2184 



ULCERA TIONS 



deeper layers consist of fairly dense fibrous tissue. Hsemorrhagic 

 foci are to be seen in various parts, and, as observed by Keysselitz 

 and Mayer, fusiform bacilli and spirochsetes are found in the super- 

 ficial layers, while in the deeper strata only spirochsetes are present. 



Symptomatology. — The affection is generally found on the lower 

 limbs, especially the lower third of the leg, the ankle and dorsum 

 of the foot. Occasionally it may develop on other uncovered parts 

 of the body. It is single in most cases, but two or more ulcers may 

 be found in some patients. 



Ulcus tropicum begins with the appearance of a small, painful, 

 occasionally pruriginous papule or papulo-pustule, surrounded by 

 a deeply infiltrated dusky red areola. The initial lesion soon 

 undergoes purulent and degenerative changes, which rapidly extend 

 to the infiltrated area. A sloughing process sets in, andean ulcer 



Fig, 859. — Ulcus Tropicum: Early Stage, 



is formed, which gradually extends in depth and surface. The 

 margins are not sensibly raised, nor thickened, unless the case be 

 very old. They are not perpendicularly cut, nor undermined, as 

 a rule, the whole ulceration having generally a roundish or oval 

 outline, and, when the secretion is removed, a concave fundus. The 

 parts surrounding the ulcers are often oedematous, and somewhat 

 painful on pressure. It is remarkable, however, how comparatively 

 little pain there is in many cases. 



When the patients are first seen, the whole ulcer is generally 

 covered with a thickish, dirty greyish secretion, exhahng a highly 

 offensive odour. On removing the secretion the fundus will be 

 found to be of a red colour, or in chronic cases pale pinkish, and 

 feebly granulating. 



The fundus is often somewhat infundibular in its central area, 

 and not rarely may present a circular raised ridge, which divides 



