92 SURGERY. 



It is to be treated by the application of lunar caustic, and the in- 

 ternal administration of mercury and iodide of potash. Mercury 

 hastens the cure of the primary sore, and affords security against 

 secondary consequences, especially of the Hunterian chancre ; some 

 general constitutionar treatment may also be necessary. Blue pill 

 may be given every night and morning, until the gums are slightly 

 sore, and there is a slight increase of saliva : its action should be 

 maintained at this point for several weeks. 



Phagedenic Chancre. — These are rapid in their progress and 

 painful ; their surface yellow, and dotted with red streaks ; their 

 shape irregular ; edges ragged and undermined ; their discharge is 

 thin, profuse, and sanious. These ulcers eat deeply into the skin of 

 the penis and surrounding parts. This chancre is apt to occur in 

 those whose constitution is broken down with drink, debauchery, 

 prostitution, and mercury : mercury usually aggravates it. 



Treatment. — As a local application, the nitrate of mercury is 

 most beneficial ; the chloride of zinc is also calculated to arrest the 

 spread of the disease. The constitution must be supported with 

 tonics, stimulants, and good diet. 



Bubo. — Bubo is an inflamed lymphatic vessel or gland leading 

 from a venereal ulcer ; the glands may inflame from a wound of the 

 foot or from gonorrhoea, but a real syphilitic bubo is the result of 

 absorbed virus. Buboes vary in the rapidity of their development, and 

 some are termed acute, others chronic; the former hastening to sup- 

 puration, whilst the latter are indolent. If one gland only is affected, 

 and that above Poupart's ligament, it is most probably caused by 

 chancre, if one exist ; but if many glands are swelled, and they are 

 below this ligament, their swelling is probably the result of irrita- 

 tion. Inoculation is the surest test. 



Treatment. — An acute bubo will often yield to rest, leeches, fo- 

 mentations, &c., but if the venereal virus shall have created pus 

 in the interior, leeches and cold applications will rather retard 

 the cure. Poultices, and early evacuations, are then most to be 

 relied on. Extensive collections of pus, and sinuses, are often the 

 result of delay in eliminating the virus. The opening of a bubo at 

 an early stage with a sharp lancet, even should no pus exist within, 

 empties the congested vessels, and rather promotes a cure. Blisters 

 and iodide of potassium will be found of use in assisting in absorp- 

 tion. In an indolent bubo an alterative course of mercury, and 

 good diet are necessary. 



Constitutional Symptoms. — These are secondary and tertiary. 



The secondary symptoms speedily follow the primary, usually 

 during the second month ; consisting chiefly of general eruption, 

 affection of the throat, fever, change of complexion, dryness of hair, 

 rheumatic pains in shoulder and knee, headache. Different kinds of 

 eruption follow different kinds of primary sore, although there may 



