ULCUS TROPICUM 



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ULCUS TROPICUM. 



Synonyms. — Yemen ulcer, Aden ulcer, Annam ulceration, Cochin 

 sore, Mozambique sore, Sarnes (Congo). French : Ulcere Phage- 

 denique des Pays Chauds. Ulcere Phagedenique Endemique. 

 Italian : Ulcer a Tropicale, Phagedsena Tropica. German : Tropische 

 Phagedenismus. 



Definition. — Ulcus tropicum is a tropical chronic sloughing ulcer, 

 which may take a phagedaenic character, and spread down to the 

 muscles and bones, and which, left to itself, shows hardly any ten- 

 dency to heal. 



History.— Phagedaenic ulceration is mentioned in many of the 

 early works on tropical medicine. Thus, Hunter in 1792 refers to 

 it in Jamaica in the following terms: — 



' Sores . . . spread quickly, and form large ulcerated surfaces. . . . 

 The granulations turn flaccid, and even mortify in parts. The por- 

 tion skinned over ulcerates afresh, and the sore becomes larger 

 than ever. Ulcers of some standing . . . could not be healed in 

 that country. . . . Opportunity was taken to send home men with 

 ulcers. ' 



After this date there are numerous references to the complaint, 

 which is generally described under the name of the locality in which 

 it was found, which accounts for many of the above synonyms. 

 In 1862, Rochard took a broader view of the disease, and in 1864 

 Le Roy de Mericourt introduced the term ' Phagedaenic ulcer of 

 warm countries.' 



In 1874, Treille suggested that the disease was likely to prove 

 to be of a parasitic origin, but he failed to demonstrate any parasite. 

 Bacteria have since been described by many observers, and more 

 recently spirochaetes have been considered to be the cause of the 

 disease, as will be described in the section on etiology. 



Climatology. — Ulcus tropicum is found in all tropical and sub- 

 tropical regions of Africa, Asia, and America. There are localities, 

 however, such as the hinterland of Aden, the low, marshy plains of 

 Cochin China and Tonkin, and some islands of the Red Sea, where 

 the affection is particularly common. It may be found also, 

 though rarely, in temperate zones, cases having been reported from 

 Greece, Macedonia, and South Italy. 



.ffitiology. — Numerous bacteria have been described by Petit, 

 Boniet, Blaise, Crendiropoulo, as being the cause of the disease. 

 Le Dantec described in the lesions the fusiform bacillus, and con- 

 sidered it to be the cause of the affection. Vincent found in addition 

 to the fusiform bacillus numerous spirochaetes, and considered that 

 the affection was due to the association of the two germs. 

 Vincent's observations have been confirmed by Smith and Peil in 

 Sierra Leone, Patton in Aden, and many other observers in various 

 parts of the tropics. Prowazek has fully described the spirochaete 

 which he named SpirochcBta schaudinni Prowazek, 1907. This 

 term, however, is a synonym for 5. vincenti Blanchard, 1906. 



