ing sore is then substituted. _Pressure sores_ are
treated on the same lines.

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