2 1 86 



ULCERATIONS 



Oriental Sore. — An old-standing Oriental sore may present some 

 characters of a chronic ulcus tropicum, though generally a tropical 

 ulcer is much larger. The process of ulceration and breaking 

 down is very slow in Oriental sore, while it is very rapid in ulcus 

 tropicum. In difficult cases the search for Leishmania tropica, 

 which is present in Oriental sore, will clear the diagnosis. 



Ulcus Cruris Varicosum. — There are often varicose veins visible, 

 the parts surrounding the ulcer are congested and frequently ecze- 

 matous, the ulcer is often shallow and irregular. 



Ulcers of Tubercular Origin. — They are rare on the lower ex- 

 tremities, and their development is long and insidious. In ulcus 



Fig. 86i. — Ulcus Tropicum. 



tropicum the tubercular cuti and ophthalmic reactions are negative 

 unless the ulcer develops in a tubercular patient. 3 



Blastomycosis — Sporotrichosis. — In blastomycosis there are gener- 

 ally warty patches with minute abscesses; while the lesions of 

 sporotrichosis often jshow at first the characters of gummata. 

 The bicteriological examination will reveal the presence of 

 the fungi. 



Acladiosis. — The ulcerative lesions are multiple and of smaller 

 dimensions. The bacteriological examination will reveal the pres- 

 ence of Acladium castellanii Pinoy. 



Mycosis Fungoides. — Is generally preceded by a general pruri- 

 ginous dermatitis of various character, lichen-planus-like, psoriasis- 



