CLINICAL OBSERVATIONS 345 



and when the sore is clean it is once more scarified, 

 and fresh sterile globin is again "dotted" over its 

 surface. This procedure can be repeated until the 

 ulcer heals. During the scarification it is better to 

 draw blood. Latterly this treatment of ulcers has 

 been improved by using powdered globin (five parts), 

 mixed with two parts (by weight) of kreatin, a mix- 

 ture which produces more marked proliferation than 

 pure globin. 



Many ulcers have now been treated by this method, 

 and we think that we can say safely that it causes 

 more rapid healing of them than if they were treated 

 in the usual way. Callous ulcers will usually heal 

 by themselves if the limbs are kept at rest, and it 

 was suggested to us that the cell-proliferation pro- 

 duced by globin was in reality due to the fact that the 

 patients were kept in bed. This suggestion was dis- 

 proved, however, by the production of extensive pro- 

 liferation in one part of an ulcer by means of globin 

 in a patient who was made to walk about during the 

 treatment. Lastly, granulations have been induced by 

 extracts of suprarenal gland. 



It should be mentioned that globin, kreatin, etc., 

 when applied to a healing surface will not only cause 

 proliferation during the application; but once the mul- 

 tiplication has started, it will continue "automatically," 

 even though the application of the auxetic is discon- 

 tinued. This point has frequently been seen during 

 the experimentation with ulcerated legs, and it is proof 

 that the proliferation of cells is "automatic." There 

 can be no doubt that once proliferation is started 



