The venereal diseases : including stricture of the male urethra / by E.L. Keyes.

  • Edward Lawrence Keyes
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: The venereal diseases : including stricture of the male urethra / by E.L. Keyes. Source: Wellcome Collection.

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    That his skin did not become easily syphilized, and incapable of pro- ducing pus upon inoculation with chancroidal secretions, is shown by his 2,700 successful inoculations upon himself of the pus of chancroid, as recorded by Fournier. Six to eight weeks is a very fair period of second- ary incubation—longer than the average. Why may it not have been, then, that Lindemann, being in a pyogenic state, produced an ulcer upon his skin by inoculating pus from the tonsillar ulcer of his friend ? And, supposing this similar to his previous self-inoculated chancroids, he sim- ply records it as a take. The true syphilitic character of the sore may not have appeared until some days later—a feature which would have lengthened his primary incubation and shortened the secondary incuba- tion, making both conform more nearly to the type. Be this as it may, ten days may be well allowed as the shortest period of incubation. Clinically, cases have been reported near this date. I have seen a case where I believe the incubation to have been eleven (nearly twelve) days; although, in the great majority of instances, it has been the full three weeks, or more. The incubation in cases of experi- mental inoculation has very rarely gone over the month, and, in the greatest number, has lasted between three and four weeks. During this period of rest, as a rule, absolutely nothing happens of which the patient is conscious. Sometimes an abrasion has occurred during sexual intercourse. This gets well in a few days, or it may ulcer- ate slightly; but, finally, everything clears up, and just as the patient (if his fears have been aroused) has begun to consider himself fairly safe, at the spot where poisoning occurred the primary lesion shows itself, and goes on to full development. Clinically, without confrontation, it is often difficult to establish the exact limits of the incubation period, on account of the promiscuous and repeated intercourse which the patient has indulged in. Syphilitic chancre.—The initial lesion of syphilis is a chancre, ^vhich appears after a period of incubation upon the spot at which the poison was first absorbed. It occurs clinically, under a variety of forms which resemble each other very little. There is, indeed, nearly as great a variety in the local expression of primary syphilis as is known to be the case in secondary syphilis. The simplest method of giving a comprehensive view of these different primary lesions will be to describe in short detail a typical case of each variety, afterward treating the subject as a whole, and discussing the different variations from the true type, which may be encountered, and the occasional complications. Chancres, as encountered clinically upon the male and female genitals, are: (1) the raw erosion, more or less indurated; (2) the superficial ulcer, more or less indurated; (3) the deep, funnel-shaped ulcer, always indurated; (4) the herpetiform chancre, running into one of the above varieties; (5) the mixed chancre. The syphilitic chancres of the lip, of the nipple, of the general integument, also have their type-forms, and chancres of the urethra, anus, and rectum must be considered. The raw erosion.—This is the most common form of syphilitic chan- cre. Most estimates place its occurrence as high as sixty to seventy-five per cent, of all forms. It is found in both sexes on the integument, as well as upon a mucous or semi-mucous surface, of variable size from that of a small split-pea to a large beefy patch as big as a copper penny. The surface may be in any shade of red. Occasionally it is of a light subdued ]nnk. Generally the color approaches purple, passing through all shades of lividity. Sometimes in a large patch extravasated blood makes it more