Extract: In 1910 I was holding the appointment of Medical Officer and Magistrate at Anguilla in the St. Kits presidency of the Leeward Islands, British West Indies, when the Administrator one day handed me a cable, asking if I would accept the Medical Superintendency of the “Central Lunatic Asylum,” Tanjong Rambutan, Perak, Federated Malay States. Fortunately the cable explained that Tanjong Rambutan was in the Federated Malay States, as neither he nor I had the slightest idea where it was.
1. Seventy-seven cases of tropical ulcer were studied in the General Hospital, Johore.
2. Age was found to be an important factor in the incidence and duration of the disease.
3. One or more debilitating factors could always be established. After removal of these factors, the ulcer in many cases tended to heal.
4. The course of the ulcer is divided into three stages. Stage I is the spreading stage. In Stage II, a mild sloughing occurs within the original boundaries of the ulcer. This is a chronic stage. In stage III, there is either a stationary or a healing ulcer.
5. Treatment for the first stage is mainly directed towards the general condition of the patient. In the second stage the associated debilitating factors are treated. In cases which do not respond to these measures we tried many forms of treatment. Of these, the most rational seems to be application of strong antiseptics to the sloughs themselves. We have used quinine, as recommended by Innes for this purpose, and we have obtained very satisfactory results in a small series of obstinate cases. Stage III is treated by the application of elastic adhesive bandage.