CHRONIC INFECTIOUS DISEASES. 



first and bursts ; or, what is more common still, the chancre proceeds 

 from infection of a laceration, which, instead of healing immediately, 

 becomes covered with a dirty-looking exudation. The characteristics 

 of a sore arising in this way are not always so well marked as to admit 

 of its ready distinction from other forms of ulceration. In doubtful 

 cases, therefore, it is very advisable to inoculate the thigh of the patient 

 with some of the secretion of the sore ; two or three such punctures 

 should be made, and should be covered with a watch-glass attached by 

 adhesive plaster. As we shall hereafter learn, the inoculation of a 

 patient having a syphilitic ulcer with some of his own matter results 

 negatively. When the inoculation takes place, and the changes de- 

 scribed above occur, there can be no further doubt of the chancrous 

 nature of the ulceration. For the present, we shall merely describe 

 the more common forms of simple uncomplicated chancre ; then, after 

 giving an account of the primary syphilitic ulcers, we propose to treat 

 of the modifications of the chancre which arise from its complication 

 with syphilitic induration. 



The common diphtheritic chancre is characterized by ragged and 

 detached edges. The loss of substance looks as if it were made by a 

 punch. Its most common seat in men is upon the inner surface of the 

 prepuce, the surface of the glans and sulcus between the prepuce and 

 glans, and, above all, the fraenulum ; less frequently, it is upon the outer 

 surface of the prepuce, or the integument of the penis. Ulcers of the 

 fraenulum are nearly always deep and excavated, and the fraenulum 

 itself is perforated. When the sore is situated in the sulcus, between 

 the prepuce and glans, the ulceration is apt to extend, by spontaneous 

 inoculation, over a large portion of the corona glandis. If it penetrate 

 deeply at this point, the loose subcutaneous tissue becomes infected 

 by the secretion, and gives rise to a virulent abscess. When seated 

 upon the glans, it usually penetrates more profoundly than when 

 upon the prepuce, although perforation down to the urethra, with the 

 formation of a urethral fistula, is rare. The urethral chancre is not 

 common. It usually begins at the mouth of the urethra, and a small 

 loss of substance which extends inward is visible upon its swollen and 

 deeply-reddened lips. At other times the urethral chancre is more 

 deeply situated, and only betrays its existence by the purulent flow 

 from the meatus and by pain in the urethra, situated at some particu- 

 lar point, and which is increased by pressure or by making water. If 

 a concealed urethral chancre be not complicated with gonorrhoea, it is 

 easy to recognize it, as the scantiness of the purulent flow will attract 

 attention, and prevent its being mistaken for a clap. Successful inocu- 

 lation, however, is the only means of making the diagnosis sure. It 

 is hardly ever detected, though, when accompanied by a gonorrhoea, 



