The treatment of ulcers caused by burns and scalds will be described later.

In ulcers of the leg due to interference with the venous return, the primary indication is to elevate the limb in order to facilitate the flow of the blood in the veins, and so admit of fresh blood reaching the part.  The limb may be placed on pillows, or the foot of the bed raised on blocks, so that the ulcer lies on a higher level than the heart.  Should varicose veins be present, the question of operative treatment must be considered.

When an imperfect nerve supply is the main factor underlying ulcer formation, prophylaxis is the chief consideration.  In patients suffering from spinal injuries or diseases, cerebral paralysis, or affections of the peripheral nerves, all sources of irritation, such as ill-fitting splints, tight bandages, moist applications, and hot bottles, should be avoided.  Any part liable to pressure, from the position of the patient or otherwise, must be carefully protected by pads of wool, air-cushions, or water-bags, and must be kept absolutely dry.  The skin should be hardened by daily applications of methylated spirit.

Should an ulcer form in spite of these precautions, the mildest antiseptics must be employed for bathing and dressing it, and as far as possible all dressings should be dry.

The perforating ulcer of the foot calls for special treatment.  To avoid pressure on the sole of the foot, the patient must be confined to bed.  As the main local obstacle to healing is the down-growth of epithelium along the sides of the ulcer, this must be removed by the knife or sharp spoon.  The base also should be excised, and any bone which may have become involved should be gouged away, so as to leave a healthy and vascular surface.  The cavity thus formed is stuffed with bismuth or iodoform gauze and encouraged to heal from the bottom.  As the parts are insensitive an anaesthetic is not required.  After the ulcer has healed, the patient should wear in his boot a thick felt sole with a hole cut out opposite the situation of the cicatrix.  When a joint has been opened into, the difficulty of thoroughly getting rid of all unhealthy and infected granulations is so great that amputation may be advisable, but it is to be remembered that ulceration may recur in the stump if pressure is put upon it.  The treatment of any nervous disease or glycosuria which may coexist is, of course, indicated.

Exposure of the plantar nerves by an incision behind the medial malleolus, and subjecting them to forcible stretching, has been employed by Chipault and others in the treatment of perforating ulcers of the foot.

The ulcer that forms in relation to callosities on the sole of the foot is treated by paring away all the thickened skin, after softening it with soda fomentations, removing the unhealthy granulations, and applying stimulating dressings.

Treatment of Ulcers due to Constitutional Causes.—­When ulcers are associated with such diseases as tuberculosis, syphilis, diabetes, Bright’s disease, scurvy, or gout, these must receive appropriate treatment.