THE CHANCRE. 



to infection. On the contrary, chancres are often observed to develop 

 upon parts of the genitals where the most careful search immediately 

 after coitus had failed to detect any breach of continuity of the epider- 

 mis. Upon other parts of the body, too, where the epidermis is thin, 

 such as the lips or the nipples, infection may occur without wound of 

 the cuticle, while upon the hand or other region thickly covered with 

 cuticle, as long as there is no breach of continuity, the contact of the 

 poison produces no effect. The seat of the chancre, therefore, is most 

 generally upon the genitals, far more rarely upon the anus, between 

 the breasts, in the mouth, or upon the hands. 



SYMPTOMS AND COURSE. According to the concurrent belief of 

 all trustworthy observers, the period of incubation of the chancre-virus 

 is a very brief one. Hicord goes so far as to declare that it has no 

 incubative period, but that changes arise at the point of contact of the 

 poison immediately upon its implantation, although they are not com- 

 monly noticed at first, owing to their apparent insignificance. 



Course of an Inoculated Chancre. Upon introducing some of the 

 secretion of a chancre beneath the epidermis, through a puncture from a 

 lancet-point, no change takes place at the point of inoculation during the 

 first twenty-four hours. At about the thirty-sixth hour a slight redness 

 appears, and in forty-eight hours there is a distinct, bright-red macula. 

 In the course of the third day the macula rises into a flattish papule, 

 and upon the fourth day the epidermis is raised, forming a vesicle, sur- 

 rounded by a reddened areola. In the next day or two its contents 

 become more yellow and purulent, the vesicle transforming into a pus- 

 tule, which bursts between the fifth and eighth day ; or else, together 

 with its contents, dries up into a scab. After rupture of the pustule, 

 or after removal of the scab, we see an ulcer of the size of a pin's 

 head, or perhaps as large as a pea ; it is almost circular, and penetrates 

 into the corium in a manner disproportionate to its size. Its edge, 

 which is cedematous from inflammation, has a puckered appearance. 

 In the next few days, the base and edges of the sore are attacked, by 

 a diphtheritic process, and it begins to enlarge. As the elements of 

 the tissues are necrosed, and broken down into detritus, the base of 

 the sore assumes a grayish, dirty, lardaceous appearance. As the diph- 

 theritic destruction goes on irregularly at its periphery, the borders of 

 the ulcer acquire a gnawed, ragged form. If the point of inoculation 

 be destroyed by caustic within the first four days, the destructive pro- 

 cess may generally be cut short. After the fourth day this is scarcely 

 ever possible. 



A chancre of accidental origin begins either by a macule or papule, 

 upon which, after repeated exfoliation of the cuticle, an excoriation 

 and loss of substance takes place, or else a vesicle or pustule forma 



