ON THE USE OF THE 
SOLID RUBBER BANDAGE 
IN THE TREATMENT OF 
ECZEMA AND ULCERS OF THE LEG 
BY 
L. DUNCAN BULKLEY, A. M., M. D. 
Physician to the Skin Department, Demilt Dispensary, New York; Attending Physician 
for Skin and Venereal Diseases at the Out-Patient Department of the New York 
Hospital; Permanent Member of the American Medical Association; 
Fellow of the New York Academy of Medicine; Member of the 
New York County Medical Society; Member of the New 
York Dermatological Society; Member of the American 
Dermatological Association; Translator and Editor 
of Neumann's Hand-book of Skin Diseases; 
Editor of the Archives of Dermatology ; etc. 
[reprinted from the “archives OF DERMATOLOGY,” JULY, 1878] 
NEW YORK 
G. P. PUTNAM’S SONS 
182 Fifth Avenue 
1878 ON THE USE OF THE 
T c J - / 
SOLID RUBBER BANDAGE 
IN THE TREATMENT OF 
ECZEMA AND ULCERS OF THE LEG 
BY 
L. DUNCAN BULKLEY, A. M., M. D. 
Physician to the Skin Department, Demilt Dispensary, New York ; Attending Physician 
for Skin and Venereal Diseases at the Out-Patient Department of the New York 
Hospital; Permanent Member of the American Medical Association; 
Fellow of the New York Academy of Medicine; Member of the 
New York County Medical Society; Member of the New 
York Dermatological Society; Member of the American 
Dermatological Association; Translator and Editor 
of Neumann's Hand-book of Skin Diseases; 
Editor of the A rchives of Dermatology ; etc. 
[reprinted from the “archives OF DERMATOLOGY,” JULY, 1878] 
NEW YORK 
G. P. PUTNAM’S SONS 
182 Fifth Avenue 
1878 G. P. Putnam’s Sons, Printers. 
182 Fifth Avenue, N. Y. ON THE USE OF THE SOLID RUBBER BANDAGE IN 
THE TREATMENT OF ECZEMA AND ULCERS 
OF THE LEG* 
FEW cases of chronic affections of the skin are more dis- 
tressing to the patient and annoying to the physician, 
than those of eczema and ulcer of the leg which are depen- 
dent upon varicosity of the veins ; and it is the fact these cases 
occur in those who are least able to rest, and to put themselves in 
a condition for recovery that makes them more rebellious to treat- 
ment. Every one can recall cases of chronic eczema of the legs 
(often erroneously called erysipelas), and of ulcers, which either, 
they have treated for a time with moderate success only, until the 
patient was tired of treatment, or else in which they have simply 
advised the wearing of a bandage, or a laced- or elastic-stocking, 
hardly expecting more than a palliation of the troublesome symp- 
toms. My mind runs back, during the past few years, to many 
many such cases in Dispensary practice, when relief has been 
given time after time, only to be again sought for when some un- 
usual amount of standing or exhaustion has occasioned the old 
enemy to break out anew. And these cases often occur in hard- 
worked house-wives, the mothers of large families, whose very 
existence depends upon their being on their feet all the day, like 
as not at the tubs or ironing table ; the same is seen in men or 
women who stand continuously as cooks, waiters, factory hands, 
etc. And these cases are also very commonly seen in those in 
whom poverty has also had its share in producing the lesion, and 
scanty and poor food has so relaxed the tissues that the veins easily 
become distended, and the capillaries readily dilate and rupture. 
Now to attempt to put such patients in bed is utterly out of the 
question, and even when it is possible it is well known that the re- 
sults of treatment in bed are often temporary, and that when the 
patient resumes the standing position the eczema or ulcer may 
and frequently does return. 
* Read before the New Hampshire Medical Society, June 19, 1878. 4 
L. DUNCAN BULK LEY; 
If an ordinary bandage, or an elastic- or a laced-stocking is 
used to keep the disease in check, we have the constant distress 
and aggravation of the trouble occasioned by the sticking of the 
dressing to them, or to cloths placed beneath them, while the firm, 
non-elastic tension of the cotton bandage and the laced-stocking 
is often really distressing to the patient : the cost of elastic web 
stockings and the necessity of their frequent renewal is a serious 
obstacle to their use in very many cases. 
For these reasons the solid rubber bandage promises, I think, 
to effect a revolution in the treatment of such cases, and will be 
hailed with pleasure by multitudes of physicians and patients. 
One year ago Dr. H. A. Martin, of Boston, brought the subject 
before the notice of the American Medical Association,* and his 
claims for the solid rubber bandage were so extraordinary that I 
determined to make use of it on the first opportunity, feeling as- 
sured that this was just the means I had long wanted for the cure 
of a certain class of my patients whom I felt certain were not re- 
ceiving all the relief which medical skill should furnish them. 
The article fell under my notice some months after it was de- 
livered before the Association, so that my time for testing the 
matter has been somewhat limited, (shortened also by sickness and 
consequent absence from work and from the city), and the actual 
number of my cases is small compared with the several hundred 
cases in which Dr. Martin has employed it. 
But the subject has appeared to me to be of such vast importance, 
and my results with this method of treatment have been so uniformly 
good, as have also those obtained by others to whom I have recom- 
mended it, that I feel it my duty to again present the subject, 
somewhat modified, and to urge with all my powers the immediate 
attention of the profession to this new and exceedingly valuable 
addition to our therapeutical resources in the management of some 
of the worst cases which can distress both patient and physician. 
Not claiming originality in the matter, I shall consider myself free 
to use Dr. Martin’s valuable paper as best I may in developing 
the subject and impressing it upon my hearers ; and, as my ex- 
perience has been identical with his, I shall of necessity refer to 
many of the points to which he calls attention, and shall not al- 
ways refer to him, but here give him all credit for his work, and 
advise my hearers to read or re-read his paper in connection with 
this. He treats of the use of the bandage in ulcers and varicose 
conditions of the leg, also in certain surgical aspects of diseases 
and injuries of the joints, etc., but does not mention eczema, al- 
though he alludes to having used the bandage in some cutaneous 
affections of the legs, “ to which ” he says, “ very learned words 
of sesquipedalic length are applied in the jargon of dermatology,” 
“ that great science of words,” as he styles it in another place. 
My practice being confined to diseases of the skin I purpose to 
* Chicago Med. Journal, October, 1877 ; Transact. Am. Med. Asso. Vol. 
28, page 589. SOLID R UBBER BANDA GE IN ECZEMA, ETC. 
5 
give you my experience in the use of this measure in eczema and 
ulcers of the leg, as it is only in these lesions that I have myself 
employed it ; I will afterwards briefly allude to other conditions 
in which it has been or may be successfully used. I will very 
briefly mention the cases, because more impression is thus made 
than if simply the results of treatment are stated in a general man- 
ner. 
Case I. Long standing eczema of the leg with great mduration. 
The most striking case perhaps, was the first one to which I ap- 
plied the bandage, and as this patient has been the longest under 
observation, both before and since its application, it is perhaps to 
me the most instructive and valuable of all. 
Mrs. E. F., a large and rather fleshy woman of 45 years, applied 
for treatment at Demilt Dispensary, in February, 1877. She then 
had well marked tubercular syphilis about the nose and upper lip, 
with many cicatrices from the same on the forehead and else- 
where. Her right leg presented a most distressing state of dis- 
ease, which had existed more or less severely for over nineteen years. 
It was enlarged from the knee down to and including the ankle, so 
as to be twice the size of the other ; was hard with the thickening 
of the skin ; its surface exhibited a raw and exuding eczema to 
nearly its entire extent; and there were numerous ulcers, espe- 
cially about the ankle, with hard, sharply-cut edges and indolent 
bases. The leg itched intensely and she scratched it more or 
less ; it also gave her almost constant pain while standing, which 
she was obliged to do continually, washing, and caring for the 
family. Some of the ulcerations of the leg had very much the 
appearance of those of tubercular syphilis, and I had great hopes 
that the treatment for that disease would also be of much benefit 
to this portion of her body. 
Not to enter too much at length into clinical details, suffice to 
say that she attended the Dispensary quite faithfully, and was 
treated assiduously until August; but that the leg entirely refused 
to heal, although the syphilitic lesions on the face yielded to 
proper measures. This medication would often seem to make the 
eczematous element on the leg worse, and yet when the anti- 
syphilitic was discontinued the tubercular eruption reappeared. 
Various local measures of approved kinds were also ineffective on 
the leg, owing, undoubtedly, to the insurmountable obstacle of her 
occupation. 
On November 22d the rubber bandage was applied at the Dis- 
pensary, and the internal treatment for the syphilis was continued. 
On December 4th she was exhibited before the gentlemen at- 
tending my clinic, and the note was made that the leg was better 
than it had been for nineteen years. The limb was then reduced 
at least one-half in size, and was hardly larger than the other ; 
the entire surface was smooth and dry, and very red, the enlarged 
papillae showing distinctly beneath the thin layer of epidermis ; 
many of the ulcerations had healed : she experienced no pain or 6 
L. D UNCAN B ULKLE Y ; 
itching in it, and she had been on her feet all the time as before. 
There had been no local treatment employed of any kind, except 
the application of the elastic bandage, as will be described later. 
In three weeks more the ulcers had healed, and the leg ap- 
peared as well as the other, except the red, glossy condition, which 
still remained. This patient has been under observation and 
treatment ever since, for her syphilis ; the leg remains perfectly 
well, and although she still continues to wear the rubber bandage 
for the support it gives the limb, she has no signs of her former 
trouble ; the leg is the same size as the other, every trace of the 
very great thickening is gone and, consequently, there is no itch- 
ing or pain. Varicose veins seem to have played a very small if 
any part in this case. 
Case II. Acute eczema accompanying ulceration of the leg. This 
case is almost as striking : Mr. J. P. B., aged 41, a mercantile 
reporter, presented himself at my clinic at the Out-Patient De- 
partment of the New York Hospital, March nth, 1878, for the 
treatment of eczema of the leg with numerous ulcerations, with 
the following history :— 
Nine months previously he had had acute inflammatory rheu- 
matism, affecting principally the ankles. This was followed by 
swelling of the leg, with enlarged veins and the appearance of 
several ulcers. For the ulcers he had been for six weeks laid up 
in the hospital, and as the ulcerations were in part healed, and his 
business prevented further confinement, he applied at my clinic 
for subsequent treatment. When first seen, the whole of the left 
leg was greatly enlarged from the knee down ; about the ankle 
there was much oedema : the surface was red and glazy, much of 
it exuding copiously, and with a number of rather small ulcers in 
various situations. It was done up in lint, covered with a cotton 
bandage ; he had on a large cloth shoe, and was quite disabled by 
the bulk of the limb, and the pain and itching. All the dressings 
were removed and a rubber bandage applied. 
March 15, four days afterward, it was recorded that there was 
great improvement; very much of the swelling was gone ; the leg 
was hardly three-quarters the previous size ; many of the eczema- 
tous spots and some of the smaller ulcers were healed. There 
was little or no itching and no pain. He had returned to his 
business immediately after the application of the bandage, and on 
the preceding day had walked six miles. 
March 20. All the ulcerations but two are healed. No eczema 
remains ; the leg is about the natural size and he walks all day 
with ease. 
March 27. The leg is about as well as ever : he is now for the 
first time put under some constitutional treatment for eczema on 
the arms. 
Case III. Severe chronic eczema rubrum of both legs and thighs ; 
one only treated by bandage. Mr. H. L., a large, rather corpulent 
gentleman, aged 56, seen in private practice, has had eczema of SOLID R UBBER BANDA GE IN ECZEMA, E TC. 
7 
both legs, for a year and a half, gradually extending so as to cover 
the entire limbs, to the groins, during the past four months. He 
has been under approved treatment at the hands of a well-known 
New York physician during a considerable period, who finally re- 
ferred him to me. He gives the history of having had eczema 
over much of the body during the first seven years of life. He 
has had asthma since a boy, until the last few years, when he has 
remained free from it. During the past year and a half he has 
been constipated, depending on the compound cathartic pills for 
movements from the bowels. 
When first seen both legs, from the ankles to the groins were the 
seat of a red, exuding eczema, terribly itchy, and showing many 
signs of the results of scratching. Both legs were covered with 
cotton wadding and bandaged firmly, and he was in the habit of 
removing this two or three times a week, and washing the legs 
thoroughly, and coating them with camphorated vaseline. There 
was also more or less eczema upon the arms. He was treated in 
a general way with considerable relief to the itching, and on 
May 23, the rubber bandage was applied to the right leg, 
from the toes to the groin, two twelve-foot, three-inch bandages be- 
ing used. 
May 25. To-day it is recorded that there is great improvement 
in the limb to which the rubber bandage was applied ; all itching 
has ceased in it; when removed, the surface is red and shiny, but 
perfectly dry and with a moderately firm epidermis. The left 
limb, which was left in the cotton, still exudes, is itchy and has a 
considerable amount of scaly crusting upon it. 
June 1. The right leg to which the bandage was applied is 
virtually well. At night when it is covered with cotton batting, 
there is no exudation and no itching. He begs to have the same 
applied to the left leg, which is still scaled and crusted, and at 
times intolerably itchy ; formerly the right leg was the worse. 
Case IV. Cath. S., aged 65, applied at Demilt Dispensary, in 
November, 1877, with chronic eczema rubrum of the left leg, of 
two years duration. As she was obliged constantly to be on her 
feet, she was treated with but indifferent success. 
Feb. 19. To-day a rubber bandage wTas applied. 
Feb. 26. Leg very much better. 
March 5. Still marked improvement. She did not return after 
this date, and as she had paid for the bandage and it gave satisfac- 
tion we may believe that the ultimate result was good. 
Case V. Ellen C., aged 50, applied at Demilt on February 
20th, 1878, with eczema rubrum of the right leg; she was treated 
with moderate success for a while. 
March 2. A rubber bandage was applied and other treatment 
stopped. 
March 16. The leg is much better, the swelling has disappear- 
ed, and the limb presents a smooth, moist, and slightly exuding 
surface, over which the enlarged papillae are plainly evident. The 8 
L. DUNCAN BULK LEY; 
patient expressed herself as much relieved ; she has not been seen 
since. 
Case VI. George C., a fairly developed young man of light 
hair and delicate skin, aged 17 years, applied at the New York 
Hospital Out-Patient Department, May 3d, 1878, with an eczema 
of the right leg, the result of an injury two months previously. 
Under appropriate treatment there was considerable improvement, 
when on 
May 20, the rubber bandage was applied and other treatment 
stopped. 
May 24. Considerable improvement ; much of the raw surface 
is healed, there being very little exudation when the limb is 
bared. The itching, which was previously considerable, ceases 
while the bandage is on. Several small ulcers which existed are 
healed, and there is some artificial eruption excited by the band- 
age, in the way of small, scattered, acutely inflamed, and very 
superficial pustules ; for these he is ordered first to cover the limb 
with thin muslin, and then to apply the bandage. 
May 27. Very considerable improvement ; the acute irritation 
has disappeared and most of the eczema is well. 
Case VII. Thomas C., aged 56, a night-watchman, applied at 
Demilt, November 3d, 1877. The whole right leg was the seat of 
an eczema from the knee down, largely due to varicose veins, the 
result of his occupation, although there was also some eczema on 
the arms. After a short course of treatment with diachylon oint- 
ment and a cotton bandage, on November 24th, the rubber band- 
age was applied in the presence of the class, and all other treat- 
ment was discontinued. 
Dec. 1. Very great improvement, much of the moist surface is 
smooth, dry and glossy ; the itching has ceased : he has con- 
tinued his occupation, and remains standing all night with ease. 
Dec. 8. There is still very great improvement, and the surface 
is largely covered with healthy epidermis ; there is no itching, 
and none of the aching pain from the varicose veins. The patient 
expresses himself in the highest terms as to the very great relief 
to all the symptoms afforded by the bandage. Three days after 
this his wife came bringing the bandage, saying that the patient 
had met with an accident, breaking his thigh, and as he was re- 
moved to a hospital the bandage would not be needed. 
Case VIII. William McC., a laboring man aged 53 years, was 
first seen March nth, 1877, at the Out Patient Department of 
the New York Hospital. He had a patch of chronic, thickened 
eczema, about four by two inches in diameter, over the middle of 
the left tibia : it had been of at least three months duration. A 
rubber bandage was applied without other treatment, and on 
March 15th, it was recorded that there was great improvement in 
the appearance of the patch, and that the itching which had be- 
fore been distressing had about ceased. 
March 27. Still great improvement, the patch is nearly well. SOLID R UBBER BANDA GE IN ECZEMA, ETC. 
9 
The treatment was ordered to be continued and the patient did 
not return. 
Case IX. Mrs. S., aged 53, a fleshy lady, who had always en- 
joyed excellent health, came to my office April 6th, 1878, with a 
patch of hard, thickened, rough, and dry eczema on the right 
instep ; also with some eczema on the left foot and on the right 
forefinger. The patch on the right instep extended nearly around 
the ankle, and was nearly three inches in width ; it itched exces- 
sively. She had had a similar eruption two years previously, and 
had been treated for the same by another practitioner with little 
benefit, from February to June, 1877. 
She was given treatment suited to her case, and made slow but 
steady improvement. 
May 18. The surface on the right ankle is now dry and scaly, 
and still gives much annoyance by the itching. The thickening 
does not yield to considerable stimulation, and a rubber bandage 
is applied from the toes to the knee. 
May 25. The affected patch has improved greatly beneath the 
rubber, the itching ceased while it was on. Three days ago she 
left it off and the same day was greatly exposed to cold, riding a 
long distance ; the following day she had a severe chill with high 
fever, and yesterday the upper part of the leg became hot and 
red in blotches, swollen and burning, and to-day there are large 
patches of congestion along the whole middle of the leg. She 
feared that this was caused by the bandage, but was assured to 
the contrary ; the eruption did not at all resemble the very super- 
ficial eruption of minute pustules which the bandage sometimes 
occasions ; it was probably due to the sudden and severe ex- 
posure of the leg to the cold, after the tissues had been relaxed 
by the profuse sweating which occurs beneath the rubber. She 
was ordered a cooling lotion of lead and opium, with elevation of 
the limb, and an alkaline diuretic. 
May 28. The acute eruption has subsided, leaving the original 
patch much improved by the rubber treatment, though there is 
still redness and thickening. 
June 17. To-day there is very much less thickening ; there is no 
itching while the bandage is on ; but when removed at bed-time, the 
desire to scratch the part is still severe. For this she is directed to 
rub the diseased surface with the compound tincture of green soap, 
and to apply diachylon ointment during the night, carefully re- 
moving it wholly before replacing the bandage in the morning. 
Case X. Elizabeth O’H., aged 36 years, was first seen by me 
at Demilt, January 17th, 1878. She came for the treatment of 
large and painful ulcerations on the left leg, mainly about its 
middle and upper part, with the history of their having developed 
from a scratch received five months previously. The whole leg 
was the seat of a large, smooth, somewhat contracted cicatrix from 
a scald early in life. 
Although there was considerable varicosity of the veins, the 10 
Z. DUNCAN BULK LEY; 
ulcers had so much the appearance of syphilis, that in spite of the 
absence of corroborative history, (which is so often wanting in 
women) she was placed upon an anti-syphilitic treatment, which 
was continued for over six weeks without producing any improve- 
ment in the sores. 
At the end of this time an eczematous eruption developed 
spontaneously upon the right leg, which was also somewhat vari- 
cose, and on March 14th a rubber bandage was applied over the 
eczema ; a mixture containing acetate of potassa was given, and 
the ulcerated left leg was still treated with a mild calomel ointment. 
March 26. The itching of right leg has about ceased, and the 
condition is much improved ; no change in left leg. 
April 11. Still improvement in eczema; no other local treat- 
ment but the bandage. 
April 26. The eczema is about well: bandage continued on 
account of the varicose veins. 
June 15. The results of the treatment of the eczema were so 
good, that the patient has cut the bandage in two, in order to 
have the same applied over the ulcerated limb, and still to con- 
tinue the support to the varicose veins in the right leg. 
The two following cases of eczema treated in this manner, are 
furnished me by my friend, Dr. F. B. Lawson, who employed the 
bandages at my suggestion : 
Case XI. Mrs. A., German, aged 38, married, with seven 
children ; besides attending to household duties, she stands many 
hours behind a lager-beer bar. She was found in bed, pulse 110, 
temperature 102°, complaining of great pain in right leg ; bowels 
constipated, has headache and backache. The right leg below 
the knee was enormously swollen, hard and hot, and the whole 
surface red, or covered with thick crusts, a perfect type of eczema 
rubrum, with varicose veins. 
The bowels were relaxed with compound cathartic pills ; a 
diuretic was given, and the crusts were removed by means of re- 
peated, cold flax-seed poultices ; on the following day a rubber 
bandage was applied from the toes to the knee, and a towel was 
directed to be kept wet with cold water over the bandage. 
Three days later the patient was going about the house as 
usual, and said that her leg had not felt better for years ; there 
was great reduction in the size of the leg, and the redness had 
almost disappeared. She applied the bandage herself with ease, 
washing the part every evening on removing it. Two small ulcers 
which existed near the internal malleolus were healing well. 
Four days later she called at the office, the leg looking well and 
the ulcers healing. 
May 1. Nine weeks later, the affected leg was about well, and 
a common roller bandage was ordered in place of the rubber one. 
The left leg was found to be swollen and tender about the ankle ; 
a rubber bandage was applied, but it gave so much pain that it 
was removed and a thin layer of cotton interposed. SOLID R UBBER BANDA GE IN ECZEMA, ETC. 
11 
June 2. The right leg is quite well of the eczema, and the left 
was very comfortable until she left off the rubber bandage a few 
days ago, when it again became swollen and hot ; she had been 
standing much. She is several months pregnant. 
The very great severity of the case, and the very rapid yielding 
of the disease to the rubber bandage, even during pregnancy, are 
points of special interest. 
Case XII. Mrs. C., aged 63, a widow, who had had ten 
children, presented herself with an eczema of the right leg, espe- 
cially marked near the ankle ; it itches and burns, and at times 
discharges serum ; there is a small ulcer over the malleolus. A 
rubber bandage was applied, with instructions to cleanse the leg 
and re-apply the bandage daily. She was not seen again for many 
weeks, when the affected leg was found to be entirely well. She 
said that the improvement had begun immediately on the appli- 
cation of the bandage. 
Case XIII. J. E., aged 38, was admitted to the New York 
Hospital, service of Dr. G. A. Peters, April 15th, 1878. He had 
had the femoral artery ligated two years previously for popliteal 
aneurism, and since that time has suffered from eczema of the leg. 
He was given a wash of bi-carbonate of soda, a drachm to the 
pint, to be applied on sheet-lint, and a rubber bandage 
over it. 
At the end of three weeks he was discharged cured. 
Case XIV. The following case exhibits the value of this plan 
of treatment in chronic dermatitis, a state often closely resembling 
eczema, but due to local causes entirely. In this instance it was 
owing to the woman’s occupation which necessitated her being 
all the time on her feet : Caroline McC , an English woman of 50 
years, came to me at Demilt at the end of September, 1877. She 
had a considerable amount of varicose veins, and the whole right 
ankle was surrounded by a mass of inflamed and thickened skin, 
which made standing very painful. Some portions of the diseased 
skin showed immensely hypertrophied papillae, which stood out 
separate of a brilliant purple color, and which bled easily when 
much irritated. The condition had lasted many, many years, and 
at times she was almost, if not quite, laid up with her sore foot. 
She had long had treatment from many hands, and seeing that 
mild measures had always been futile, she was given a pretty 
strong caustic potash wash, with directions to rub and stimulate 
the parts excessively once a day, and then to cover them with a 
zinc ointment ( 3 j ad § ss.) To accomplish this she promised to 
rest for a while. There was very considerable improvement 
following this plan of treatment, whenever resorted to, but as 
she got relief each time, she would then neglect the matter, and 
would return with the foot as bad as ever ; she dreaded the pain 
of the caustic application, and begged for other treatment. 
February 9. Rubber bandage applied from toes to knee. 
February 23. The leg is very much better ; the thickening has 12 
L. DUNCAN BULK LEY; 
largely diminished, and with it the pain ; the papillary prominences 
have about disappeared. She feels that she cannot do without 
the bandage. 
May 7. The leg is all healed, and the thickening of tissue 
gone. She still has pain in it at times. 
The following cases exhibit the value of this solid rubber band- 
age in ulcers of the leg : 
Case XV. Very painful varicose ulcer of left leg. Christopher 
O’H., a laborer, 53 years of age, applied at Demilt Dispensary, 
August 18th, 1877. He then had a varicose eczema of the pos- 
terior surface of the left leg, upon which an ulcer soon developed 
in spite of careful treatment, in consequence of his being on his 
feet continually. He attended quite faithfully, and at times the 
ulcer would almost heal, when his work would oblige him to neg- 
lect it, and it would become very much irritated. 
February 29. The ulcer is very painful, about an inch in diam- 
eter, situated on the back of the calf on the lower half of the leg. 
He is confined to bed with it, and says he could not rise if the 
house were on fire. It bleeds very easily ; the veins of the leg 
are considerably varicosed. A rubber bandage is applied from 
the toes to the knee while in bed. 
February 23. To-day he presents himself before the class, and 
says that immediately after the application of the bandage he rose 
from bed, and has been up and around since, feeling perfectly 
comfortable. The ulcer bleeds as the bandage is removed. The 
day following the application of the bandage he walked several 
miles with perfect ease. 
March 16. Ulcer healed ; feels very well. 
April 25. The leg remains well; patient is at work. He still 
wears the rubber bandage, and finds it a great comfort to the 
varicose veins. 
Case XVI. Hard-edged varicose ulcers of right leg. Lawrence 
G., a waiter-man, aged 57 years, came to the New York Hospital, 
Out-Patient Department, on March 3d, 1878, with very painful 
varicose ulcerations of the right leg. There were several indolent 
ulcers, with hard, everted edges, and unhealthy bases. He was 
quite incapacitated from work, and had failed to find relief from 
various remedies. A rubber bandage was applied at once from 
the toes to the knees, no other dressing being used. He was 
directed to remove it in the evening in bed, to wash the leg and 
the ulcers with tepid water, and to leave it without dressing 
during the night. The bandage was to be cleansed, and hung 
up to dry, and to be put on again in the morning, before stepping 
out of bed. In the day time he is directed to walk considerably. 
March 10. There is great improvement; healthy granulations 
fill the cavity, and much of the hardened edges have melted away. 
March 25. The ulcers have cicatrized from the sides, and all of 
them are about well. There is but one very small spot, one-quarter 
by two-thirds of an inch in diameter on the ankle, yet unhealed. SOLID R UBBER BANDAGE IN ECZEMA, ETC. 
13 
The patient did not return, and as the progress had been so 
extremely satisfactory to him, it is fair to suppose that he became, 
and remains quite well. 
Case XVII. Michael G., a laborer, first came to me at De- 
milt Dispensary, October 9th, 1877, with a varicose ulcer on the 
back of the right leg. He was treated with the ordinary stimu- 
lating treatment, with varying results, the leg being better and 
worse, until March 12th, when a rubber bandage was applied, and 
he was instructed how to apply it himself every morning. 
As he had been a faithful patient, and was a hard working man, 
it is fair to suppose that his failure to return was due to the per- 
fect relief afforded by the bandage. 
Case XVIII. Peter C., a laborer, aged 53 years, applied at my 
clinic at Demilt, March 5th, 1878. He had an ulcer on the left 
leg, probably due to varicose veins, as it possessed all the features 
ordinarily seen in such. I may here remark that these lesions 
are exceedingly common among those of the poor of this city, 
whose occupations require them to be long upon their feet. He 
was treated with a balsam of Peru ointment ( 3 j ad § j), which 
produced some benefit for a while. On March 23d a rubber 
bandage was applied, and the patient shown how to re-apply it, 
with directions to wear it until well. As he was at work, he did 
not return to report results. 
Case XIX. James F., a clerk, aged 48, applied in the service 
of my colleague, Dr. Morris, as an out-patient at the New York 
Hospital, in August, 1877. He had varicose ulcers of the leg, 
which were treated by approved methods, with but indifferent 
success. 
In March Dr. Morris applied the rubber bandage, and in a few 
weeks the ulcerations had entirely healed, no other treatment 
being employed. 
The following cases, occurring in the New York Hospital, in 
the service of Dr. Geo. A. Peters, are kindly furnished me, with 
his permission, by the house surgeon, Dr. S. S. Kahn. 
Case XX. G. H., aged 37, was admitted April 15, 1878, with 
a varicose ulcer of the leg, four by two inches, which had existed 
for two years. It was treated by strapping and stimulating ointment 
for two weeks, with no improvement. A rubber bandage was 
then applied, and changed every second day. Cicatrization took 
place very rapidly, and in seventeen days he was dicharged cured. 
Case XXI. Ulcer after severe laceration of leg. F. M., aged 
8 years, received a lacerated wound of the leg, eight inches long, 
from being run over; the muscles were torn, and the bone ex- 
posed. The wound was under the Lister treatment for fourteen 
days, when there resulted a granulating ulcer, eight by two inches 
in size. A rubber bandage was applied, and in three weeks it 
had cicatrized up to two and a half inches by one-half inch, and 
is progressing very rapidly at the time of this report. 
Case XXII. Ulceration of the foot after severe laceration. R. 14 
L. DUNCAN BULK LEYj 
D., aged 40, was admitted on March 2d, with a contused and 
lacerated wound of the dorsum of the foot, with compound frac- 
ture of the toe. When the slough separated, the anterior half of 
the dorsum of the foot was gone. The resulting ulceration was 
treated with usual measures until April 15, when it was about 
one-half its original size, but it had stopped healing, the edges 
became indurated, and the base indolent. Active stimulation 
failed to produce any effect; actual cautery failed to induce 
repair, and no change took place in it, until on May 15th a rubber 
bandage was applied. 
June 3. The ulceration has made rapid progress in healing since 
the application of the bandage, and to-day there is a small, healthy, 
level, granulating surface, one-fifth the size of the original ulcer, 
which is healing very rapidly. 
Case XXIII. Abscess over ankle. J. L., aged 38, was admitted 
to the New York Hospital April 15, 1878, with an abscess of the 
ankle, which had opened spontaneously prior to admission. There 
was found a small opening from which sinuses ran in different 
directions ; everything appeared sluggish. He was treated by 
astringent injections, and an ordinary bandage for six days, with 
little or no change. 
A rubber bandage was then applied, and in six days more he 
was discharged cured. 
Case XXIV. Ulcerations from burn of arm and forearm. J. S., 
aged 42, was admitted December 20, 1877, with extensive burns 
of the face, back, neck, both arms and right ankle, received at 
the Barclay Street explosion and fire. After the immediate 
effects of the burn had passed off, including an erysipelas on the 
sixth day, the resulting ulcerations were treated by strapping, with 
frequent applications of nitrate of silver, and repeated skin graft- 
ings. Some of these latter took, but at the end of three months 
after the accident there was still a very extensive ulceration of the 
right arm, which progressed very slowly towards recovery. 
March 24. The ulceration on the right arm extends from the 
wrist to two inches above the elbow, involving the entire anterior 
surface, and at the middle of the forearm reaching entirely around 
the member. A rubber bandage was applied over the whole forearm. 
April 14. The ulcerated surface is becoming less ; he is dis- 
charged, and made an out-patient, returning every second day ; 
still to wear the bandage. 
May 20. There are now but four or five ulcers left on the 
surface of the forearm, an inch and a half in diameter ; the band- 
age to be continued. 
Case XXV. Enormous ulcerations of arms after a burn. G. 
H., aged 17, another victim of the Barclay Street disaster, was 
admitted December 20th, 1877. He was frightfully burned, 
much the same as the last patient, and was treated similarly for 
three months, with the result of having both arms covered with 
granulating surfaces, which refused to heal. SOLID It UDDER D AND AGE IN ECZEMA, ETC. 
15 
March 22. Rubber bandages are applied to both arms, which 
are the seat of enormous masses of exuberant granulations. 
May 27. The healing has progressed rapidly and steadily, and 
now on the right forearm are only two spots of ulcerative surface, 
two inches in diameter, very healthy looking, and on the left arm 
there are also two ulcers, each about an inch in diameter. The 
granulations are level with the surface, and cicatrization is pro- 
gressing well. The patient is still in the hospital. 
Case XXVI. Ulcerations from a scald of thigh and leg. R. S., 
aged 27, was admitted December 22, 1877, suffering from an ex- 
tensive scald from escaping steam. The entire outer side of thigh 
and leg and ankle were implicated. On the separation of the 
slough at the end of a week, there was an ulcerating surface down 
the whole extent, to the breadth of four to five inches. It was 
strapped from January 12th to March 22d ; grafted freely (about 
40 grafts took) ; burned with nitrate of silver, etc.; and at the last 
date there was still a mass of exuberent granulations over almost 
the entire extent, which refused to heal. 
March 22. Rubber bandages are applied from the foot to the 
groin. 
May 20. The progress of cicatrization has been very rapid 
beneath the rubber ; the improvement could be seen daily. By 
the end of a week the granulations were on a level with the skin. 
There is now but a single spot of ulceration on the thigh, an inch 
and a half in diameter, and one of about the same size on the leg. 
The discharge was very profuse for the first few days, so that the 
bandage was re-adjusted several times daily; this gradually dimin- 
ished as the cicatrization progressed. The direction of the band- 
age was reversed every alternate day, to overcome irregularities 
in the granulations resulting from unequal pressure. 
The contrast in the labor and expense of the dressing was very 
striking in this case. Before the use of the bandage about two 
yards of adhesive plaster were consumed daily in each dressing ; 
with the bandage no other measures were required. 
Case XXVII. Extensive and severe burns from nitric acid. 
Edward D., aged 38, was admitted to the New York Hospital 
April 17, 1878. After the separation of the sloughs, rubber 
bandages were applied to the forearm and leg. The result up 
to June 3d has been a prevention of exuberant granulation, and 
a reduction of the size of the ulcerating surfaces about one-half 
their original dimensions. There were, however, some drawbacks 
in the case : sloughing took place unexpectedly over the crest of 
the tibia for about four inches. Although only moderate pressure 
was applied by the bandage, it was perhaps more than the weak- 
ened vitality of the tissues could bear. On the left forearm the 
bandage did well for a few days, when severe hemorrhage occurred 
twice beneath it, which finally required Paquelin’s cautery before 
it was controlled. 
In addition to the cases here detailed, I have employed the rub- 16 
Z. D UNCAN B ULKLE Y y 
ber bandage in other cases, and I have reports of its use in the 
Mount Sinai Hospital, where certain cases did excellently under it; 
they need not be given. The bandage has also rendered excellent 
service in the hands of several other of my professional friends. 
The cases here narrated are quite sufficient to illustrate the subject, 
and all the experience I have thus far obtained confirms in every 
respect the claims made for this method by Dr. Martin ; claims 
which are so extraordinary as to possibly give rise to a doubt as to 
their truth in the minds of those who were not assured of the 
writer’s veracity, and who applied neither reason nor experience 
to prove or disprove the facts. 
A few remarks in regard to the details of this method of treat- 
ment may render the subject more clear to my hearers, and may 
perhaps assist some in employing it. 
First, in regard to the bandages : they are made of the best, 
solid, pure rubber, and are very elastic. They are twelve feet 
long and three inches wide, as I have employed them, though 
they may, of course, be made of any desired dimensions.* On 
one end a piece of cloth is cemented, an inch or so wide, to give 
firm attachment to the tapes which are to tie the free extremity. 
These tapes should, of course, be rolled inside, and the bandage 
prepared for application exactly as any other roller bandage. 
With a little care these bandages may be worn for a considerable 
length of time. In the first case I have given, the patient has 
worn one of Dr. Martin’s bandages for more than six montns, 
and it is now as good as when first applied, with the exception of 
one slight tear. Dr. Martin has known a single one to be worn 
two, three, or four years, and has even cured several successive 
poor patients with the same bandage, which was yet perfectly 
serviceable. It is to be remembered, however, that grease or 
glycerine must not be applied at the same time, for they will soon 
destroy the elasticity and worth of the bandage. That this is not 
necessary will be seen from the history of the cases, and from 
what will follow. 
Second, as to the cases to which it is applicable : I have treated 
of eczema principally because this disease comes under my no- 
tice more than any other. Dr. Martin laid more stress on the 
treatment of ulcers. I may remark then, first, in regard to the 
principles of treatment involved, that the idea of the rubber 
bandage is the protection and support of the tissues, and where 
these are indicated it will do good. Much of the eczema of the 
lower leg is associated with, and more or less dependent upon, a 
*The bandages I have employed are made by the Goodyear Rubber Curler 
Co., 729 Broadway, New York, and cost a dollar and a quarter each, for those 
of the dimensions given. Those employed by Dr. Martin are made of rubber 
twice as thick, and are of various widths and lengths. For those ten and a 
half feet long by three inches wide, I paid two dollars and a half each, or 
double the cost of mine. They may be obtained of T. Metcalf & Co., 39 
Tremont Street, Boston, Mass. SOLID R UBBER BANDA GE IN ECZEMA, ETC. 
17 
varicose condition of the veins, and it is generally this element 
which makes the disease so rebellious to ordinary measures ; and 
even where the veins are not distinctly enlarged, still the natural 
condition of eczema is one of capillary enlargement, and the 
gentle compression of the bandage remedies this. 
The rubber bandage, then, is applicable to and serviceable in a 
large share of the cases of ordinary eczema, it being more 
especially valuable in chronic cases, such as ordinarily resist all 
measures commonly employed. I have put it on when there wTas 
an acute or sub-acute inflammatory condition, and again when 
there was simply the infiltrated tissue left after an eczema, with 
no inflammatory phenomena, and with equally good results, as 
the cases narrated show. The bandage may, and often does, for 
a short time, sometimes for a longer period, cause an eruption of 
its own, namely, a few scattered minute pustules, running their 
course rapidly; but this need not interfere with its employment. 
If it is annoying, a cotton bandage or piece of thin linen, well 
fitted, may be placed beneath the rubber, but as a rule this is not 
required, for this condition will cease of itself under the continued 
use of the bandage. 
Not less serviceable, if indeed not more valuable, will this 
plan of treatment be found in that very large mass of cases which 
are now suffering from long standing, uncured, and that otherwise 
almost incurable condition of ulcer of the leg. To these 
the solid rubber bandage is of almost universal application, and 
of well nigh certain efficacy. Indeed, Dr. Martin states that of 
many hundred cases to which he has applied it during the last 
twenty-five years, “ all, without exception, have been perfectly 
and absolutely cured.” A strong statement, but one which my 
judgment and experience leads me to accept as true. In thus 
speaking, it is not affirmed that every case to which every prac- 
titioner may give a rubber bandage will be cured ; but, with due 
care, and a little experience in selecting the cases and applying 
the bandage, and with a proper instruction to the patient, and 
obedience to directions on his part, together with, at times, some 
other treatment which the individual case may demand, I be- 
lieve that it will be possible for every one of my hearers to cure 
all of the cases which apply to them for relief. And this is a very 
important assertion when we remember the thousands of uncured 
cases now taking their weary journey through life, with that most 
distressing clog, an uncured ulcer of the leg. Those, of course, 
which are syphilitic in origin cannot be permanently cured thus, 
but even in these it is of considerable service. 
In addition to these uses of the rubber bandage, it is useful in 
ordinary varicose veins, even where there is no skin lesion, and 
as it can be adjusted day by day to suit the condition of the 
parts, it is much more manageable and satisfactory to the patient 
than either the laced or elastic stocking, while its continual yield- 
ing and contraction render it far superior to the ordinary inelastic 18 
L. D UNCAN B ULKLEY; 
cotton or flannel bandage. At first patients will complain of the 
heat, and of the retained perspiration, but after a few days these 
will cease to give annoyance, and the comfort of the bandage will 
be appreciated. 
Some of the cases I have given show the value of this method 
of treatment in ulcerations from other causes, as burns, etc., and 
the results in these cases are so striking as to leave no doubt of 
the very general applicability of this form of dressing, where pro- 
tection, support, and pressure are required. 
I have not had opportunity of testing the rubber bandage in 
other conditions, but, as suggestions for those who may not have 
access to Dr. Martin’s paper, I may mention the other uses to 
which he has put this method of treatment. 
In injuries and diseases of the joints, particularly of the knee 
and ankle, it has been found especially serviceable. In ordinary 
sprains it gives the greatest relief, and the patient may with ad- 
vantage take exercise, the rubber answering in place of the rup- 
tured or strained ligaments. 
In effusion into the synovial sacs Dr. M. has found the rubber 
bandage of the greatest service, also in distension of the bursae 
mucosae, as “ house maid’s knee.” In this he has had perfect 
success in seven cases, the bandage being worn night and day 
for a month, the sac having been first thoroughly evacuated. 
In oedema and anasarca of the limbs most perfect relief is 
afforded by this means. Dr. Martin has recently informed me 
that he has used this means with great service in phlebitis. Like- 
wise in certain injuries of the bones, as in “ green stick” fracture, 
the gentle, constant pressure of the elastic bandage over a splint 
has restored the normal condition. 
In rheumatism and neuralgia about joints Dr. M. has found 
much benefit from the application of the rubber bandage, the 
warmth, moisture and pressure causing absorption of effused matter. 
In regard to other conditions of the skin in which the 
rubber bandage might do well, I may mention psoriasis, exfolia- 
tive pemphigus, pityriasis rubra, xerosis, ichthyosis, lichen ruber, 
pruritus, true prurigo, elephantiasis Arabum, etc. 
Third. A few words may be added as to the method of apply- 
ing the bandage : the first care to be exercised is that it be not 
too tight, for it is possible by means of it to force all the blood 
out of the limb, and quite check the circulation, as when em- 
ployed in Esmarch’s bloodless operations. Ordinarily it need be 
drawn only just tight enough to perceive that there is the slightest 
possible stretching of the rubber, no more. The bandages should 
be applied from the toes, and with a little care they can be made 
to fit the limb perfectly with but little stretching, and they need 
never be “ reversed,” as in bandaging with cotton or flannel band- 
ages ; the heel as a rule need not be covered. I always apply 
them myself first, and have the patient watch very carefully, 
taking pains to give a little instruction as I make the turns, and SOLID R UBBER BANDA GE IN ECZEMA, ETC. 
19 
I find that even more ignorant patients in dispensary practice 
can apply them afterwards very satisfactorily. 
It is better to apply the bandage while the patient is in bed ; 
that is, before he leaves it in the morning, and to remove it while 
in bed, after undressing, and I direct patients not to put the foot 
to the floor without the bandage. On taking it off at night, the 
rubber is to be immersed at once in water, and if the odor is very 
fetid, the water may contain thymol (1:1000), or a small propor- 
tion of carbolic acid. The leg is then to be washed off with luke- 
warm water and dried carefully ; if there is still a discharging, 
eczematous surface, it may be covered with cotton batting, and an 
ordinary roller bandage or other dressing applied for the night. 
If there is a raw, exuding ulcer, it may be covered with a rag and 
any mild protective ointment, as simple cerate, to prevent it ad- 
hering ; this grease must be well removed by wiping, in the morn- 
ing, before the application of the rubber bandage. After the leg 
is dressed for the night, the bandage is to be removed from the 
water, dried and hung up to air for the night; in the morning it 
is to be rolled up and applied while in bed, as before stated. 
Sometimes I further aid the treatment by having the foot of the 
bedstead elevated with a couple of bricks, that the blood pressure 
of the limb may be lessened during the hours of sleep. If the leg 
is very hot and painful, much relief and benefit may be obtained 
by making cool applications outside of the bandage, as was done 
in Case XI. 
A caution may be here given in regard to the removal of the 
bandage. In Case IX. it was left off on a very cold day, and the 
body was much exposed to cold, and, as a consequence, acute 
congestion of many parts of the skin of the leg occured, which 
nearly developed into eczema, but which happily yielded to 
prompt treatment; the tissues being softened by the rubber, and 
the sweat glands having been very active, the chill of the surface 
produced a congestion, which threatened serious trouble. In cold 
weather it might be prudent always to advise some extra protec- 
tion to the limb for a while after leaving off the rubber bandage. 
Care must also be exercised not to leave off the bandage too 
soon ; indeed, it should be worn for a shorter or longer period 
after the eczema or ulcer is apparently well ; when there are 
varicose veins the patients are very willing and desirious of con 
tinuing the application on account of the constant sense of relief 
experienced. 
A very important point to bear in mind in relation to this 
method of treatment is, that as a rule, if the bandage is well ap- 
plied, walking and exercise is a benefit rather than a drawback. 
In Case II., the patient with sub-acute eczema walked six miles 
a few days after the application ; and Case XV., with a very 
painful ulcer, rose immediately from bed and walked several miles 
on the following day, remaining on his feet working, until cured. 
Thus far, I have said nothing in regard to cases to which this 20 
L. DUNCAN BULKLEY; 
method is not applicable, and for the reason that such cases have 
not yet presented themselves to me. Undoubtedly, cases will 
occur where the rubber bandage cannot be borne, and this side 
of the subject remains to be yet developed. I can only say that I 
have absolutely no negative experience to offer. 
A word in reference to other or previous mention of the use of 
rubber tissue in the treatment of skin lesions. The only sug- 
gestion of its use at all similar to this of Dr. Martin’s, is by Dr. 
Turney*, of Circleville, Ohio, who reported having treated seven 
cases of ulcer of the leg with the application of an Esmarch band- 
age wound very tight, “ as long as it could be borne,” (for ten or 
fifteen minutes) each day. Six of the cases were cured, the 
seventh one disappeared before the cure was completed ; one of 
the cases was in a woman eighty-five years old, in whom the ulcer 
had existed for fifteen years. It will be seen that the idea in this 
was quite different from that of the continuous, lightly applied 
rubber bandage, as described in this paper. 
In 1869, Hebra f, made a report on the treatment of certain 
skin lesions with vulcanized rubber cloth, which he had employed 
on the suggestion of Hardy, of Paris, made in 1867. In this he 
reports a certain amount of good results in eczema, and consider- 
able benefit in pruritus and in diseases exhibiting epidermal thick- 
ening. But the applications of rubber here suggested are quite 
and entirely different from those I have described ; the applica- 
tions of Hardy and Hebra were made of rubber cloth, totally in- 
elastic, and the element of pressure and support to the part are 
entirely wanting ; whereas, the bandages here described are of 
pure, solid rubber, are extremely elastic, and the pressure and sup- 
port afforded by them is an all-important element in the treatment. 
I have used the impervious dressings as advised by Hebra, and 
have had some most excellent results in eczema of the hands from 
wearing rubber gloves, that is, of rubber cloth. I have also tried 
the impervious dressings on eczema elsewhere, but have never 
obtained results on the legs which satisfied me ; whereas, with the 
rubber bandage as here described, the results have far surpassed 
my expectation. 
More recently, Mr. Balmanno Squire J, of London, has advo- 
cated rubber suits of clothing in psoriasis, and has reported some 
cases in which the eruption was removed in a remarkably short 
space of time. But this again is but a development of the method 
of Hardy and Hebra, the suits are made of rubber cloth and there 
is no pressure exercised. 
I have made these references because some, who may have 
tried the simple application of rubber cloth, or who have even 
* London Practitioner, May, 1876, page 367. 
\ Archiv fur Dermatologie und Syphilis, 1869, page 1. 
X'British Medical Journal, Vol. I., 1876, pp. 311 and 586, and Vol. II., 
1876, p. 43. SOLID R UBBER BANDA GE IN ECZEMA, ETC. 
21 
bound it on firmly with a roller bandage, and who have not had 
good results, might be led to think that the same might be ex- 
pected from the method advocated in this paper. To these I can 
only say that there is the greatest difference imaginable between 
the firm, resisting, non-elastic cotton bandage, and that of soft, 
pliable rubber, which yields with every motion and yet exercises 
its ceaseless pressure and support, to an extent which can be reg- 
ulated to the utmost nicety, with each day’s changing condition of 
the part.