Under proper treatment this foul ulcer is soon converted into an ordinary granulating surface, which heals by cicatrization.
CHANCROIDAL BUBO.
Infection, by propagation along the lymphatics, of the inguinal nodes is frequent, and, since the infection is almost always a mixed one, suppuration is frequent.
The pus of a suppurating chancroidal bubo is as infectious as the discharge from the original sore; hence the need of great caution. The edges of the local incision should be promptly cauterized so that they may not become linear chancroids. Phagedena shows itself here as well as about the genitals proper, and differs only in that it makes the case more serious. A chancroidal bubo may, however, subside without abscess formation. The signs of suppuration are those incident to pus formation anywhere near the surface. When pus is present its early evacuation is demanded.
Diagnosis.
—Chancroid is likely to be confounded with chancre and herpes preputialis. It has no period of incubation. Destruction commences after infection, so that within twenty-four hours macroscopic evidence may be observed, and within two or three days the sore has attained distinct size and shape.
| Chancroid. | Chancre. | Herpes. |
|---|---|---|
| Local ulcer. | First local sign of a constitutional disease. | Local neurosis. |
| A distinctly venereal infection. | Usually a venereal infection. | May be non-venereal, from friction, irritation, uncleanliness, etc. |
| No incubation; lesion noticed within a few days. | Incubation from ten to seventy days before first lymphatic induration. | No incubation. |
| Commences and remains as an ulcer. | Commences as a papule, or occasionally as an erosion. This may ulcerate later. | Commences as a crop of vesicles. |
| Usually multiple. | Usually single. | Multiple and occurring in crops or series. |
| Secretion purulent and abundant. | Secretion slight and serous or bloody. | Little or no secretion. |
| May occur again and again. | As a rule, it only occurs once in the same patient. | Patients who once have it are frequently subject to it. |
| Auto-inoculable. | Not auto-inoculable. | Not inoculable. |
| Phagedena frequent. | Phagedenic action very rare. | Never. |
| Buboes in about 65 per cent. of cases. | Bubonic enlargement nearly always. | Lymphatics rarely involved. |
| Buboes usually suppurate. | Buboes as a rule do not suppurate. |
Prognosis.
—Except in the most debilitated and dissipated, in whom phagedena may prove fatal, recovery always occurs, but often with the loss of tissue and disfiguring scars.