ULCUS TROPICUM 



like, eczematous-like. The ulcerative lesions are multiple, and 

 have the characters of granulomata. 



Prognosis. — If untreated, tropical ulcer has very little or no ten- 

 dency to spontaneous recovery, and in some cases may extend, 

 damaging the deeper structures, tendons, muscles, nerves, and 

 vessels. Occasionally a general septicaemia and pyaemia may super- 

 vene. In countries where framboesia is endemic the ulcer often 

 gets infected with its virus, and the patient develops a general 

 eruption of framboesia. 



Treatment. — Salvarsan, neosalvarsan, and their substitutes have 

 been administered by intravenous or intramuscular injection by 

 Werner, Hallenberger, and others, with success in certain cases. 



Fig. 862. — Ulcus Tropicum, with Cornu Cutaneum. 



The details of the treatment are found in the chapter on Fram- 

 boesia (p. 1560). Mercury and potassium and sodium iodides are 

 useless, but calcium iodide (gr. iii.), well diluted, three times daily, 

 seems occasionally to be of some slight benefit. As regards local 

 treatment, the patient, whenever possible, being kept at rest, the 

 dirty greyish, foul-smelling secretion is removed by using a disin- 

 fecting solution, such as mercury perchloride, i in 1,000; cyllin, 

 I in 300; hydrogen peroxide, 10 per cent.; permanganate of 

 potash, I in 2,000. 



For the first few days it is better not to apply any so-called 

 disinfectant ointments or powders: simply keep the ulcer covered 

 with gauze, moistened as often as possible with one of the disin- 

 fecting solutions already mentioned. This generally stops the 



