98 
J. CAMPBELL. 
removed, fully believing that a full and free circulation to the 
affected part would very soon change the indolent character of 
the ulcer ; that being accomplished, the sore would rapidly 
heal. It has long been held by many in the profession, and is 
still held by some, that the free use of caustics or the actual 
cautery, by setting up a local inflammation in the part, will 
attract a full circulation and maintain it until the solution of 
continuity has been repaired. While this mode of treatment 
looks well from one standpoint, and from that standpoint ap¬ 
pears rational, yet we know that in practice it is an absolute 
failure in the conditions to which I refer. The reason becomes 
very plain to us when we study the conditions that are neces¬ 
sary to produce and maintain an indolent sore. 
I agree with the general teaching, that this condition is pro¬ 
duced by a diminished circulation to the part, but I do not agree 
with the generally accepted statement that the diminished cir¬ 
culation is per se the cause. I believe, as I shall fully demon¬ 
strate to you, that the quality of the circulating medium and 
not the quantity is responsible for the conditions. If you exam¬ 
ine the blood in an ulcer or wound of this kind, you- will find 
that the proportion between oxygen and carbon dioxide is con¬ 
siderably increased beyond the ratio of one to four. This being 
true, we understand at once why the sore will not heal: we 
know why the application of any cautery is perfectly useless 
and why the general antiseptics at present in use are of no 
avail. This brings us to a consideration of the cause or causes 
which produce this condition and the means by which the 
cause can be eliminated. As to causes, they are both general 
and local. Anything that will decrease the normal supply of 
oxygen in the blood must necessarily increase in the same ratio 
the amount of carbon dioxide. In this paper it will only be 
our purpose to deal with local causes ; and, first, we believe the 
primary cause is a lack of oxygen in the blood, generally local; 
this produces a sluggish movement of the white blood cells ; a 
little more oxygen removed from the blood and they become 
immobile ; this produces a congested condition which results in 
