In Guam, the natives separate the ulcerations about the lower extremities from the naso-pharyngeal ones by designating the former cases llagosos and the latter gangosas. It is probable that the leg ulcers are manifestations of the same disease as the naso-pharyngeal ones whether it be syphilis or yaws. These ulcers of the leg in Guam as well as those studied by Butler in the Philippines would certainly be classed as tropical ulcers.
There are undoubtedly many cases which can be explained by infections with ordinary pyogenic organisms of the skin which are enabled to get a foothold in an abrasion or other minor wound, in a person whose resistance has been reduced by such cachexia-producing diseases as malaria, dysentery or ancylostomiasis.
Indeed some authorities attach special importance to the tibial ulcers found in advanced cases of hookworm disease. Some of the sores are due to irritating applications used by the natives of many countries as setons. In many instances the sores are from neglected wounds.
Vincent has called attention to the association of the fusiform bacillus and delicate spirillum, better known in connection with Vincent’s angina, in smears from tropical ulcers.
Such findings have also caused many to consider tropical ulcer as related to hospital gangrene. There is no doubt but that smears from the dirty membranous deposit on these ulcers do frequently show the fusiform bacillus and at times the spirillum, but we also frequently find various fungi in such smears. Very few hold that these have anything to do with the production of the ulcer.
Inoculation experiments have as a rule been indefinite in result.
LeDantec has incriminated a very large Gram-negative bacillus which was noncultivable.
Prowazek believes that he has found the cause in a spirochaete which possesses fewer turns and these more widely separated than those of the spirochaete of syphilis. The association with the fusiform bacillus has also been noted.
Wolbach and Todd note the frequent finding of spirochaetes in tropical ulcers and attach considerable importance to a spirochaete with abruptly tapering ends. The name of Spirochaeta schaudinni has been given to the organism. They also generally found associated micrococci and bacilli as well as the fusiform bacillus.
Other than the noting of granulation tissue and the presence of plasma and small round cells there does not seem to be anything definite in the histopathology of tropical ulcer. This is what one might expect in view of the lack of definite knowledge of the condition.