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Soft Chancre - Venereal Ulcer.There is a second sore which is also usually found upon the genitals, where it is produced by impure sexual contact. This sore - which is technically called a chancroid or soft chancre - is entirely different from the chancre after the first week or ten days, though during the first few days it may be impossible even for a practiced eye to say which of the two varieties it is. It is, however, important that the distinction between the two should be made, for the venereal ulcer is in the vast majority of cases a local, and not a. constitutional affection; the poison does not seem to enter the system, or if it does, it exerts no injurious effect upon the body generally. After the sore is healed, the individual is just as sound in every respect as he was before he contracted the disease ; he need fear no subsequent manifestations of the affection, and his children will show no evidence of hereditary taint derived from this disease. It is not necessary to enter into any discussion upon the different views which have been in times past entertained by medical men as to the nature of the respective venereal poisons. It will suffice to repeat what has been already stated, that while the chancre- the hard chancre - is almost invariably the first symptom of constitutional syphilis, the venereal ulcer or soft chancre is very rarely followed by any evidences of constitutional infection. The soft chancre or venereal ulcer is characterized by a sharp, abrupt edge, which often seems to have been cutout with a punch, so regular and steep is the border of the ulcer. Sometimes this edge is undermined so that a little border of skin projects from the side over the ulcer. The depth of the ulcer varies extremely, being sometimes quite shallow, and at other times deeply excavated. The bottom is covered with a grayish or dirty yellow layer which is composed of matter. In a few days there is usually considerable discharge of matter or pus from the ulcer - a point of difference between the soft and the hard chancre, since the latter rarely discharges matter in considerable quantity. There are two features by which the soft chancre can usually be distinguished from the hard chancre or primary sore of syphilis. The first and most important point of distinction is, that the skin around the soft chancre is not hardened nor elevated; the sore appears to be simply an excavation in the skin, without any swelling around it, as is the case in the hard chancre. This is one of the symptoms which is relied upon chiefly by physicians in predicting whether or not the sore will be followed by constitutional syphilis. If two or three weeks elapse without the production of any hardening around the sore, it may be confidently expected that the disease will remain a local one, without any infection of the blood. Another feature characteristic of the soft chancre is the early period at which it appears after impure contact. This sore is sometimes apparent within 24 hours after exposure, while several days commonly elapse before the true chancre is seen, and two or three weeks pass before the chancre becomes well developed. A third feature which is quite characteristic of the soft or venereal ulcer, is the fact that several of these sores usually appear at the same time. Sometimes there may be a dozen or more situated near each other, or scattered about on different parts of the genitals. If the infection be a hard chancre, on the other hand it rarely happens that more than one sore is discoverable. Furthermore, it will often be observed that new sores appear in the neighborhood of a soft chancre ; this seems to result from the escape of the matter from the original sore into cracks or abrasions of the neighboring skin ; for wherever this matter enters the skin a new sore is produced, which resembles, in all particulars, that which was contracted during the venereal contact. The hard chancre, on the contrary, does not produce similar sores in its vicinity ; even when the matter from it is intentionally inoculated in the skin of the individual, no such sores are produced. This fact may often aid the uninitiated individual in distinguishing between the hard and the soft chancre. It may be stated in general, that if only one sore makes its appearance within a week after exposure, it is in all probability the hard chancre, the forerunner of constitutional disease; while if numerous sores are formed within a few days, they are in all probability chancroids, and will not be followed by a disease of the blood. This fact that the soft chancre can be reproduced in different parts of the same individual by transferring the matter from the original sore, while the hard chancre is not so reproduced, has been often used by physicians in deciding a doubtful case. The plan consists simply in inoculating the individual at different points of the skin with matter from the sore ; if a new sore similar to the original one is produced at each of these points, the disease is the venereal ulcer and not constitutional syphilis ; if on the other hand these inoculations are not followed by the production of similar sores, the disease is probably hard chancre, which will be followed by general disease of the system. This artificial inoculation has sometimes been carried to extremes ; thus one physician produced over 8,000 sores on his own body by inoculating himself with the matter from a soft chancre. Soft chancres may appear on any part of the body ; they are, of course, most frequent on the genitals of both sexes, but may also be found upon the tongue, the lips, the nipples, etc. When they occur in and around hair follicles, they often produce sores which resemble boils. When they are located in parts where the skin is loose - as in the web between the fingers - the soft chancres are often surrounded by a swollen base which may resemble the hardness of the true chancre ; yet this base is never so hard and firm as that which surrounds the hard chancre. Bubo. - This affection - vulgarly known as " blueball" - is an incident in the course of a soft chancre. It consists in an inflammation of one or more of the glands in the groin, which is due to the absorption of the matter from the sore. This matter travels along the little channels which are known as lymphatic vessels, until it comes to the gland, where it is stopped and excites an inflammation ; sometimes indeed a red line can be seen along the skin from the sore to the vicinity of the gland, indicating the course of the lymphatic vessel. The swelling of the gland rarely appears before the second week after the formation of the sore. It may be ushered in by shivering and fever, accompanied by tenderness in the groin ; but in most cases the attention of the patient is first attracted by stiffness and pain felt in the groin upon walking. When he examines the tender spot he finds a little lump or tumor, which is quite painful upon pressure. This tumor rapidly increases in size and occasions the individual great pain, especially when he walks or indulges in other exercise ; in a week or ten days the swelling and pain are so great that he is compelled to keep the recumbent posture as much as possible. The skin over the swollen gland becomes red and tender, and if the inflammation be severe, the skin often assumes a livid or bluish color. In rare cases the swelling will gradually subside without further difficulty; but in the vast majority of instances it will be observed, within two or three weeks, that the central part of the swelling is not hard as before, but has become quite soft and less painful. This softness is due to the formation of matter in the tumor ; and nothing can be done after this except to open the abscess without delay. Patients often make a mistake in refusing to have the swelling opened, thinking that they can thereby avoid the unpleasantness as well as the pain. In this they are greatly mistaken, since if the tumor be not opened it will break of itself. It is. therefore, far more desirable, in every way, to have the abscess opened promptly: ist, because the pain is thereby relieved and the patient saved several days, or even weeks of suffering ; and 2d, because the abscess will be smaller and easier to heal if the matter be let out early. For when the abscess is permitted to break spontaneously there is always produced a ragged sore with undermined edges, which often needs trimming with the scissors before it can be persuaded to heal. After the buboes are finally healed, the individual need expect no further difficulty from the venereal ulcer. In most cases the ulcer is healed in two to six weeks ; but the bubo may remain open for months unless carefully treated. Physicians distinguish several varieties of soft chancre, according to the characteristics of the sore itself. Thus we recognize a phagedenic ulcer, which is characterized by its tendency to progress and extend indefinitely. This ulcer sometimes causes extensive destruction of tissue, and even the loss of a part of the genital organs. It is accompanied by extreme pain and tenderness. This variety occurs with especial frequency in debilitated individuals, particularly those who are afflicted with scrofula or tuberculosis, and those who are addicted to excess in drink. The serpiginous ulcer is so called because of its form ; it heals in the center, but progresses irregularly around the edges. It is apt to spread with extreme rapidity, and to cause great destruction of the organs attacked. This, like the former variety, occurs chiefly in individuals suffering from depraved constitutions. The venereal ulcer, unlike the hard chancre of syphilis, can be communicated to the lower animals, where it produces sores similar in appearance, and in other characteristics, to those found upon the human subject. Such are the characteristic differences between the primary sore of syphilis and the venereal ulcer. As has been stated, these differences are visible usually only after several days have elapsed since exposure to contagion. At the very beginning it is impossible to say positively which of the two diseases - syphilis or the venereal ulcer - is present. In every case the sore is apt to begin as a pimple, which merely causes a slight itching for a time until the top is scratched off, leaving the bottom of the ulcer exposed to view. Treatment.-The treatment of a venereal ulcer is always a purely local one ; that is to say, it consists in applications which ^re intended simply to heal the sore and to prevent, if possible, the formation of a bubo. There is in this disease no infection of the system, and hence no necessity for agents which shall " purify the blood. " In fact, no medicines need be given internally in this disease, so far, at least, as the affection itself is concerned. It sometimes becomes necessary to administer remedies which shall build up the patient's health and thus prevent the sore from enlarging ; but these remedies are not intended to exercise any influence in counteracting the poison, since this poison does not remain in the blood nor cause any constitutional disease. The local applications vary according to the condition of the sore itself, as well as the general health of the individual. If a suspicious pimple, which causes considerable itching, be discovered on the genitals within a few days after impure contact, it will be advisable to cauterize it thoroughly once with lunar caustic. If the matter be not discovered until the sore is already ulcerated, one of the following plans should be pursued: If the patient be in good general health, the ulcer should be thoroughly cauterized once either with lunar caustic, nitric acid or carbolic acid. It will be better for any other than a professional man to employ the lunar caustic for this purpose, since the acids named are liquid and cannot be so easily controlled ; unless extreme care be taken, these acids will run over the sore and destroy the sound flesh around, making an extensive and painful ulceration. After the sore has been cauterized with lunar caustic, it may be dressed for twenty-four hours with a little vaseline spread upon lint. At the end of this time the cauterized surface will come away as a dirty white or grayish layer, leaving a red base. This may now be dressed by pouring upon the sore powdered iodoform, over which a piece of soft rag may be applied. At the end of twenty-four hours the sore may be washed and closely inspected. The bottom of it should now be uniformly red and clean; if grayish patches be noticed which stick closely to the bottom of the sore, the ulcer should be cauterized a second time ; that is, those parts which are still covered with grayish matter should be burned again. It will not be necessary to cauterize the entire base if the surface generally be clean and red. In all cases the cauterization should be done, not by the patient himself, but by a second individual ; because the application of the caustic causes considerable pain, and the patient himself will flinch and fail to apply the caustic thoroughly to all parts of the sore. On the second day the iodoform dressing may be renewed; this will indeed constitute the best dressing for the entire duration of the sore. The iodoform may be applied morning and night ; since it is a solid, and comparatively insoluble, it lasts for several hours. The one objection to the use of iodoform is its unpleasant odor, which clings to the fingers and the clothing for hours. The patient must, therefore, be careful that the powder touches no part of his person except the sore. It may be advisable to apply the iodoform only at night and wash it off in the morning, since the odor will thereby be less perceptible during the day. Or, better still, the odor of the iodoform may be masked by adding two drops of the attar of roses to every drachm of the drug. If the sore be thoroughly cauterized at first, as has been directed, and the patient be in good condition, the ulcer will usually heal under this simple treatment in one or two weeks. If, however, it be not thoroughly cauterized at first, it may last a much longer time and finally require to be cauterized again before complete healing occur. After it becomes evident that the ulcer is healing, that is, after the bottom has become and remains clean and red, and the sore is observed to become shallower day by day, it will be necessary to use only a simple salve of carbolic acid or vaseline. The iodoform does no harm, and the substitution of the vaseline or carbolic acid ointment has merely the advantage of dispensing with the odor of iodoform. If the patient be debilitated, and suffer from scrofula, tuber culosis, or any other constitutional taint which interferes materially with his general health, it becomes necessary to administer some remedies which shall improve his condition. This is an important part of the treatment ; without it great difficulty will be experienced in preventing the ulcer from spreading extensively and destroying considerable skin. Such individuals should take the following prescription : Tincture of the chloride of iron, - Six drachms. Tincture of nux vomica, - Five drachms. Compound tincture of gentian, - To make four ounces. Mix, and take a teaspoonful in half a wineglassful of water before meals. The local treatment in such cases must be conducted with caution, for in such individuals the use of caustic will cause severer effects than in robust persons. During the first few days it will be better not to cauterize the sore, but simply to dress it with the ointment of mercury, which should be applied upon a soft rag. After a few days the sore will probably be clean and red if the internal treatment have also been followed. If the progress of the ulcer be not satisfactory the patient should take cod liver oil - a teaspoonful after meals ; in these cases it may also be necessary to cauterize the sore with lunar caustic. These individuals require the most careful management, and should always place themselves in the hands of a physician. In every case of venereal ulcer it should be remembered that a bubo may result, and this constitutes one of the worst, if not the worst, feature of the case ; care should, therefore, be taken to avoid the occurrence of buboes. The most important measure to secure this result consists in the careful avoidance of unnecessary effort on the part of the patient, as well as in the improvement of the general health. A patient suffering from venereal ulcer should, therefore, be upon his feet as little as possible ; should ride and not walk whenever he can in performing his daily duties. At the first sign of tenderness in the groin the patient should take to his bed, or at least keep the recumbent posture. He may rest assured that the occurrence of a bubo terminating in an abscess is almost inevitable. The next most important measure for the prevention of buboes consists in attention to the general health. Among individuals who are in robust health at the time when they contract the disease, buboes are far less numerous, and their effect far less severe than among those whose general condition is unsatisfactory. It is therefore advisable for the patient to use a generous diet, to have plenty of sleep and to enjoy the best possible conditions for the maintenance of health. Various remedies have been employed and recommended in order to prevent the formation of matter in the bubo. The most frequent remedy consists in painting the skin over the bubo with the tincture of iodine, or by applying a tight bandage around the waist and the thigh so as to compress the bubo. In recent years it has been claimed that the sulphide of calcium, when administered internally, will also prevent the formation of an abscess. Yet we have no definite grounds for believing that any or all of these remedies combined have any marked effect in preventing the formation of matter. After it becomes evident that matter is forming - a condition which is made manifest by a softening in the middle of the swelling and perhaps by blueness of the skin - there remains but one thing to be done : the bubo must be opened ; the sooner this is done the better ; the pain is thereby relieved and the abscess will heal far more readily and easily than if the bubo be allowed to break of itself. After the bubo has been opened it should be carefully washed out three or more times a day, according to the amount of discharge. Extreme care should be taken that all the matter be removed at every dressing ; for this purpose a small syringe with a narrow point may be employed in order to inject the water into all the crevices of the abscess. After it has been thoroughly cleansed, powdered iodoform should be dusted into the cavity. A still better way is to pack the cavity full of gauze, such as surgeons use, which has been saturated with iodoform powder. If this cannot be procured, some fine lint may be impregnated with iodoform by rubbing the powder thoroughly into the cloth ; this is then cut into narrow strips, say half an inch, wide and tucked into the cavity ; it should be packed tightly down so as to bring the gauze in contact with the raw surface. One of the most important items in the treatment of bubo is that the patient should remain quiet; if he can maintain the recumbent posture, so much the better. At any rate the healing of the wound will be very slow and troublesome unless the patient avoid walking and standing. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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