abscesses form along the inflamed vessel, which become ulcers or chancres, which are tedious as they leave sinuses that fill and break alternately, with little tendency to heal if left to themselves.

SUMMARY.

Chancre, or the simple contagious sore, is produced by inoculating its discharge on a breach of surface. Though it is often coexistent with syphilis, there is no connection between them, and it produces no constitutional disease. It probably always requires a breach of surface for its propagation; some persons are more easily affected than others from greater delicacy of their skin. This venereal sore is twice as frequent as the syphilitic ulcer. In its course it has no period of incubation; it begins to irritate immediately, but the activity of its progress varies very much in different persons. It always causes destruction of the tissue around the point of inoculation. There are three varieties. In one, the sore reaches through the whole thickness of the skin and mucous membrane, has an irregular form, and sharply cut edges; the floor is not hardened but spongy, and covered with thick pus. Another variety is very shallow, or prominent with spongy granulations over its surface. The third variety is produced by the changes of acute inflammation and rapid destruction of tissue. The leading characters of the local sore are, suppleness of the base, sharply defined area, irritating and abundant discharge, consecutive inoculation of this discharge, and the production of fresh sores; lastly, its activity and liability to spread.

The duration of simple sores is,variable, but six weeks is a common time, though it may be prolonged to months or years.

The seat of this sore is nearly always on the genitals,

but they are met with or easily produced on any part of the surface of the body, even on the head and face, where it was at one time supposed the local sore could not be generated. In men the furrow behind the glans penis, in women the fourchette and entry to the vagina are the favourite localities. Ulcers about the neck of the uterus are seldom true chancres, though their secretion is at times contagious. The main complications of chancre are inflammation, rapid sloughing, and slow phagedena. The first is a consequence of irritation from violent exercise, debauchery, or other cause. The second is produced by the same irritation acting on a very feeble or exhausted condition of the body. The slow phagedena also generally occurs in debilitated persons, but its exciting cause is obscure.

The diagnosis of local simple sores from syphilitic ulcers depends mainly on the absence of incubation; the activity of the ulceration; the tendency to multiplication; the aspect of the ulcer; the absence of hardness in the base; the readiness with which it inflames and spreads; and the ease with which it is repeated on the same person time after time. Herpes preputialis, fissures and excoriations are all distinguished by their readiness to heal when kept clean. Mucous patches when ulcerated often closely resemble chancres, but the presence of syphilis elsewhere distinguishes them.

The prognosis is good, as this sore usually heals in six or eight weeks, if not sooner, and it has no power to implicate the constitution.

Bubo.-This most serious consequence of chancre has two varieties; one, simple lymphatic abscess from irritation, the other, abscess from absorption of matter from the sore and its transmission along the ducts to the lymphatic glands. This is the virulent bubo, it always suppurates, and the matter, when it escapes from the interior of the gland, communicates to the abscess the characters of the original sore.

Bubo without chancre has been supposed possible, but the cases considered to be of this kind are not satisfactory; they are probably always due, not to contagion, but to strain or irritation of a similar kind. The lymphatic vessels, as well as the lymphatic glands, sometimes inflame, or indurate, and small abscesses form along their course, which leave tedious sinuses.

CHANCRE.

CHAPTER II.

TREATMENT.

General treatment of the early stages-Local treatment of the sore; simple dressing, astringents-Caustics, suitable conditions for their use-Inflamed sores—Indolent sores-Sloughing sores-Other dressings-Bubo, preventive treatment Suppurating bubo-Indolent bubo-Sinuses Virulent bubo.

All

Treatment of Simple Chancres.-The first thing in treating venereal sores is to remove general causes of irritation, such as too stimulating diet, wine, and especially venery. severe exercise must be relinquished; in fact, confinement to the house for some days is often time gained by the progress the sore makes with rest. While the wound is healing, the patient should always avoid standing long at a time, to lessen the risk of bubo: the horizontal position, moreover, greatly promotes healing of the sore. If erections at night are troublesome, they may often be prevented by the patient's last meal being a light one, taken two or three hours before bedtime. For persons of ordinary health it is not necessary to do more than this; but if patients are exhausted or in a debilitated condition, ordinary rules for improvement of the health are necessary, quiet, rest, with good diet, and stimulants must be freely given. The digestion may be invigorated by tonics, such as 10 or 15 drops of dilute nitric acid with 20 to 30 drops of liquor cinchonæ in water three times daily; or the tincture of perchloride of iron with

spirit of chloroform and glycerine, 20 to 25 drops of each to the dose. Many other preparations, quinine and acid, ammonia and bark, may be used for the same purpose.

Local Treatment of the Sores.-Most sores need only cleanliness to allay irritation and induce them to granulate. The sore should be washed three or four times a day while the discharge is abundant, and covered with pieces of lint dipped in cold water, over which oil-silk should be wrapped if the sore is situated in an outward part, like the dorsum penis or groin. If the patient is a man he should be directed to support the penis in a suspensory bandage or handkerchief against the abdomen, never to let it hang down, and to be particular that the dress is loose enough not to chafe the parts in walking. If the sore is underneath the foreskin, the lint should be so interposed that the skin does not touch it, both to prevent the sore being chafed and to avoid the formation of fresh ulcers. Care is particularly necessary in women, whose genital organs are difficult to dress. Strips of lint should be laid between the labia on each side and in the folds of mucous membrane round the vagina. A pledget of cotton wool dipped in some weak astringent (diacetate of lead, copper, alum, or borax) may be placed in the entry to the vagina. The oedema of the vulva, which is so common with chancres, is best managed by allaying the irritation with frequent washing and by lying down.

If the sore is indolent, and shows no tendency to heal, it should be dressed with some weak astringent solution, diacetate of lead, sulphate of zinc, or nitrate of silver, from 1 to 4 or 5 grains to the ounce of water; or a lotion of 5 or 10 grains of tannin to the ounce of water with a little red wine; or black or yellow wash, are all useful in stimulating the sore to granulate if the first-mentioned applications do not answer. Solutions of a caustic strength should not be continually applied, as they only increase the irritation and spread of the