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In what Modern Pox, or Syphilis, Consists. 5 In the phagedenic chancre, the ulcer increases pe- ripherally or advances, eating right and left, almost in a zigzag. It penetrates into the connective tissue, which it destroys, and under the skin, which it perforates at various points. Sometimes one of the extremities cica- trizes as the chancre pursues its destructive march. Its invading and serpiginous course is rarely regular, and the disturbances are difficult to repair. They may even bring on death. I saw a case of this nature at Lourcine, when I was interne at that hospital, in 1881. Case I. (Personal).-A poor girl of 23, in the salle Fracastor (formerly St. At the time I saw the patient, the chancre formed a very regular circle 10 centimetres in diameter, without exaggeration; the skin and con- nective tissue were absolutely destroyed, as well as the 6heath of the muscles, which latter appeared naked, admirably dissected. One would have said that the coverings had been removed with a punch, and that a part of the skin had been cut out with scissors and Scarpa’s triangle1 prepared for demonstration.
The unfortunate died of ex- haustion about eight months after the first appearance of the chancre. It is the only death from a venereal disease that I had an opportunity of witnessing during my stay at Lourcine, and yet I observed many patients in that hospital; it would be difficult to tell the exact number within a few hundreds. So, one can die of a non-infecting chancre, for this woman was not syphilitic; but it must be admitted that this is rare, especially nowadays. A last point to note, and I will have done with this parallel. 3c5i’, groin), or “kernel” which is always painful, and often suppurates. With the primary lesion of 1 Scarpa’s Triangle: An anatomical region which is dissected pre- paratory to examinations. 6 Syphilis To-day and Among the Ancients. This ganglion, which is sometimes as large as a walnut, is known, in hospital slang, under the name of prefet of the groin. This ganglionic pleiad, very hard to the touch, is absolutely indolent and never sup- purates.
It is not a bubo, then, to speak properly. When these buboes suppurate, the syphilis is accom- panied by gonorrhoea, soft chancre, or scrofula, or a neighboring wound; but that it could occur from the syphilitic process, I would almost regard as an impossi- bility. Thierry de Hery, lieutenant-general of the king (Henry II), knew already, in the sixteenth century, that there were chancres not followed by secondary accidents, and that the suppurating bubo did not belong to syphilis. He had then foreseen the duality of the chancre estab- lished in our days by Ricord in an irrefutable manner. “ As often appears in many who have bad and malignant ulcers, which will be difficult to cure, because nature makes an effort to evacuate the said venom by those parts, and if a bubo appears, otherwise called a ‘ kernel,’ which receives the said fluxion, the ulcer will be healed and cured in a short time, and the patient will be free from pox.”1 Besides, we have stated that the indurated chancre itself does not suppurate, and we shall see shortly that the secondary accidents do not suppurate either, or very slightly, this second period being a vege- tating phase rather than a destructive one.
1 Tlie following is the original: Comme souvent appert en plusieurs ayant ulceres cacoeths et malings, qui seront rebel les a curer, pour se que nature s’efforce d’evacuer ledict venin par icelles parties, et s’il survient un bubon, autrement diet poulain, qui regoive la dicte fluxion, en brief l’ulcfere sera cure et guary; et sera le patient exempt de la verolle. Thierry de Hery: La Methode curative de la inaladie venerienne, vul- gairement appelee grosse verolle. Paris, 1552. The Curative Method of the Venereal Disease commonly called the Big Pox. In what Modern Pox, or Syphilis, Consists. 7 In addition, the soft chancre appears immediately, two or three days after the infecting intercourse, rarely after eight days, whilst the syphilitic virus gathers its forces, as it were, and it is only at the end of twenty- five or one month on an average, that it sends its first rocket, the indurated chancre.