Stelwagon, in his monumental work,1 writes under the heading of "Tropical Ulcers" that the term seems to be both a comprehensive and uncertain one in the Tropics, employed to designate ulcers that terminate several diseases, such as tuberculosis cutis,2 syphilis,3 or the oriental button,4 which is also often termed "endemic ulcer," or frambesia,5 also called "endemic ulcer." He quotes Manson,6 Crocker7 and others, who think there is a suggestive resemblance in tropical sloughing to hospital gangrene, except that the tropical ulcer has a more marked tendency to self-limitation. Cabois8 is convinced that there is a destructive ulcus phagedenicum due to Bacillus phagedenicus. But Stelwagon thinks the bacillus is probably only one of many factors, the one that may give rise to the more virulent cases. He says, further, that the prevailing view is that there is no distinctive idiopathic tropical ulcer other
ADAMS WB. ULCUS EPIDEMICUM: A PRELIMINARY REPORT. Arch Derm Syphilol. 1923;7(5):605–610. doi:10.1001/archderm.1923.02360110034006
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