The local treatment of the tuberculous ulcer calls for special mention.  If the ulcer is of limited extent and situated on an exposed part of the body, the most satisfactory method is complete removal, by means of the knife, scissors, or sharp spoon, of the ulcerated surface and of all the infected area around it, so as to leave a healthy surface from which granulations may spring up.  Should the raw surface left be likely to result in an unsightly scar or in cicatricial contraction, skin-grafting should be employed.

For extensive ulcers on the limbs, the chest wall, or on other covered parts, or when operative treatment is contra-indicated, the use of tuberculin and exposure to the Rontgen rays have proved beneficial.  The induction of passive hyperaemia, by Bier’s or by Klapp’s apparatus, should also be used, either alone or supplementary to other measures.

No ulcerative process responds so readily to medicinal treatment as the syphilitic ulcer does to the intra-venous administration of arsenical preparations of the “606” or “914” groups or to full doses of iodide of potassium and mercury, and the local application of black wash.  When the ulceration has lasted for a long time, however, and is widespread and deep, the duration of treatment is materially shortened by a thorough scraping with the sharp spoon.

#Treatment in relation to the Condition of the Ulcer.#—­Ulcers in a weak condition.—­If the weak condition of the ulcer is due to anaemia or kidney disease, these affections must first be treated.  Locally, the imperfect granulations should be scraped away, and some stimulating agent applied to the raw surface to promote the growth of healthy granulations.  For this purpose the sore may be covered with gauze smeared with a 6 to 8 per cent. ointment of scarlet-red, the surrounding parts being protected from the irritant action of the scarlet-red by a layer of vaseline.  A dressing of gauze moistened with eusol or of boracic lint wrung out of red lotion (2 grains of sulphate of zinc, and 10 minims of compound tincture of lavender, to an ounce of water), and covered with a layer of gutta-percha tissue, is also useful.

When the condition has resulted from the prolonged use of moist dressings, these must be stopped, the redundant granulations clipped away with scissors, the surface rubbed with silver nitrate or sulphate of copper (blue-stone), and dry dressings applied.

When the ulcer has assumed the characters of a healing sore, skin-grafts may be applied to hasten cicatrisation.

Ulcers in a callous condition call for treatment in three directions—­(1) The infective element must be eliminated.  When the ulcer is foul, relays of charcoal poultices (three parts of linseed meal to one of charcoal), maintained for thirty-six to forty-eight hours, are useful as a preliminary step.  The base of the ulcer and the thickened edges should then be freely scraped with a sharp spoon, and the