﻿556 SHATTUCK. 



THIRD TYPE OF ULCERATION. 



Case III. — Native, 5 age 37. The patient states that he had smallpox long ago, 

 but no other illness or skin affection until two years previously when he received 

 a wound from a board on the left leg. A large ulcer developed from the wound 

 and at about the same time others appeared spontaneously on the other leg. 

 These healed, but the primary ulcer did not. The patient was unusually well 

 developed and well nourished. There were no lesions in the throat, no glandular 

 enlargement and no anaesthetic areas nor infiltrated nodules. 



On the anterior surface of the left leg, midway between knee and ankle, was 

 a smooth scar about 15 centimeters long and 0.5 centimeter wide. The skin 

 over the scar was pale, and the hair along its margin was white. On the external 

 aspect of the leg, surrounded by pigmented scar tissue, was a shallow, granulating 

 area. The edges were neither elevated nor undermined. The surface was clean. 

 There was a small ulcer on the front of the leg. covered with a viscid, purulent 

 exudate and a brownish crust. Grouped around the right ankle were many pig- 

 mented sears. The man was put on small doses of potassium iodide the day 

 before I saw him and antiseptic dressings were used. When he was again seen 

 six weeks later, the large ulcer had a border of new skin around the edge, and the 

 granulations in the center appeared healthy. Two smears from the exudate of 

 the small ulcer were examined. None were taken from the large ulcer because 

 it had been cleaned. They showed polymorphonuclear leucocytes in abundance, 

 tissue fragments and very numerous cocci and bacilli, some lying intra- and 

 some extra-cellular. 



The history and course of this case is typical of many others in 

 which chronic ulcers developing after trauma have heen followed by 

 ulcerations in other parts of the body, particularly on the leg. It may 

 be seen that lesions occurring in this manner are not all alike by refer- 

 ring to the second ease described under the fourth type of ulceration. 

 Some cases gave little indication of syphilis, but others had lesions 

 suggesting this disease strongly. The second case (Case V, p. 557) of 

 the fourth type of ulceration is such a one. 



Mense (3) states from personal observation that leg ulcers from 

 trauma are very common in Africa among the negroes. He says that 

 they heal without antisyphilitic treatment, are often large, but generally 

 single. In our case the balance seems to swing toward syphilis as the 

 most probable diagnosis, but there is much room for doubt. The bac- 

 teria observed were probably nothing more than secondary invaders. 

 In favor of syphilis are the multiplicity of the lesions and their close 

 resemblance to other lesions seen in undoubted syphilitics. Other 

 characteristics are ambiguous. 



5 6536-3-P, Bilibid Prison. First seen March 22, 1907. 



6 St. Luke's No. 14584. 



