LUES VENEREA. 



■ftie other TianJ, fince the matter is eafily rubbed off pro- 

 ■aiincnt parts by every thintr that touches them, they oftener 

 cfcape the diloafe. In lefs common initances, chancres are 

 ■feen on the fcrotum, and even on the (kin of the pubcs. 



In women, cliancres moftly take place on the labia and 

 nymphs. In a few examples they are met with on the 

 perinoum. They arc generally formed on the inner furface of 

 the labia, thongh fometimes juft on their edge, or even on 

 their outfide. Cliancres have been oblerved in the vagina ; 

 in thcfe cafes Mr. Hunter fufpefted, that the fores never 

 occupy ftich llluatidn originally ; but arife there from the 

 Ipreading of ulcers on the infide of the labia. In women 

 ■the ulcenitions. are apt to be more numerous than in men, 

 becaufe tlie furtacc, lor the occurrence of chancres, is more 

 e-^teiifive. 



From what has already been obferved, it mull be o!)vious, 

 ■that chancres may be caught in other ways befides coition. 

 Whenever venereal matter accidentally comes into contaft 

 'with any part of the (km, where a fore, cut, or fcratch 

 cnifts, or whenever fuch matter is applied where the cuticle 

 is thin and moid, a chancre is likely to be the confequence. 

 Mr. Hunter faw on the red part of the lip a chancre, which 

 was as broad as a fi.xpence, and caught the patient knew 

 ■rot how; it was attended with bubo under the jaw, and 

 might have been the confequeuce of infectious matter inad- 

 vertently conveyed to the part by the patient's own hngcrs. 

 ( P. 217.) In Dr. W. Hunter's leflures, mention ufed to be 

 -made of a midwife in exter.five praftice, who, having caught 

 ■a chancre on her right fore-hnger in examining a pregnant 

 woman that had the difeafe, infcfted no kis than eighty 

 other women in the courfe of her bufinefs. That lurgeons 

 occafionally catch chancres by venereal matter lodging in a 

 •flight cut, or fcratch, on their hands or fingers, is univerfally 

 known. 



It does not follow, as a matter of certainty, that becaufe 

 •venereal matter has been applied to the furface of the body, 

 a chancre is lure to enfue. The thicknefs of the cuticle, no 

 jdaubt, frequently hinders infeftion, and the difeafe is often 

 prevented by the matter being waftied or rubbed away. It 

 -is believed, that fome perfons cohabit with difeafed women 

 with little rifle, and we are toM they are, for the mofl part, 

 -ilroiig fubjefts, with a fhort prepuce, and of courfe thegians 

 always uncovered. 



It is a circumftance worthy of attention, that when a 

 ■chancre is caught upon the hands or fingers, as related 

 above, the virus leems conltantly to operate more power- 

 fully than when fuch a fore is formed m one of the ufual 

 fituations. " I know a midwife," favs Svvediaur, " who 

 having been infected in this manner feveral years ago, Pill 

 fuffers from the dileafe ; and we have another inftance in 

 this metropolis of an eminent male practitioner in the fame 

 art. who, by delivering an infe<iled woman got ulcers in his 

 hand, and at this preient time llill laboiu'S under the confe- 

 quences, though it is now three years fince he received the 

 iufeiliopi. I know a gentleman, who wounding his linger 

 by accident with a pen-knife, expofed it the fame evening to 

 infection, without 'fufpe<5ting any bad confequences ; the 

 uound changed in two days to a very bad venereal ulcer, 

 -accompanied with a painful and obftiuate fwelling of the 

 whole arm, together with a bubo under the arm-pit, and 

 fymptoms of a general infection." Praftical Obfervations 

 jon Venereal Complaints, p. 194, edit. 1. 



The time, which elapfes between the application of tlie 

 virus ar.d the appearance of a chancre, is exceedingly dif- 

 ferent in difi'ereiit cafes, depending however, in fome mea- 

 sure, uu the nature of the part affected. According to Mr. 



Huntqr, the difeafe generally begins earlier in the franiim, 

 or termination of the prepuce in the glans, than on the glans 

 itfell, the fcrotum, or ihecomuron flcin of the penis. This 

 celelirated furgcon was acquainted with examples, in whi«li 

 chancres made their appearance as early as twenty-four hours 

 after infeftion ; but on tiie other hand, he mentions inftanccs 

 in which fuch fores did not begin till feven or eight weeks 

 after the application of the virus. 



The inflammation which precedes a chancre, like mofl 

 other inflammations which terminate in ulcers, begins firlt 

 with an itching in the part. If it is the glans that is in- 

 flamed, a fmall pimple generally appear* full of matter, 

 without much liardnefs, or feeming inflammation, and with 

 very little tumefadtion, the glans not fwelling fo much from 

 inflammation as many other parts do, efpecially the prepuce. 

 Chancres on the glans are alfo lefs painful and annoying than 

 thofe on the prepuce. When, however, an ulcer of this 

 kind affefts the froenum, or in particular the prepuce, the 

 inflammation is more extenfive and viiible. The itching 

 gradually changes into pain. In fome cafes the furface of 

 the prepuce is lirfl excoriated, and ulceration afterwards 

 takes place; while, in other inftanccs, a fmall pimple or 

 abfcefs is the forerunner of the ulcers as on the glans. The 

 fore becomes furrounded by a thickening, which, at firft, 

 and while of the true venereal kind, is very circiunfcribcd, 

 and iiiftead of diftufing ilfelf imperceptibly into tlie fur- 

 rounding parts, has rather an abrupt termination. The 

 bafe of a chancre is hard, and the edges fomewhat promi- 

 nent. ^\^len the fore begins on, or near the fra;num, it 

 often happens that this p^rt is quite deftroyed, or elfe a 

 hole is made through it by the ulceration. Hunter, 

 p. 2i8, 219. 



The indurated bafe, or furrounding thickening of a 

 chancre, is a moft: remarkable fymptom, and one to which 

 fiirgical writers exhort us to pay confiderable attention ; 

 for if the chancre heal, and a hardnefs remain, it will either 

 break out again, when the eonftitution becomes infeftcd, or 

 the hardnels will ftill be increafed, as ominous and indicative 

 of a conftitutional infeftion. " This fymptom, therefore, 

 will always explain, by its prefence, that the local infeftion 

 is not radically removed ; and by its abfence that it is." If, 

 by embracing the part, which was the feat of the chancre, 

 the appearance be thin, fo that the finger and thumb do 

 almoil meet, the cure may then be concluded to be perfect ; 

 but if a hardnefs and thicknefs remain, although it be 

 healed, and it there be a fcale upon the part where the chancre 

 was, then the cafe mult be deemed as not cured, and as 

 requiring much more to be done for it." Foot on Lues 

 Venerea, p. 413. 



When chancres occur on the fcrotum, or body of the 

 penis, they generally firlt appear in the form of a pimple, 

 which turns to a fcab, and this being rubbed off, is fuc- 

 ceeded by a larger one. Chancres, thus fituated, are at- 

 tended with lefs inflammation than fuch as take place on 

 the fncnum or prepuce; but v\itli more than thofe on the 

 glans. 



When the difeafe advances, it fomxtimes partakes of the 

 inflammation peculiar to the habit, and becomes more dif- 

 fufed, fo as to produce phymofis, paraphymofis, and other 

 difagreeable complaints, which tend to retard the cure. 



Trie local or immediate elfefts of the venereal difeafe are 

 feldom wholly fpecific, but partake of the conilitutioual 

 inflammation. The firllappearance and progrels of chancres, 

 tlierefore, fliould be watched, as the nature of the conlli- 

 tution may thereby be afcertaincd. If, fays Mr. Hunter, 

 the iiifiammation ipreads fall and cofifiderably, it Ihews a 



conftitutioB 



