DISEASES AFFECTING THE SKIN 300 
We have previously discussed the importance of Spirochaeta schaudinni and 
Bacillus fusiformis as an etiological factor in tropical or phagedenic ulcer.! 
From our observations and from those made by other investigators it seemed 
probable that Spirochaeta schaudinni cannot usually establish itself in healthy 
skin or even in many aseptic wounds, but after the epithelium is bruised, burned, 
or otherwise injured, the circulation interfered with, and the vitality of the tissues 
otherwise impaired so that necrosis occurs, it may then sometimes gradually 
assume pathogenic properties and a phagedenic ulceration result which assumes 
a chronic character. Some observers have inclined to the view that the spiro- 
chaetes and fusiform bacilli are merely saprophytic invaders. However, evidence 
is from time to time being produced, showing that these organisms are clearly 
capable of producing suppurative and necrotic lesions. Thompson” has very 
recently reported upon another case of fatal brain abscess (the third of such 
nature of which we have knowledge), following extraction of a second molar 
tooth. The spirochaetes and fusiform bacilli were found in the lesions in the 
mouth during life. At the necropsy, Thompson writes, an abscess was found in 
the sphenopalatine fossa, extending by way of the middle meningeal vein to the 
longitudinal sinus, both of which contained pus. There was an abscess of the 
right temporal lobe, moth-eaten in appearance, typical of Vincent’s angina, and 
presenting Vincent’s organisms, spirochaetes and fusiform bacilli on smear. 
There were abscesses in both orbits and there was thrombosis of the cavernous 
sinus with the spirochaetes and fusiform bacilli also present in both. The blood 
culture taken during life was negative after four days. 
Dalrymple * has recently called attention to a possible dietetic origin for 
tropical ulcer in West Africa. After changing and improving the diet of the 
natives and providing for their use, hot and cold baths, the affection became 
much less prevalent among them. By diet and other hygienic measures he 
evidently improved the general health and resistance of the natives and rendered 
them less susceptible to infection. Phagedenic ulcer in its developed stage, is 
the result of an infectious process. 
1 Strong: Spirochaetal Infections of Man. Atlantic Med. Jour. (May, 1926), p. 29. 
* Thompson: Jour. A. M. A. (1929), XCIIT, 1063. 
* Dalrymple: West African Med. Jour. (1928), II, 133. 
