CHRONIC INFECTIOUS DISEASES. 



with a wash of zinc or lead. When the fraenulum has been perforated 

 it is best to divide the remaining bridge of mucous membrane at once. 

 Where a phimosis prevents the proper treatment of the chancre, injec- 

 tions beneath the prepuce must be practised methodically, in order 

 to remove the accumulated secretion. It is sometimes necessary to 

 operate for phimosis ; but this is never to be done excepting in urgent 

 cases, as the entire wound generally becomes converted into a chancre. 



In the treatment of the phagedenic chancre, the general health of 

 the patient must receive our first attention. His strength is to be 

 husbanded rather than reduced ; and a nourishing diet, and sometimes 

 wine, bark, and iron, are indicated. The utmost cleanliness is to be 

 observed. As a topical application we recommend dressings of dilute so- 

 lution of acetate of lead, or of chloride of lime ( ss f j to water vj). 



Treatment of the gangrenous chancre is to be conducted upon simi- 

 lar principles, paying due attention to the surgical rules for the treat- 

 ment of mortification. 



APPENDIX. 



THE GLANDULAR CHANOBE. THE VIBULENT, ACUTE BUBO. 



ETIOLOGY. We have seen that the virus which the chancrous mat- 

 ter undoubtedly contains (although we are unable to isolate it or to de- 

 monstrate it to view) may be transferred to other parts of the body, and 

 that it will cause inflammation and ulceration at its point of implanta- 

 tion. In a similar manner the virus is very often taken up by the lym- 

 phatic vessels, and conducted to the neighboring lymphatic glands, in 

 which it also gives rise to specific inflammation and suppuration. A 

 lymphatic gland thus inflamed and suppurating from absorption of 

 the chancre-poison is called an acute, virulent bubo, or, what is better, 

 a glandular chancre. All chancres do not cause virulent adenitis with 

 equal frequency. It is most apt to accompany an ulcer of the fraenu- 

 lum. Neglect of cleanliness and a too irritating mode of treatment 

 seem to favor absorption of the virus, and the production of the viru- 

 lent bubo. Cases seem to occur now and then, in which the virus 

 reaches the corium through the epidermis without producing any lesion 

 at its point of entry, but is there taken up by the lymphatics, carried 

 by them to their glands, where it gives rise to specific inflammation and 

 suppuration. Such a bubo, which has not been preceded by a chancre, 

 is called a " bubon d'emblee." 



SYMPTOMS AND COURSE. A virulent bubo generally makes Us ap- 

 pearance in the second, third, or fourth week, more rarely in the fifth 

 ar sixth week, and it sometimes develops immediately after the forma- 



