Tropical ulcer: Observations on its treatment and cause

Abstract

1. 1. Tropical ulcer is an important cause of invalidity in parts of the Sudan. 2. 2. Observations directed to etiology and treatment were made on cases in the Nuba Mountains affecting pagan carbohydrate feeders, and Arab carbohydrate feeders with rather more protein in their diet. 3. 3. Half the year, locally, is a dry season, there is a practically total absence of vitamins A, B 2 and C. 4. 4. By comparing the healing rates of ulcers, it was found that cod-liver oil dressings with vitamin A by mouth gave better results than those of pooled other treatments, especially for chronic and recurrent ulcers. Vitamin A does not appear to play the major part in the process. 5. 5. It seems that idiopathic tropical ulcer originating in a vesicle or papule is a manifestation of malnutrition. 6. 6. The malnutritional background is one of subnutrition in protein and vitamins A, B 2 and C with a relative excess of carbohydrate. 7. 7. Sex, age, race and occupation are factors in as much as they control diet and exposure. 8. 8. Season has an important influence, periods of climatic crisis, coupled with acmes of deficiency-experience and agricultural activity caused two peaks a year, on an incidence curve. 9. 9. Similar peaks occur in pellagra, the common factor being activation of a deficiency state. 10. 10. Recurrence of ulceration has a seasonal character also, two peaks occurring, likewise at periods of climatic crisis coupled with deficiency-experience. 11. 11. Patchiness in the geographical distribution of tropical ulcers is due to variations in dietary coupled with variations in malaria incidence. 12. 12. It seems that a high protein dietary may benefit ulcer cases; added vitamins A and B 2 are probably of value also. 13. 13. Signs of malnutrition were more pronounced in old and recurrent ulcer cases than in recent ones, and also in those with slower, as contrasted with those with faster, healing rates. 14. 14. Malaria decreases the healing rate in ulcers, possibly through ( a) malarial toxin, ( b) increased endogenous protein metabolism, ( c) anaemia and ( d) splenic dysfunction in its immunological aspect. 15. 15. ( a) Cod-liver oil dressing with skim-milk powder added to the diet is recommended as a treatment. ( b) Factors in ulcer-diathesis are considered to be deficiency in protein and probably vitamins A, B 2 and C; and malarial infection.