tence, during which period the patient had pursued his usual avocations, and used various local remedies. When I first saw this case, there was a deep burrowing ulcer involving the whole under surface of the glans, having destroyed the frænum, and extended to the integument on the under surface of the penis; this ulcer was covered with a tenacious slough, black in some places, white in others. The glans penis itself was swollen and much inflamed, and the whole body of the penis was in a similar condition. The patient was now confined to bed, placed on a low diet, the parts enveloped in a bread poultice, and aperients, with nauseating doses of antimony, exhibited. In two or three days, the ulcer continuing to spread, I destroyed the whole surface with the acid nitrate of mercury, and after the separation of the eschar, no improvement having taken place, I did this a second time. The slough was again reproduced, the ulcer still spreading, and threatening to open the urethra; a circumstance I have seen more than once consequent upon ulcers in this situation. It is to be remarked also that the general inflammation in the glans and penis were very little reduced by the rest, diet, and antiphlogistic treatment. I now resorted to the mercurial fume. The patient was immersed daily for forty minutes; there was no extension of disease after the second bath. At the end of eighteen days the sore had healed without induration, leaving, however, an excavated cicatrix on the glans. The mouth was moderately sore. Profuse night perspirations also accompanied the ulcerating and sloughing stages.

CHAPTER XI.

OF CHANCRES AND ULCERS IN THE FEMALE.

WHAT has been already said at pages 109 and 110, on chancres and non-specific ulcers in the male, finds also its application here, especially in reference to sores situated on the external parts of generation.

Primary venereal ulcers in the female are most commonly seated on the external parts, as the labia majora, the nymphæ, the folds of mucous membrane surrounding the clitoris, at the orifice or other parts of the vagina, or at the meatus urinarius.

Ulcers, yielding a characteristic pustule by inoculation, are rare on the neck or at the orifice of the womb; although ulcerations, unquestionably syphilitic, are by no means uncommon in this situation.

Primary venereal ulcers, as we observe them on the external parts of the organs of generation, are rarely found on the neck, on the lips, or in the canal of the cervix uteri, yet they have been found in all these situations. I can only find one case on record where an ulcer of the uterus yielded a positive result when tested by inoculation, and this is mentioned by M. Ricord, at page 212 of his Treatise on Inoculation.' Another case is given, by the same surgeon, at p. 11 of his Iconographie,' and figured in the fifth plate. Here the ulcer was single, and its existence suspected from two persons having contracted chancres from the subject of it. No account is given of its having been inoculated artificially, and therefore I conclude that no test of this kind was instituted. It is described as "a round ulcer, with well-defined and sharp edges, and an ash-coloured surface, surrounded by a red areola or border."

A man was admitted, under my care, as an out-patient at the Queen's Hospital, some time ago, with several soft chancres round the corona glandis. He said the disease had been given

to him by his wife, who was suffering from syphilis when he married her, and soon after this event the disease under which he laboured broke out. He brought his wife with him for examination.

On the lower lip of the cervix existed a deep ulcer with sharp edges, surrounded by a well-defined inflammatory patch; the ulcer appeared to run into the canal of the cervix. I never saw anything more closely resemble a chancre, yet it produced no result when inoculated.

Dr Whitehead, at page 367 of his treatise on Abortion and Sterility,' says: "I have seen but one case of this kind. The husband had orificial chancre with gonorrhoea, which were contracted about three months after marriage. His wife had no external sores; she had constitutional syphilis. The ulcer occupied the boundaries of the orificium uteri to the extent of a sixpenny piece; it had lost its primary character, as far at least as the infecting power of its secretion was concerned, as no result was obtained by inoculation of the matter on the skin; but it still retained a genuine chancrous appearance, having an excavated centre with raised overhanging margins and a yellow base."

A girl was admitted into the Queen's Hospital, under my care, in August of last year, with a syphilitic eruption, a wellmarked "lichen corymbosus." On examination of the uterus, a large well-defined ulcer was discovered on the lower lip, which ran into the canal of the cervix. It was surrounded by a ring of inflammation. The remaining portion of the mucous membrane was healthy, and contrasted strongly with the diseased one.

Nothing appears more likely to happen than inoculation of the uterine surfaces, when the male has chancre of the urethra. The comparative frequency of this may be seen from an examination of the work of M. Fournier, who, out of 824 cases in which the seat of chancre was noted, found 32 of the meatus urinarius, and 20 seated within the urethra, which could not be seen till the lips of the urethra were opened.

The latter belong to the class of concealed chancres, or "chancres larvés," as they are termed by the French pathologists. Such ulcers in the female may be seated within the canal of the cervix, and thus bear a strong analogy, as far as their

situation is concerned, to those placed within the urethra of the male. The 17th case narrated by Dr H. Bennet, in his treatise on 'Inflammation of the Uterus,' appears to have been one of this kind. It occurred in a female, who had communicated to her lover a chancre and a bubo; and these circumstances led to an examination of the vagina and uterus. No trace of disease could be discovered, except a profuse puriform discharge from the vagina, and a muco-pus which issued from the os uteri. On the third examination with the speculum, "a small ulceration was discovered issuing from the os uteri, and turning over the anterior lip. The ulceration presented a greyish surface and an irregular indurated margin; it was deemed to be a true chancre by M. Emery, as well as by Dr Bennet, and many other persons who saw it." (Bennet, On the Uterus,' p. 442.) This case is narrated by Dr Bennet as one of chancre concealed within the cavity of the os uteri for several weeks, the first symptom of which was the discharge of muco-pus from the uterine orifice.

It will be remarked, in the two cases I have mentioned from my own observation, that both the ulcers which I thought might be primary, turned into the canal of the cervix. They might have commenced there, as the cases were not examined till disease had been in existence some time.

It is very probable that the concealed chancre of the canal of the cervix may be a more frequent affection than is generally supposed; for it is not uncommon to see females with secondary syphilis, who have had no external sores, but who complain merely of discharge more or less profuse. On examining these cases with the speculum, a thick muco-pus is found to issue from the os uteri, which may or may not be symptomatic of concealed chancre of the canal of the cervix.

From what has been already said, it will again be observed, that although in one instance only, and that of a sore situated on the external portion of the neck of the uterus, could a successful inoculation be produced; still three of the females mentioned produced chancres in the persons with whom they cohabited, and yet had no external sores; they presented no other marks of primary syphilis than those which were found on the uterus.

In addition to the cases of presumed chancre of the canal of the cervix uteri which I have already mentioned, M. Robert has cited four cases of discharge from the os, which yielded a characteristic pustule when tested by inoculation; from this fact it was believed that such discharges were symptomatic of chancre situated within the canal of the cervix uteri. There was no external trace of ulceration, and the successful inoculation of the pus discharged was the only symptom which led to the suspicion of the existence of such chancres. (Quoted from a paper by Dr Achille Dron, in Diday and Rollet's Annuaire de la Syphilis, &c.,' p. 220.)1

1 What has already been said as to the treatment of chancres in the male, both constitutionally and locally, finds also its application here. If caustics be used to ulcers situated deeply in the vagina or in the uterus, they must of course be applied through the speculum: the best and safest caustic to uterine ulcers is the liquor hydrargyri pernitratis; care must be taken in applying it that none drop on the healthy portions of the vagina; a small pledget of lint should be placed over the ulcer after the application of the caustic.

See also the chapter on Secondary Syphilis of the Uterus.