CHRONIC INFECTIOUS DISEASES. 



the chancrous virus, since we have no means of deciding it ; but there 

 is no doubt that at the present time it never develops spontaneously, 

 and that no one nowadays contracts a chancre who has not been in- 

 fected with its virus. The chancre, then, belongs to the class of purely 

 contagious diseases; and we are fully entitled to employ the term 

 chancre-contagion instead of chancre-virus. 



Unlike the contagion of measles, scarlatina, and small-pox, the con- 

 tagion of the chancre is not volatile, nor capable of poisoning the at- 

 mosphere about the patient, and of infecting individuals within its 

 reach. It is of a fixed nature, and is only found in the secretion of the 

 sore, and in the contents of a chancrous bubo. The poison itself can- 

 not be detected in either of these vehicles, either under the microscope 

 or by means of chemical examination. The matter which covers the 

 sore, and the contents of a glandular chancre, do not differ perceptibly, 

 either morphologically or chemically, from the discharge of an ulcer of 

 any other kind, or from the pus of other suppurating glands. 



The predisposing conditions for the chancre are usually more gen- 

 eral perhaps than those of any other disease. Neither age, sex, nor 

 constitution, seems capable of modifying the susceptibility to its infec- 

 tion. It is true that individuals in the prime of life are more often af- 

 fected than children or old persons ; that men suffer oftener than wo- 

 men, the vigorous and healthy more frequently than the feeble and 

 sickly; but this is simply because the former expose themselves to 

 contagion more than the latter, and not because they are more sus- 

 ceptible to its influence. Hence persons with a thin epidermis are 

 more liable to infection, because slighter injuries suffice to produce 

 solution of continuity of their skin, thereby enabling the poison to act 

 upor the corium. The results of syphilization, that is, the artificial 

 production of chancres by inoculation, seem to show that such inocula- 

 tions, when repeated a great many times, have the effect of extinguish- 

 ing the susceptibility to contagion. 



By far the most common mode of transmission of the chancre is by 

 coitus with a person who is already diseased. Infection also some- 

 times results from lewd embraces, from kisses, and from the use of 

 water-closets, tobacco-pipes, tumblers, and similar articles, impregnated 

 with the chancre-virus. Physicians and midwives are sometimes in- 

 fected in making vaginal examinations, and conversely, women are 

 now and then inoculated by nurse or doctor ; but these and all other 

 modes of origin of the chancre, often as they are assigned by patients, 

 are extremely rare in comparison with that of impure intercourse. 

 Excoriation of the cuticle or epithelium, at the point where the poison 

 comes in contact with the genitals, favors transmission of the disease, 

 but it has not been proved that an abrasion of the surface is essential 



