222 TROPICAL MEDICINE AND HYGIENE 



GRANULOMA OF THE PUDENDA. 



SERPIGINOUS ULCERATION OF THE GENITALIA 

 (McLEOD) ; ULCERATING GRANULOMA OF THE 

 PUDENDA ; SCLEROSING GRANULOMA OF THE 

 PUDENDA. The disease manifests itself as a chronic 

 indurated superficial growth on or near the genitalia, 

 male or female. It is slow growing and extends along 

 moist surfaces, whilst the older and deeper portions of 

 the growth are converted into a dense fibrous mass of 

 tissue. It is very vascular. 



Geographical Distribution. It occurs in many islands 

 of the West Indies, in Tropical South America, on the 

 West Coast of Africa, and either it or a similar disease 

 occurs in India, Northern Australia, and many of the 

 Pacific Islands. 



Clinical Course. This differs to some extent in 

 different races, and in the two sexes. It usually commences 

 in the male on the penis, and extends in the neighbourhood 

 of that organ ; if situated on the skin it is very slow 

 growing, but is more rapid when the glans is attacked, 

 and the granulations may then be very large and coarse ; 

 it extends for a fraction of an inch up the urethra, and 

 causes very serious stricture. It rarely extends by direct 

 continuity down the penis ; more often the inguinal folds 

 or other places with which the penis may rest in contact 

 become infected (fig. 61), and from such a point extension 

 by continuity along the fold of the groin (fig. 62), and 

 backwards on the inguino-scrotal fold, takes place, and 

 from that directly backwards on the perineum surrounding 

 the anus, and extending up it into the lower part of the 

 rectum (fig. 63). Sometimes both groins are affected. 

 Frequently the penis and scrotum become slightly ele- 

 phantoid, probably from compression of the lymphatics 

 by the indurated subjacent tissue. 



In the female the early growth is on the inner surface 

 of the labia majora or nymphae, which may become 

 elephantoid, and the growth extends upwards into the 

 vagina, and rarely into the bladder. It also extends over 



