An Intractable Ulcer on the Scalp

Previous history.?About three years ago the boy had a continued fever lasting for about six weeks. This was very severe and during its course he had convulsions and was delirious. Towards the end of this pyrexial attack the lobes of the ears, the ate nasa? and the scalp on the vertex became 'black' (probably gangrenous). One day he scratched his scalp and the whole of it came away over an area about six and a half by four and a half inches, leaving the skull exposed. The ears and nose gradually recovered and appear to have healed without any scarring. The large exposed area on the scalp also gradually lessened and in about six months there was a granulating ulcer about one and a half inches in diameter which was surrounded by a ring of dense scar tissue of the already-healed portion. Various treatments were tried for a period of about two years without any permanent benefit, though at times the ulcer diminished in size, but it always broke down again and reached its former dimensions. On one occasion a skin graft was done in another hospital and after about six months he was discharged with the ulcer reduced to about one-third of an inch in diameter, but it very soon broke down again.