Studies on Phagedenic Ulcers *

Since the days of Hippocrates6 the terms phagedena, phagedenic ulceration, and phagedenism have been applied to "corrosive" ulcers which became "spreading and inveterate." With a few exceptions, the early writings on the subject are limited to the consideration of phagedena as the sequel of chancre or chancroid. In 1879 Gosselin5 and Fournier4 independently emphasized the fact that phagedena was not a disease entity, but a symptom independent of syphilitic infection. Senlecq,9 in 1908, supporting Fournier and Gosselin came to the conclusion that, with the exception of those lesions infected with fuso-spirochetes, phagedenic ulcers are associated with streptococcal infections. Recently, Meleney1' 7 8 has described two clinical types of progressive ulceration which he calls "the chronic, non-gangrenous burrowing ulcer," and the "gangrenous synergistic ulcer." The lesion of the former "which he believes is caused by a microaerophilic hemolytic streptococcus is characterized by prolonged suppuration, with the gradual development of an ulcer with undermined, rolledin skin margins, and sinuses which tend to burrow beneath the skin . . . The ulcer gradually . . . enlarges. The base is covered with greyish, gelatinous, anemic, shaggy granulations. Hematomas occasionally form spontaneously in the superficial layer of the granulation tissue. The infection frequently produces daughter ulcers by a perforation of the skin from beneath or by the secondary inoculation of the skin from the surface. If a perforation occurs from within, the daughter ulcer gradually enlarges and may fuse with the main ulcer or leave a bridge between them, which may become completely surrounded by epithelium on the deep, as well as on the superficial, surface . . . The infection rarely involves muscle or bone; but when it invades bone, it is almost impossible to eradicate it. The organism rarely invades the blood stream . . . and in such cases may produce metastatic foci in other parts of the body. The infection rarely invades the blood vessels but in long-