—In mild cases—i. e., those showing but little destructive tendency—cleanliness and the use of hydrogen peroxide, followed by local use of any of the ordinary antiseptic powders, or even of calomel, will usually prove sufficient. Sodium sozoiodolate makes an excellent application. It is odorless and non-toxic. At first its use may be preceded by morphine or cocaine, but after a few days it will prove a painless application. If the ulcer manifest any tendency to spread, it should be cleansed, cocainized, and then cauterized with nitric acid or the actual cautery, after which it should be so treated as to encourage granulation. This plan should be followed in phagedenic cases, which may call for general anesthesia, with the use of scissors and a sharp spoon, followed by cauterization of every particle of raw or diseased surface.
Widespread phagedena is more rare now than formerly. Cases which are extensive do best when submitted to continuous immersion of the hips in a sitz-bath as hot as can be tolerated. All aggravated cases call for invigorating and tonic measures, laxatives, improved nutrition, and stimulants.
Suppurating buboes should be incised, usually curetted, and thoroughly swabbed with pure carbolic acid, followed by pure alcohol to neutralize the acid, then packed lightly with antiseptic gauze, and allowed to close by granulation. Virulent cases will be accompanied by sloughing of so much tissue that it is best to remove all sloughs with scissors. Here even stronger caustics will be called for. Phimosis often complicates chancroid, and will necessitate circumcision or incision along the dorsum of the prepuce, with such attention to the parts thus exposed as their condition may require.
Mixed Chancre.
—Mixed chancre, or the combination of the two lesions, has been already discussed.
Extragenital Chancroid.
—Extragenital chancroid may occur upon any portion of the body, but is more rare than extragenital chancre. It is characterized by the same peculiarities as pertain to the venereal sores already described, and is amenable to similar treatment.
CHAPTER XII.
GONORRHEA.
Gonorrhea is an acute infectious process, involving especially the mucous membranes of the genito-urinary organs, but met with elsewhere about the body, in both superficial and deep tissues. The name itself is a misnomer, since it implies a flow of semen, whereas the discharge which issues from the male urethra is simply mucopus, and is the product of a severe inflammation of the mucous membrane. A less inaccurate name for it is blennorrhea, although this is usually limited rather to a discharge from the vagina, and indicates a whitish and copious fluid exudate, mingled with pus corpuscles and bacteria. It is stated that probably 80 per cent. of men have at some time contracted this disease. Neisser claims that it is a more common affection than measles.
True gonorrhea is the result of an infection by a specific organism universally recognized as the gonococcus of Neisser, though the discharge, when studied in the clinical laboratory, may give evidence of being the product of a mixed infection and contain the ordinary pyogenic or other organisms. The common name for the disease is clap.