CHRONIC INFECTIOUS DISEASES. 



penis, and scrotum ; and in women, eats away the labia, perinaeum, 

 and parts about the anus. The phagedenic ulcer only appears in 

 broken-down, cachectic subjects, and loses its malignant character as 

 the constitution improves. Then the devastation ceases ; the diphthe- 

 ritic coating upon the base of the ulcer is cast off; healthy granulations 

 form, and the malignant, eating sore changes into a simple ulcer, with 

 a tendency to cicatrize. If the constitution of the patient does not 

 improve, or if it becomes still more depraved by the further exposure 

 to noxious influences, especially by the use of mercury, the destructive 

 process, which continues without stopping, finally becomes complicated 

 by a slow fever which consumes the patient. 



The gangrenous chancre is sometimes a modification of the phage- 

 denic chancre, while at other times it develops from the ordinary form 

 of the disease ; in either case, the base of the ulcer and the parts about 

 it become bluish, and are afterward converted into a black, insensi- 

 ble moist slough. There is a dusky redness immediately around the 

 3schar, which is encircled by a somewhat extensive and severe oedema. 

 The disease may advance until it has destroyed a large portion of the 

 penis, or labia and perinasum, and life itself may be imperilled by the 

 constitutional disturbance which accompanies the gangrene. At other 

 times the destructive process ceases sooner; a line of demarcation 

 forms, the sloughs separate, and the disease recovers, leaving a more or 

 less extensive loss of substance behind it. We do not always know 

 why chancres become gangrenous. Now and then, owing to the action 

 of unknown causes, gangrenous chancres become of very frequent 

 occurrence, or, at least, are more common than usual. In many in- 

 stances, however, mechanical action, such as straining or tension of the 

 inflamed part (as, when the chancre is complicated with phimosis or 

 paraphimosis), chemical agents, or irritation of the sore by the putre- 

 faction of retained secretion, may be regarded as causes of the malady. 



TREATMENT. In proportion as the opinion has gained ground that 

 the chancre never leads to constitutional syphilis, the old and erroneous 

 practice of treating chancres by mercury has died out. The progress 

 of knowledge has speedily borne fruit in this instance, the importance 

 of which cannot be sufficiently prized. We have only to consider that, 

 but a few years ago, at least one-half of the physicians used to subject 

 all patients with chancres to a course of mercury, and thus often enough 

 ruined their health by means of this pernicious poison, under the mis- 

 taken impression that they thereby averted induration of the ulcer, and 

 prevented constitutional contamination. Nowadays, a physician who 

 treats a simple chancre with mercury makes a gross blunder. On the 

 other hand, I do not think it judicious to make the treatment of a sim- 

 ple chancre a purely local one. It will heal much more rapidly if the 



