ULCUS TROPICUM 



2185 



the ulcer into two portions — an external more superficial one, and 

 an internal infundibuliform one. 



Occasionally, if left untreated, the ulcer may take a real phage- 

 dsenic character, involving a large surface, and deepening till the 

 deeper structures — muscles, tendons, and periosteum — are affected. 



The course is always chronic, lasting for months — in fact, the 

 ulcer has hardly any tendency to spontaneous heahng if untreated. 

 Heahng takes place by a very slow process of granulation, and 

 begins from the periphery. A thick, whitish, often disfiguring 

 scar is left at the place of the ulcerations. At times, however, the 

 cicatrix is at first very dehcate, and the ulcer may break out again 

 after the least irritation or traumatism. 



The microscopical examination of the greyish, bad-smelling secretion shows 

 leucocytes undergoing various degenerations, some red-blood cells, threads 

 of connective tissue, and very 

 often spirochaetes and fusiform 

 bacteria of various tjrpes, some- 

 times accompanied by the usual 

 pyogenic cocci. In old untreated 

 cases larvae of flies may be found, 

 small acarids, and ants. 



Diagnosis. — According to 

 Le Dantec, Vincent, and 

 several other observers, ulcus 

 tropicum is identical with 

 ' hospital phagedsena.' The 

 faxt, however, that, in con- 

 trast to ' hospital phage- 

 daena,' ulcus tropicum shows 

 very little or no direct con- 

 tagiousness, and in most 

 cases is self-limited, clearly 

 shows, in our opinion, that 

 the two are separate diseases. 



Differential Diagnosis — Framhoesia. — The lesions in framboesia are 

 generally multiple — either granulomatous or ulcerative. Scrapings 

 from framboesia lesions — after the superficial strata have been re- 

 moved — will often reveal the Treponema pertenue Castellani, which 

 is much more slender than any of the spirochaetes found in ulcus 

 tropicum. Occasionally an ulcerative framboesia lesion may become 

 infected with the virus of ulcus tropicum. In our experience, 

 however, the reverse is much more common — viz., an ulcus 

 tropicum becomes infected with framboesia virus, takes a papil- 

 lomatous appearance, and is followed by a general eruption of 

 framboesia granulomata. 



Syphilis. — Ulcus tropicum does not show usually the clean-cut 

 margins and the punched-out circular or reniform appearance, with 

 the frequent wash-leather slough on the surface, of a tertiary ulcer. 

 The mercury and potassium iodide treatment has no influence on it. 



Fig. 860. — Ulcus Tropicum. 



