mouth must be carefully cleaned after each meal, with warm water and a small piece of sponge on the end of a stick; and ulcers or patches painted with a solution of borax (F. 59). The treatment of the other local affections is the same as that already described for those of the acquired disease. The duration of treatment will, of course, vary according to the case; but it should always extend over a period of about six months.

Whenever the mother can suckle her child she should always do so. The risk of communicating syphilis renders it impossible to employ a wet-nurse, unless one who has had the disease can be procured. In other cases ass's, goat's, or cow's milk must be employed entirely when the mother has no milk. The meals must be given at stated intervals, every two, three, or four hours, according to the age of the child.

The treatment of the later forms of inherited syphilis is similar to that of the corresponding affections in acquired syphilis, and has already been indicated in the preceding pages. Iodide of potassium combined with mercury in some form, according to circumstances, is of the greatest value, and iodide of iron and cod-liver oil are most useful adjuvants.

PREVENTIVE TREATMENT OF SYPHILIS.

Every syphilitic person should be cautioned as to the danger of spreading it to others. Coitus must be forbidden while the disease remains active. The

contagious nature of lesions of the mouth and throat should also be pointed out, and the consequent risk attending kissing, and the use of pipes or drinking vessels, towels, etc., in common with healthy persons.

The student should also remember that syphilis has been conveyed by dirty surgical and dental instruments and appliances; hence the necessity for extreme care in cleansing all such articles.

Marriage.-Syphilis in an adult usually subsides into quiescence within two years. But the disease sometimes retains its activity much later than this; in which case, after the last symptoms have disappeared, there should be an interval of at least twelve months before marriage takes place. Under any circumstances, the shortest period between infection and marriage ought to be three years.

When marriage has already taken place, and the husband suffers a relapse, he must at once desist from sexual intercourse, and from close embraces or kissing, and submit to renewed treatment of his disease. As regards the wife, it is best, as a general rule, to wait for evidence of syphilis before submitting her to specific treatment, but she ought to be watched, that treatment may be begun as early as possible, if events show it to be necessary. A woman who has already borne a syphilitic child ought to be treated throughout her pregnancy. In this way the child may often be shielded from syphilis during its maturation in the womb, and the mother also cured of her disease.

Nursing. The lesions of acquired and of inherited syphilis being equally contagious, it of course follows that a healthy nurse should never suckle a syphilitic child, and that a healthy child should never be nursed by a syphilitic woman.

CHANCRE.

CHAPTER I.

DESCRIPTION.

Synonyms.-Local, soft, simple, non-infecting chancre or sore; Amer., Chancroid; Fr., Chancre mou; Ger., Schanker.

Chancre is a local, virulent, contagious sore, which is never the beginning of syphilis. It is produced by inoculating the pus of a similar ulcer on the patient himself or on another person.

Chancre is often co-existent with syphilis. It has no period of incubation; irritation begins immediately, but the activity varies much in different persons. The chancre is generally discovered as a minute but well-defined ulcer, about five or six days after contagion. It always causes destruction of the tissues around the point of inoculation. There are three

varieties. In one, the sore reaches through the whole thickness of the skin or mucous membrane. Another variety is very shallow. The third variety is prominent, with spongy granulations over the surface. The leading characters of the local chancre are, suppleness of the base, sharply cut, undermined edges, uneven, spongy floor, irritating and abundant puru

lent discharge, consecutive inoculation of neighboring parts producing fresh sores, activity, and liability to inflame and spread. In men, the furrow behind the glans penis, in women, the fourchette and entry to the vagina, are favorite sites.

The main complications of chancre are inflammation, sloughing phagedæna, and slow phagadæna or serpiginous ulceration. The first is a consequence of irritation from violent exercise, debauchery or other cause. Phagedæna often occurs in debilitated persons, but its exciting cause is not seldom obscure.

The diagnosis of the local from the 'syphilitic sore depends on the history; the absence of incubation; the activity of the ulceration; the tendency to multiplication; the absence of induration, and of indolent multiple enlargement of the nearest group of lymphatic glands. Though the base of a typical chancre is supple, a certain degree of inflammatory hardness is often seen in practice. Such hardness, however, is like that of a boil, not like the induration of syphilis. Still, both in syphilis and in chancre, the application of caustics or other irritation may cause so much inflammation, that a diagnosis cannot be made at the time. A primary sore on the body of the penis is usually syphilitic. Herpes and excoriations are distinguished by their readiness to heal when kept clean. Secondary or tertiary syphilis, when ulcerated, sometimes resemble chancres, but the presence or history of other signs of syphilis distinguishes them.

The prognosis of chancre is good; the sore usually