phlebilio condition. On my visit the 
next day, I found him full of gratification at the result. He had 
experienced almost immediate relief from pain in the limb, and 
more comfort than for several weeks; had slept all night, etc. 
This case improved with great rapidity, and in a little over three 
weeks the entire field of ulceration was covered by a firm sound 
cicatrix. He has had no trouble since (nearly three years), no 
return of the ulceration nor of the tendency to phlebitis, the 
starting point of which was invariably inflammation at the seat 
of the ulcer. The only precaution he has taken has been to put 
on the bandage when obliged to be much on the feet. lie has 
become its ardent practical advocate, as he was formerly theo- 
retically opposed to its use, in his own case at any rate, and has 
sent me several patients to be treated for ulcers and varicose 
veins of the leg. 
Cake IV.—This was the case of a girl of about ten years, unusu- 
ally fat and very well nourished. Shortly after birth a tumor 
was noticed on one leg; it gradually increased until, when I first 
saw her, it extended over two-thirds of the space from the popli- 
teus to the heel, doubling the size of the leg. The case had been 
seen bv other surgeons who had diagnosticated a fatty tumor. 
My d iagnosis was that it was polycystic, and so it proved. The 
tumor was composed of an immense multitude of round cysts, 
from those of microscopical minuteness to the size of a cherry. 
In one sense, it was a fatty tumor, but of cellular tissue remark- 
ably metamorphosed. It was very difficult to remove the entire 
mass, for there was no distinct capsule, and after three pairs of 
young eyes had decided all the cysts to be removed, a pair of old 
ones, aided by a strong glass, discovered several score of very 
small ones scattered about in the cellular tissue. It was abso- 
lutely necessary to make a long incision (of three-fourths the 
length of the whole leg). This wound did very well, except that 
the cicatrization of the skin was not satisfactorily completed, the 
entire line of incision became the seat of a troublesome ulcerative 
action, and the leg was gradually covered by an impetiginous erup- 
tion. I tried all sorts of washes and other applications, but they 
did no good; the leg had now, for two months after it had got 
nearly well, been in this uncomfortable state, annoying me, and, 15 
THE STRONG ELASTIC BANDAGE. 
of course, exciting the apprehensions of the parents; I thought 
of the bandage, it was applied without any other treatment, and, 
in less than a fortnight, the leg was perfectly well. 
Use of the Elastic Bandage in Injuries and Disease of the Joints, 
particularly of the knee and ankle.—Next to its utility in cases of 
ulcer of the leg, I consider the elastic bandage of great advantage 
in certain injuries and diseased conditions involving the joints, 
and particularly the knee and ankle. The cases usually called 
sprain or subluxation of a joint, consisting mainly of injury or 
even rupture of one or more of its ligaments, give a great deal of 
trouble to patients, and very often lead to serious and destructive 
disease. The ordinary treatment by liniments, anodyne, stimu- 
lant, corroborative, etc., is certainly not very fertile in brilliant 
results, and, in a very large proportion of cases, is the most irra- 
tional and fruitless treatment possible. IIovv rubbing the outside 
of a joint with any liniment, or painting it with tincture of 
iodine of any strength, can in any way strengthen a joint, or 
repair an injured or broken ligament, is very difficult to conceive. 
The end to be attained, if possible, is rest to the injured part till 
nature can restore it. The method of applying splint and band- 
age, or, better still, a plaster or starch bandage, by which the 
joint is fixed and kept from motion, does attain this, and at a great 
price, in loss of time and exercise, and is very apt to lead to a 
very decided stiffening, sometimes to a degree permanently impair- 
ing the usefulness of the articulation and nearly approaching an- 
chylosis. The joint is also weakened through want of exercise, 
by an atrophy of its ligaments and of the muscles of the limb from 
disuse. The strong elastic bandage wound round a joint affords 
a constantly present substitute, externally, for the ligament or 
ligaments temporarily disabled. The constant pressure induces 
a rapid absorption of exudation among the tissues about the seat 
of injury, and the gentle equable warmth and moisture, which 
always accompany its application, have a most favorable effect 
in alleviating and preventing inflammation. The great advan- 
tage of the elastic bandage in these cases is best seen after their 
most acute stage, but I now always apply such a bandage soon 
after injury and often it is the first and only application. The 
judgment of the surgeon must be exercised in the application 
of this as of all other remedies, but it may be emphatically as- 
serted that in all cases of sprain of the knee and ankle, after the 16 
THE STRONG ELASTIC BANDAGE. 
first most acute symptoms have subsided, and in a very large 
proportion of cases as the first and only treatment the bandage 
will be found to afford results quite unapproached by any other 
mode of treatment. I not only permit patients, suffering from 
injury or weakness of the knee or ankle resulting from previous 
disease, to take exercise, but urge them to do so, as a means of 
restoring the injured joint to its original strength. The one 
thing to be borne in mind is that the bandage is a temporary 
substitute for the injured ligament or ligaments; to take the 
place of these, and so permit them to have that undisturbed rest 
which is absolutely essential to their perfect repair. The appli- 
cation of the bandage must, therefore, be so made as to support 
the joint in such a way as to prevent motion, to an extent or in 
a direction which would apply extension to the injured ligaments. 
There is some difficulty in explaining in words the exact way 
in which the application of the elastic bandage is best made to a 
knee or ankle, one or more of the ligaments of which are elong- 
ated, weakened, or sensitive from disease or injury, but a single 
application in such a case will make all this clear to the practi- 
tioner if he has any just idea of the true indications of treatment. 
Take, for instance, a “sprained” ankle. There is a want of 
strength and control of the joint; it is very easily “ turned,” to 
use the common phrase, in the direction in which it was thrown 
by the original injury. This turning of the ankle, if extreme, 
violently extends the ligaments already injured, increases their 
sensitiveness, stretches and weakens them still more, and possibly 
even completely ruptures tissues which, before, had been only 
strained. The bandage, one, two, three, or more turns of which 
surround the joint, affords a firm, strong, constantly resisting and 
resilient force to prevent extreme distortion, and still permitting 
the natural motion of the joint to a sufficient degree. That 
lateral motion which does not exist at all, or only to a very 
limited extent, in a healthy ankle, and is only rendered possible 
by the rupture or stretching of certain ligaments, is prevented or 
sufficiently limited. Injury has weakened or broken the strong 
bands which bind the bones together and limit motion in a cer- 
tain direction beyond a certain point. Art must supply a means 
to replace, for a time, these injured structures. The elastic band- 
age does this in the best possible way. Its employment does 
not involve entire immobility and uselessness of the joint, does 
not involve the danger of weakening it from disuse, nor of an- 17 
THE STRONG ELASTIC BANDAGE. 
chylosis or an approach to it from continued and entire fixation. 
Its use affords other advantages, to which I have already alluded, 
in the absorption of interstitial exudations, in the diminution of 
congestion and inflammation by the gentle constant equable 
pressure, and by the profuse sweating and constant warmth always 
induced by its application. These last effects are precisely those 
of a poultice and useful for similar reasons, but in a way and to 
a degree far superior to any possible poultice, as will be most 
evident to any careful observer after a very limited amount of 
practical observation. Sometimes the foot can be moved freely 
and painlessly in any direction but one. It will be found that, 
perhaps, one little ligament binding one of the tarsal bones to one 
of the metatarsus is injured, any motion of the foot is painless 
but that particular motion which exercises traction on that one 
little ligament. I know no way but by the use of the strong 
elastic bandage that such a case can be successfully treated with- 
out a fixed apparatus. I have treated many cases of sprain or 
subluxation of the knee and ankle as I have indicated with per- 
fect and speedy success. 
In many cases of disease and injury of the knee and elbow, and 
also of other joints, but chiefly of these, there is an increase of 
effusion in the synovial sacs. In recent cases I have found the 
bandage alone to be sufficient to promote its rapid absorption. 
In cases of long continuance, if the increase of synovia is slight, 
I have also succeeded without other treatment; but in chronic 
cases, with a considerable amount of effusion, I have been lately 
almost always in the habit of aspirating the synovial sac before 
applying the bandage: and I have never known a case in which 
this was done in which the effusion returned. I have never known 
a case where such a joint was “aspirated” and no such support 
afterwards applied in which effusion did not return, whether the 
synovitis was the result of injury or of disease. The synovitis 
following rheumatism of a chronic character, I have never seen at 
all benefited by the entire apparatus of iodine “ paint,” blistering, 
cupping, leeching, etc. I have treated several such cases by 
aspiration and the subsequent constant use (night and day) of 
the bandage for at least six weeks, and with complete success. 
I think my readers can apprehend, from what I have written, 
my views of the rationale of the treatment of injuries and certain 
diseased conditions of the joints by the strong elastic bandage; 
if so, my object is attained. I will narrate briefly two cases, one 18 
THE STRONG ELASTIC BANDAGE. 
of disease, the other of a result of injury, both of the knee-joint, 
to illustrate what I have written. 
Case Y.— A lady, the wife (now widow) of a most distin- 
guished and heroic officer of our navy, wrote me from Ports- 
mouth, N. IT., that she had heard from a lady friend of her per- 
fect relief at once, and cure in a few weeks of a lame knee, which 
had been treated persistently for over two years quite ineffectually 
by the usual methods. This cure, she had been informed, was 
bv a bandage applied by me. She wished to appoint a time for 
meeting me, to ascertain whether her knee, which had for several 
years resisted the most varied treatment, might perhaps be capa- 
ble of relief by the same means. In due time she came to see 
me, was lifted out of a carriage by the coachman, and, with the 
same assistance, limped painfully to my door. She had sprained 
one knee nearly four years before, and had suffered lameness and 
pain in the joint, which had slowly but steadily increased until 
now she was rendered almost helpless, and suffered extremely. 
The knee was not painful on pressure, but motion beyond a very 
limited extent was extremely painful. The synovial sac was 
enlarged, extended much beyond its natural limits, and could be 
felt and seen forming a sort of tumor in front of the upper end 
of the tibia. It formed a flaccid sort of bag, which had evidently 
at one time contained a much greater amount of effusion; this 
had distended the sac, had been to a great extent absorbed, and, 
as a consequence, this flaccid sac, stretched ligaments, and a pain- 
ful weakened joint. All I prescribed was a strong rubber band- 
age wround several times about the joint in such a way as to fulfil 
the indications I have already sufficiently defined. In two months 
a carriage drove to my house, a lady jumped briskly out and ran 
up to my front door. She had called, she said, to tell and show 
me how' perfect a result had followed the simple treatment I had 
recommended, and, seeing me sitting at my parlor window, had 
been more demonstrative of her agility than she might otherwise 
have deemed necessary. This lady had been continually under 
treatment from the time of injury till I saw her, the treatment 
not of quacks and bonesetters, but the regular accepted routine 
practice of the regular accepted routine profession, and all with- 
out the slightest benefit that she or anybody else could discover, 
but, on the contrary, with evident injury to her general health 
and an apparent aggravation and increase of local trouble and 
infirmity. THE STRONG ELASTIC BANDAGE. 
19 
Case VI.—A merchant, aged about 35, subject to rheumatism, 
came under my charge at the height of an attack of that disease. 
Almost every joint was swollen and extremely painful. Under 
treatment this all very soon got well, with the exception of one 
of the knee-joints. This one joint resisted all treatment. The 
synovial sac was distended by a considerable amount of effusion. 
I applied a blister, and prescribed other treatment, but with no 
effect. One day I expressed my surprise that this one joint gave 
so much trouble, and the patient told me that it had troubled 
him for over nine years; that, during all that time he had been 
subject to attacks of pain and swelling limited to that one joint, 
and laying him up for weeks. This was the very first case of 
effusion in the synovial sac in which I used the elastic bandage, 
and was before I was entirely familiar with its use and effects in 
such cases. There was an open blister over the head of the tibia, 
and in my ignorance I did not like to apply the bandage till that 
was healed. I pemovechby aspiration 3X of synovial fluid. In 
ten days the sac was more distended than before, and the blister 
closed. I again aspirated the sac, which yielded 3x>>j of pure 
synovia, and applied the bandage. The man was up and about 
in three days. He wore the bandage night and day for three 
months, and has since (over four years) been entirely free from 
trouble in the knee. I have treated several cases of effusion in 
the synovial sac since that case in precisely the same manner, and 
with invariable success. In none of these cases has there been 
any return of the undue effusion if the bandage was properly 
applied for a sufficient length of time after the aspiration of the 
joint. It is very important in these cases that the patient should 
perfectly understand that the bandage must be worn night and 
day for at least six weeks. If the bandage is left off one day 
effusion may again distend the sac, and the aspiration have to be 
repeated. I have had two or three cases fully illustrative of the 
importance of this caution. One patient had 3ix of synovia re- 
moved and the bandage applied to the knee. I visited him again 
in a week, found that he had misunderstood my directions how 
to apply the bandage; it had become loosened and had not been 
reapplied, the sac had refilled; I aspirated 5xiss, and hammered 
into the fellow’s head the simple lesson of applying the bandage, 
and, when I again saw him, three months after, his knee was 
quite well. 20 
THE STRONG ELASTIC BANDAGE. 
Disease of Bnrsse Mucosse.—I have treated seven cases of what 
is called “housemaid’s knee,” by thoroughly evacuating the 
unusually distended bursa mucosa and at once applying the 
bandage, to be worn, day and night, for a month. No other 
treatment was used, and the results were, in every case, success- 
ful. One case of enlargement of the bursa patellae was treated 
in the same way with success. 
(Edema and Anasarca.—I have treated many cases of anasarca 
and oedema of the leg with the rubber bandage. By its use, 
inordinate effusion into the cellular tissue, with its many incon- 
veniences, may be prevented, and, when present, it may be 
rapidly diminished during the application of the bandage. Of 
course, in many cases, such application of the bandage is merely 
palliative. In two cases, that oedema of the arm which is one 
of the miseries accompanying the latter stages of cancer of the 
breast has been moderated and almost removed while the band- 
age was applied. 
Erysipelas and Erythema.—I have used the bandage in three 
cases of these affections of the leg, with the effect of at once 
arresting the disease, mechanically expelling the blood from the 
congested capillaries, and, as it were, extinguishing the fire 
{Ignis Sancti Anthonii) by depriving it of fuel, so rapid and 
complete was the result. 
Cutaneous Affections.—I have also used it, with great success, 
in several cases of various forms of inflammation and the results 
of mal-nutrition of the skin, to which very learned words, of 
sesquipedalic length and Greek derivation, are applied in the 
jargon of dermatology. In every case of cutaneous disease, 
however named, dependent on imperfect nutrition due to unequal 
and defective circulation, I should not hesitate to use this means, 
with confident expectation of good results. 
Injuries of the Bones.—I have made use of the bandage in two 
cases of the rare injury entitled “green-stick” fracture, both of 
bones of the forearm in children. The gentle, constant pressure, 
attained by applying it over a splint, gradually accomplished a 
perfect reduction of the fracture and removal of deformity, 
which I had been quite unable to do by persistent manipulation. THE STRONG ELASTIC BANDAGE. 
21 
I have used it in three cases, two in the arm and one, now under 
treatment, of the leg, to straighten out a bad- union of recent 
fractures, and have succeeded thus in gradually rectifying de- 
formity for which there seemed no remedy but re-fracture. 
Rheumatism and Neuralgia.—The application of bands of thin 
rubber to joints and parts of the body affected with certain 
forms of rheumatism and neuralgia is not new, but I think that 
the use of a strong bandage of the same material, capable of 
exercising graduated and continued pressure on joints and por- 
tions of the limbs affected in this manner, is original with myself 
There is no doubt that often chronic pain is the result of effused 
products of disease, pressing on nervous branches and interfering 
more or less with the innervation of parts. The constant warmth, 
moisture, and, above all, pressure produced by the bandage have 
a most undoubted effect, not only immediately in the manner of 
a poultice, but permanently by bringing about a rapid and com- 
plete absorption of morbid deposits. Whatever the theory of 
relief in these cases, I have treated so many rheumatic and 
neuralgic joints with the most gratifying, immediate, and perma- 
nent results that I can have no doubt whatever of the value of 
the method. I have found the elastic bandage a very useful 
temporary surgical dressing after the reduction of certain dislo- 
cations of the joints, particularly of the elbow, preventing entirely 
the tendency to return of displacement, and at the same time 
permitting use of the limb. I have before alluded to its use in 
subluxations and their sequelae. 
In Varicose Veins, as a Substitute for the Laced StocMng.—In a 
previous part of this paper I have, very fully, alluded to the use 
of the strong elastic bandage for ulcers of the leg complicated 
with a varicose condition of the veins, and also of the importance 
of wearing the bandage in such cases, after cure of the ulceration, 
for relief of symptoms of the disease of the veins, but more par- 
ticularly as a preventive of the return of the ulcer. From all 
this it will be naturally inferred that I also use the bandage in 
cases of varicose veins of the leg where no ulcer exists. Asa 
substitute for the familiar “ laced stocking,” I have found the 
rubber bandage very useful in the palliative treatment of vari- 
cose veins. The laced stocking, if very well made, and accu- 22 
THE STRONG ELASTIC BANDAGE. 
rately fitted, affords great comfort and relief, by supporting the 
weakened walls of the diseased vessels and preventing their dis- 
tension and the consequent pressure on nervous branches which 
produces so much and often such extremely distressing aching 
pain. The laced stocking, however, becomes every day less and 
less of a support, and in order to obtain all the relief it is capable 
of affording, it has to be frequently renewed, and, as each stocking 
is very expensive, the annual outlay is considerable even for 
comparatively wealthy patients, out of the question for the poor. 
The expense of a rubber bandage is not more than one-fourth or 
fifth of that of a silk laced stocking, and no other is worth hav- 
ing. It may, with care, be constantly worn for two to even 
four years, and afford as perfect a support, so long as it holds 
together, as it did on the first day of its application. 
There are two objections to its use, which maybe alleged: 
one, the constant and often profuse perspiratory moisture under 
the bandage, and “ chafing” of the skin. 
The annoyance from the profuse perspiration may be very 
much modified by wearing a linen or cotton or thin woollen (as 
of bunting) bandage next to the skin. A bandage of thin rub- 
ber perforated in the manner of card-board and “ porous” plasters, 
has been recommended and employed in the palliative treatment 
of varicose veins. This is too weak to afford a sufficient degree 
of support, except for patients of inactive and sedentary life and 
habits. The perforations render the bandage very liable to be 
torn and so rendered useless, and do not accomplish the end 
aimed at, of affording a means of escape for the moisture. 
Besides this, they have a very great drawback; the skin is 
pushed into each of the little holes in the rubber, and each of 
these minute herniae becomes the seat of congestion and possible 
inflammation. I have seen one case in which each of the little 
tumors became an angry suppurating pimple. Such a bandage 
might be worn over a cloth “ roller,” but would be found to pos- 
sess no advantages whatever in diminishing the amount of per- 
spiration, over one without perforation. The chafing which many 
people dread and expect from the use of a rubber bandage is 
very seldom found to offer any serious objection to its use. I 
have, in a very large experience, for over twenty, nearly twenty- 
five, years, found but three or four cases in which the patient’s 
skin could not endure the immediate contact of the rubber. In THE STRONG ELASTIC BANDAGE. 
23 
a few cases the skin is somewhat irritated by the maceration 
and removal of the outer and effete layer of epidermis, but it 
very soon becomes habituated, as it were, to the new application, 
and is invariably in a very much healthier and quite unobstructed 
condition after a fortnight’s use of the bandage than previous 
to its application. I have many poor patients wearing the band- 
age, continually, as a palliative of the symptoms of varicose legs, 
who are quite unable to bear the expense of laced stockings, and 
who are enabled to attend to their daily labor with comfort and 
without interruption. I have also patients wealthy enough to 
afford laced stockings of the best description, and who wore such 
for 3'ears, who have abandoned them and now wear the rubber 
bandage exclusively. 
Conclusion.—There are other applications which I have made 
of the bandage (as, for instance, with a compress over the track 
of a long sinus in the forearm), and others which I might sug- 
gest, but this paper has already far exceeded, unavoidably, what 
I expected at its commencement, and I will occupy my reader’s 
time and my own but a moment longer. I have written enough 
to indicate the way in which the strong elastic bandage accom- 
plishes very desirable results, and some of the applications of it. 
I am sure, from my own experience, that my readers will find 
it a very valuable means for the attainment of very important 
ends; and I doubt not that their ingenuity will suggest many 
applications of it which, in all my long experience in its use, 
have not yet occurred to me. 
Postscript.—In order that physicians may be able to obtain 
these bandages, properly made, I have made arrangements with 
Messrs. T. Metcalf & Co., 39 Tremont St., and Messrs. Leach & 
Green, 1 Hamilton Place, Boston, by which they will be supplied, 
from the same manufacturer who has always supplied me, with 
an ample stock of bandages, ready for use, not only for the leg, 
but of the varying length, thickness, and width required for 
exceptional cases and for the joints, and also the bandaging, so 
that surgeons cun have any length they require. The bandages 
supplied by these gentlemen will be precisely such as I use, made 
by the person who has always made them for me, and will be 
all inspected by myself. If there should arise any demand for 24 
THE STRONG ELASTIC BANDAGE. 
these bandages, there will, of course, be sharp and possibly not 
over-scrupulous competition in their production and sale. I 
hope, however, that if made and sold by others than those 
named above they will be of equal excellence, for I should regret 
extremely to have any physician disappointed and perhaps 
blaming me for results properly to be laid to the account of an 
ill-made bandage. 
The preceding paper was hastily prepared amid the press of 
numerous and distracting occupations and engagements, and is by 
no means so complete as I could wish, or as the practical impor- 
tance of its theme seems to me to merit. As an opportunity is 
unexpectedly offered, I wish to say a few words of the use of the 
strong elastic bandage as a means of effecting the radical cure of 
varicose veins of the leg, and of affording infinite immediate 
relief, and averting great possible permanent lesion, in that com- 
mon form of venous engorgement sometimes of both, but usually 
of one of the lower extremities of pregnant women. The appli- 
cation of the bandage affords perfect relief from the very wearing 
aching pain which accompanies the latter complication, and, if 
worn for the entire term of pregnancy, the tendency to a perma- 
nent dilatation and varicose condition of the veins is obviated. 
When I apply a bandage in one of these cases, I advise the pa- 
tient to wear it always, while on her feet, till her confinement, 
and, after that, to carefully preserve it, and, in case of future 
pregnancy, to re-apply it as soon as the first indication of venous 
engorgement occurs. Many of my patients have thus worn a 
single bandage through several successive pregnancies. 
I have already written, at some length, of the use of the band- 
age as a very effectual means for the palliative treatment of vari- 
cose veins of the leg, but nothing of the effect of long-continued 
pressure in accomplishing the radical cure of this extremely 
common and most distressing infirmity. I have long entertained 
a theory that the sort of pressure afforded by the bandage, if con- 
tinued for a long period, might effect radical cure in these cases, 
and had, when the body of this paper was written, observed some 
facts tending to confirm this theory. These facts were not, how- THE STRONG ELASTIC BANDAGE. 
25 
ever, sufficiently conclusive to induce me to “broach” my theory 
at that time. A very large proportion of my cases are only seen 
once 'by me. They come from distant places, and, except in a 
very few instances, I never see them after the first application of 
the bandage, nor, beyond information of the cure of ulcers, do I 
often hear any particulars of the results of treatment. Since writ- 
ing the paper, however, a very striking case has come under my 
notice, illustrating the effect of the constant use of the bandage 
for a long time in the perfect cure of varicose veins, so striking 
that I no longer entertain the slightest doubt of the truth and 
soundness of my theory. I will briefly narrate the case. 
Somewhat over two and a half years since, I was requested to 
visit a woman residing at a place some twenty miles distant. 
She was suffering from ulceration of both legs, and was quite 
unable to visit me, was, in fact, bed-ridden, and had been so for 
several weeks. I found a somewhat corpulent woman, aged 
sixty-five, with an extremely varicose condition of both legs 
below the knees. On one leg was an enormous ulcer nearly as 
large as the hand; on the other side were two ulcers, one of 
which was about half that size, and the other a little larger ; 
much of the skin not occupied by the ulcers was in a dark, livid, 
unsound condition, and the entire cutaneous surface was in a 
dry, scurfy, ill-nourished state. I need not enter into any de- 
tailed account of the case. It was simply a very bad one of an 
extremely common form of disease. For over eight years the 
patient had suffered continually from ulceration of the legs, and, 
for a much longer period, from the varicose disease. She was, 
just before I saw her, and had been for over a year, under the 
care of a soi-disant homoeopathist. His remedies and applications 
had been by no means homoeopathic, but had been employed with 
more zeal than knowledge, and had resulted in nothing but an 
aggravation of all her symptoms. She had, however, been pre- 
viously in the care of other physicians, and had received no per- 
manent benefit from treatment. This was a very exceptionally 
bad case. The extent and character of the ulceration and of the 
varicose disease were so great and aggravated, that I gave a 
much more “ guarded prognosis” than I generally give in these 
cases. Her son wrote me every few days in regard to the case, 
accompanying his reports with outlines of the changing shape 
and diminishing size of the ulcers. I need not detail the steps 
towards recovery, but will simply state that in a little less than 26 
THE STRONG ELASTIC BANDAGE. 
twelve weeks the final report notified me of the entire closure of 
the last ulcer. 
About a month since this old lady came to see me, and I ex- 
amined her legs with great interest. The skin was perfectly 
healthy, free from the slightest eruption or scurfiness, as soft and 
smooth as that of a perfectly healthy infant. Scars of not more 
than two-fifths of the size of the ulcers, perfectly smooth, and only 
distinguishable, at first sight, from the rest of the surface by 
their greater whiteness, remained; the dark livid color had en- 
tirely disappeared, and also every trace of the varicose condition 
of the veins in both legs. When I first saw her there was, in 
the course of the internal saphenous vein of each leg, in the usual 
position, on the inside and below the knee, an unusually large 
tumor composed of extremely varicose and tortuous veins, and 
the usual smaller masses of the same sort observed in aggravated 
cases. When I saw her, one month since, the only relics of these 
were slight traces, only discoverable by careful tactile examina- 
tion, of the two larger varices. This is but one case, but so 
extreme a case of varicose disease, and such a clear and perfect 
result, evidently of nothing but constantly and long applied 
pressure, that I think the impartial reader will agree with me 
that it goes far towards proving, if it indeed does not entirely 
prove, that such long-applied pressure may be considered a valu- 
able means to even the radical cure of varicose disease of the 
superficial veins of the leg. It would seem that in this case, the 
long-continued even pressure, never relaxed while the patient 
was in that upright position in which alone there is any ten- 
dency to undue venous distension, and the continual apposition 
of the internal walls of the diseased vessels to each other, had, at 
last, resulted in a complete obliteration of them as vessels, and 
accomplished precisely what is done in successful treatment bv 
the far from safe or invariably successful operation by ligature 
or the potential cautery. However the result was attained, of its 
thoroughness in this one case there can be no doubt whatever. 
The patient had, while in the erect position, worn bandages on 
both legs for very nearly two and a half years, and in illustration 
of what I have written of the durability of these bandages, if 
properly made, I may state that they were both in perfect pre- 
servation, as good, to all appearance, as on the day they were 
first applied. Indeed, I gave her a pair of new bandages for THE STRONG ELASTIC BANDAGE. 
27 
them, as I wished to possess them as specimens and illustrations 
of this great durability. 
Since my remarks at Chicago I have sent bandages to several 
gentlemen who were present there, and from two of these I have 
already received reports of very successful results from their use 
in cases of ulcer. I sincerely hope that other practitioners who 
may employ this method will publish their results, or, if they 
do not wish to do this, that they will communicate them to me 
with a view to publication, as I am very desirous that the merits 
of the treatment I recommend may be made evident by the re- 
sults obtained by others beside myself, who may, of course, be 
open to the usual suspicion of undue partiality for a method 
peculiarly my own. 
HENRY A. MARTIN.