2192 



ULCERATIONS 



be found covered with greenish pus. The membrane reforms 

 rapidly, and, apart from the dark colour, it closely resembles a 

 diphtheria membrane. These ulcers extend rapidly, but do not 

 take, as a rule, a true phagedsenic character. The margins after 

 some time may become indurated, but do not show a punched-out 

 appearance. Scrapings taken from the fundus show numerous 

 polymorphonuclears. The course is very long. These ulcers are 

 with difficulty distinguishable from true ulcus tropicum except by 

 the absence of Spiroschaudinnia vincenti Blanchard. 



Treatment. — Excision is not to be advised, as in Stitt's and our 

 own experience, when this has been done, additional lesions have 

 appeared. Bier's passive congestion method is painful, and does 

 not improve the condition. On the whole, the best treatment is 

 to keep the ulcers well disinfected with a perchloride lotion (i in 

 2,000), occasionally touching them with pure hydrogen peroxide. 

 Should the ulcers become phagedaenic, the application of pure 

 carbolic is advisable. 



GRANULOMA INGUINALE. 



Synonyms. — Ulcerating granuloma of the pudenda. Granuloma 

 Venereum (Brooke), Esthiomene de la vulve. 



Definition. — Granuloma inguinale is a chronic granulomatous 

 affection of probable protozoal origin attacking the generative 

 organs, from which it spreads to the inguinal regions and the peri- 

 neum. 



History. — In 1896 Conyers and Daniels described a disease of 

 the generative organs in both men and women in British Guiana 

 which was very painful, disfiguring, and contagious. Daniels 

 thinks that it was previously described by Macleod and Maitland 

 in India. Since then papers have appeared on the subject by 

 Ozzard, Galloway, Wise, Donovan, Siebert, Flu, Martini, Gabbi, 

 SabeUa, Torres, Rabello, Pijper, Mayer, Newham and Low, and 

 many others. 



Climatology. — It occurs in British Guiana, the West Indian 

 Islands, West Africa, South Africa, India, South China, and Northern 

 Australia ; but is rare in Ceylon, Malaya, Sudan, and Central Africa. 

 It has been reported from Northern Africa (Tripoli) by Gabbi and 

 Sabella. A similar or identical condition has rarely been met with 

 in Europe and North America. 



etiology. — It appears in the genitaha of both sexes after puberty, 

 but is rare after forty-five years of age. 



Donovan, in 1905, described certain peculiar rod-like bodies 

 2 /A by I /X, lying singly or in groups in mononuclear cells, obtained 

 by scraping the sores. Donovan stated that the bodies looked ' hke 

 gigantic bacilli with rounded ends,' but left the nature of them un- 

 decided Siebert, in 1907, carried out an investigation on material 

 originating from various countries, demonstrating the same or 

 similar bodies in all instances, but referring to them as diplococci. 



