CHAPTER XXX
TROPICAL ULCER
General Considerations
Under the names tropical phagedaena or tropical ulcer various skin lesions have been described, from all parts of the tropics, which vary greatly in etiology and symptomatology.
These skin ulcers are most frequently observed on the dorsum of the foot or front of the leg but may appear on the hands or forearms and have rarely been reported from other parts of the body.
There is no doubt but that many of the cases reported as tropical ulcer are really manifestations of tertiary syphilis.
Jeanselme has noted the insignificant manifestations of the secondary stage of syphilis in natives of Indo-China and the malignancy of the tertiary ones as regards the skin lesions. In fact a striking feature of the late stages of syphilis in the natives of the tropical world is the frequency and severity of skin lesions and the rarity or absence of involvement of the central nervous system to produce tabes or general paresis.
Again congenital syphilis is common in most tropical countries which have been visited by white men for long periods and Jeanselme has noted the rarity in natives so affected of interstitial keratitis and Hutchinson’s teeth, signs upon which medical men are apt to base a diagnosis of such a condition.
Again, Butler, studying the serological side of 27 ulcerations which clinically could be diagnosed as tropical ulcer, obtained strongly positive Wassermann tests in 26, or 96 per cent. of the cases. Shattuck found that about 94% of the chronic ulcerations of the Philippines could be ascribed to syphilis.
Besides syphilis one must bear in mind the possibility of the ulcers being a manifestation of tertiary yaws, a condition which also gives a high percentage of positive Wassermann tests.