A STUDY OF SOME TROPICAL ULCERATIONS OF THE SKIN 
WITH PARTICULAR REFERENCE TO THEIR ETIOLOGY. 
By Ricuarp P. Strona. 
(From the Biological Laboratory, Bureau of Science.) 
In Manila subacute and chronic ulcerations of the skin, of obscure 
origin, are not infrequently encountered. During the past two years I 
have examined, particularly from an etiological standpoint, all forms of 
ulceration of this nature which have come to my notice. So far, twenty- 
four instances have been studied. Many of the lesions in these cases 
differed widely in their clinical manifestations, and I was able to demon- 
strate conclusively that at least several of them varied in their etiology. 
It was originally my intention to review in detail the examination of 
each case ; but on going over my notes I found so little which was charac- 
teristic or of interest in many of them that I have considered it more 
advisable here to discuss merely those instances which either proved 
etiologically to be or seemed clinically to represent distinct and specific 
infections. Thus, in a number of cases, a history of various primary inju- 
ries of the skin was obtained ; and although at first it was intended not to 
include in this study ulcerations occurring in the course of certain chronic 
diseases, such as leprosy, syphilis, or yaws, nevertheless, of the lesions of 
seven of the cases investigated, five later proved really to be those of yaws 
and two of syphilis. Only staphylocci, streptocci, or saprophytic bacilli 
were isolated in the larger number of the lesions studied. However, 
in addition to those instances in which, both clinically and etiologically, 
nothing definite could be discovered, and to the ones which represented 
lesions in the course of those chronic affections I have mentioned, three 
distinct clinical types of disease were encountered, and these will now 
be considered. 
ULCERATION OF THE FIRST TYPE. 
In the first instance, the lesion to be discussed answers very well, both 
in its clinical appearance and in its history, to the usual description of 
Delhi or Oriental boil, as found in the several text-books on tropical 
diseases. The history of this case may briefly be recorded as follows: 
The patient was a native woman about 35 years of age. Approximately 
six weeks before consulting me she stated that she had noticed a small red 
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