If the patient’s health is below par, good nourishing food, tonics, and general hygienic treatment are indicated.

Management of a Healing Sore.—­Perhaps the best dressing for a healing sore is a layer of Lister’s perforated oiled-silk protective, which is made to cover the raw surface and the skin for about a quarter of an inch beyond the margins of the sore.  Over this three or four thicknesses of sterilised gauze, wrung out of eusol, creolin, or sterilised water, are applied, and covered by a pad of absorbent wool.  As far as possible the part should be kept at rest, and the position should be adjusted so as to favour the circulation in the affected area.

The dressing may be renewed at intervals, and care must be taken to avoid any rough handling of the sore.  Any discharge that lies on the surface should be removed by a gentle stream of lotion rather than by wiping.  The area round the sore should be cleansed before the fresh dressing is applied.

In some cases, healing goes on more rapidly under a dressing of weak boracic ointment (one-quarter the strength of the pharmacopoeial preparation).  The growth of epithelium may be stimulated by a 6 to 8 per cent. ointment of scarlet-red.

Dusting powders and poultice dressings are best avoided in the treatment of healing sores.

In extensive ulcers resulting from recent burns, if the granulations are healthy and aseptic, skin-grafts may safely be placed on them directly.  If, however, their asepticity cannot be relied upon, it is necessary to scrape away the superficial layer of the granulations, the young fibrous tissue underneath being conserved, as it is sufficiently vascular to nourish the grafts placed on it.

#Treatment of Special Varieties of Ulcers.#—­Before beginning to treat a given ulcer, two questions have to be answered—­first, What are the causative conditions present? and second, In what condition do I find the ulcer?—­in other words, In what particulars does it differ from a healthy healing sore?

If the cause is a local one, it must be removed; if a constitutional one, means must be taken to counteract it.  This done, the condition of the ulcer must be so modified as to bring it into the state of a healing sore, after which it will be managed on the lines already laid down.

#Treatment in relation to the Cause of the Ulcer.#—­Traumatic Group.—­The prophylaxis of these ulcers consists in excluding bacteria, by cleansing crushed or bruised parts, and applying sterilised dressings and properly adjusted splints.  If there is reason to fear that the disinfection has not been complete, a Bier’s constricting bandage should be applied for some hours each day.  These measures will often prevent a grossly injured portion of skin dying, and will ensure asepticity should it do so.  In the event of the skin giving way, the same form of dressing should be continued till the slough has separated and a healthy granulating surface is formed.  The protective dressing appropriate to a healing sore is then substituted. Pressure sores are treated on the same lines.