Tropical phagaedenic ulcer in the Pacific

Abstract

1. 1. The paper discusses 892 cases of ulcer admitted to three hospitals in three parts of the south-western Pacific (Melanesia). 2. 2. Phagaedenic ulcer is due to an infection with fusiform bacilli, spirochaetes and filamentous organisms. 3. 3. There is a striking correlation between the clinical state of the ulcers and the organisms found in smears. All ulcers in the phagaedenic state showed fusiform bacilli. 4. 4. Fusiform bacilli are the first of the phagaedenic organisms to appear. Smears show a gradation from a typical spirochaete through various filamentous forms to a typical fusiform bacillus. The possibility that they represent one organism cannot be dismissed. 5. 5. The finding that clean or septic ulcers do not show phagaedenic organisms is opposed to the statement that all ulcers in the tropics contain spirochaetes. 6. 6. The sequence of events between a break in the skin or the “idiopathic” ulcer through the fully developed phagaedenic ulcer to the healed ulcer is shown. 7. 7. A dietetic deficiency is an important predisposing cause. 8. 8. In New Britain, ulcers and their complications were the chief cause of mortality in hospital. One death only occurred in the Solomons. 9. 9. A relationship between phagaedenic ulcers and malaria is suggested. 10. 10. The virulence of the organisms may be increased by transmission amongst susceptible people. 11. 11. As a prophylactic measure, the application of iodine and adhesive to small abrasions, etc., has been successful. 12. 12. Treatment is carried out by destroying the infection in small ulcers by means of caustics, and by excision in the case of large ulcers followed by skin grafting. Any concomitant malaria or dietary deficiency must be dealt with.