Chancres are superficial, callous, eating ulcers, which may happen either with or without gonorrhœa. They are commonly seated about the glands, and make their appearance in the following manner:—First a little red pimple arises, which soon becomes pointed at top, and is filled with a whitish matter inclining to yellow. This pimple is hot, and itches generally before it breaks; afterwards it degenerates into an obstinate ulcer, the bottom of which is usually covered with a viscid mucus, and whose edges gradually become hard and callous. Sometimes the first appearance resembles a simple excoriation of the cuticle; which, however, if the cause be venereal, soon becomes a true chancre.
A chancre is sometimes a primary affection, but it is much oftener symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after the coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, the glens penis of men, &c.[[8]]
[8]. When the venereal ulcers are seated in the lips, the infection may be communicated by kissing. I have seen very obstinate venereal ulcers in the lips, which I have all the reason in the world to believe were communicated in this manner. Nurses ought to beware of suckling infected children, or having their breasts drawn by persons tainted with the venereal disease. This caution is peculiarly necessary for nurses who reside in the neighbourhood of great towns.
When the chancre appears soon after impure coition, its treatment is nearly similar to that of the virulent gonorrhœa. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected ought frequently to be bathed or rather soaked in warm milk and water, and if the inflammation be great, an emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the inflammation, and prepare the patient for the use of mercury.
Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scabby eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of the parts mentioned above, they commonly appear upon the private parts, or the inside of the thigh. They are less painful, but frequently much larger and harder than primary chancres. As their cure must depend upon that of the pox, of which they are only a symptom, we shall take no further notice of them till we come to treat of a confirmed lues.[[9]]
[9]. I have found it answer extremely well to sprinkle chancres twice a day with calomel. This will often perform a cure without any other application whatever. If the chancres are upon the glans, they may be washed with milk and water a little warm, and afterwards the calomel may be applied as above.
Thus we have related most of the symptoms which accompany or succeed a violent gonorrhœa, and have also given a short view of their proper treatment; there are, however, several others which sometimes attend this disease, as a strangury or obstruction of urine, a phymosis, paraphymosis, &c.
A strangury may be occasioned either by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former case the patient begins to void his urine with tolerable ease; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, sometimes by drops only. When the strangury is owing to an inflammation about the neck of the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesome tenesmus, or constant inclination to go to stool.
When the strangury is owing to spasm, such medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and cooling emulsions, sweetened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding and emollient fomentations will be necessary.
When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum in them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which six ounces of the syrup of marshmallows, and four ounces of the oil of sweet almonds, and half an ounce of nitre may be added. If these remedies should not relieve the complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm bath up to the middle. It will be proper in this case to discontinue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, we would rather recommend the use of mild bougies. These often lubricate the passage, and greatly facilitate the discharge of urine. Whenever they begin to stimulate or give any uneasiness, they may be withdrawn.