plained of pains in the shoulders and knees. No nodes presented while in the institution.

The last class of primary sore which remains to be described is the indurated ulcer, to the consideration of which, together with its usual consecutive results, I shall now proceed to address myself.

CHAPTER XII.

THE INDURATED PRIMARY ULCER.

THE formation of the Hunterian chancre, the true type of a venereal ulcer, is in its origin like that of the other varieties of primary sores. It commences as a vesicle or pimple, unattended with any degree of pain or uneasiness; but, unlike the other forms of which we have spoken, instead of showing an early disposition to spread, it progresses slowly, gradually, and often imperceptibly. It occasions during its advancement no local suffering, and assumes an indolent character; its distinctive features not being fully developed until sometimes the second or third week from the date of its accession. In extent it varies much, ranging from the size of a split pea to that of a fourpenny piece, and occasionally, but rarely, exceeding these latter dimensions. Its centre is usually but not necessarily excavated, smooth and destitute of granulations, and thinly smeared with an ichorous secretion. Its base and margins are indurated, giving the sensation of a piece of cartilage under the skin

terminating abruptly. This interstitial or subcutaneous effusion, constituting the cartilaginous hardness, is a superadded symptom; never exhibiting itself upon the formation of the ulcer, and being often protracted until a late period from its advent. Nor is it proportioned to the depth or circumference of the ulcer, being frequently more apparent where there is but little excavation, and when the sore is much limited in extent. Owing to this last named peculiarity, we never find the indurated sore, when uninterfered with by art, take on the characters of the phagedenic ulcer; nature having thrown around it this protecting ring, by which its local action is restricted within narrow limits. But while this is so as regards its topical disposition, we will perceive as we proceed that there is no form of primary affection more likely to produce constitutional taint than that which we are now considering, the concentration of the virus favouring enormously the absorption of the syphilitic poison; indeed, to such an extent, that it is by many believed that general contamination must of necessity succeed to the indurated chancre. Fortunately, however, the Hunterian ulcer is now but seldom met with. In referring to a former chapter, it will be observed that out of three hundred primary sores that came under my own immediate inspection, thirty only were attended with well marked induration. The paucity of these primary sores will likewise explain the less fre

quent occurrence of the constitutional symptoms, which are well known to supervene upon them. That other forms of primaries, when set astray by over local stimulation, (more especially those to which escharotics have been applied) closely simulate the indurated ulcer, is a circumstance with which all syphilographers at the present day are conversant; and from these factitious indurations has, I doubt not, arisen the mistake into which former authors had fallen, in describing these peculiar primary affections as of common occurrence. The indurated ulcer presents for the most part as a solitary sore; and although it may select as its site any position on the male or female organs of generation, it is most frequently found on the orifice of the prepuce, or the corona glandis of the male; and in the female on the external labia, at the junction of the skin and mucous membrane. The urethra of the male may likewise be the seat of the indurated ulcer, thus constituting that form of disease known as the concealed urethral chancre. These sores may be detected by a circumscribed hardness and morbid tenderness in some portion of the canal; and as they often are situated on the internal lips of the meatus, the diag nosis may be perfected by everting the orifice of the urethra, when they will immediately be brought into view. In consequence of the depth, however, to which they occasionally proceed behind the glans, this diagnostic mark will not always be

available. From the general indolent nature of these ulcers, from the constitutional affections to which they give rise, and from the speedy manner in which they yield to the appropriate remedy adopted for the cure of the indurated ulcer in other situations, they may, I conceive, as a general rule, be said to partake of the characters peculiar to the ulcer under consideration.

Before entering upon the treatment of the indurated ulcer, it will be necessary to recall to the recollection of the reader the two stages into which syphilitic ulcers are naturally divisible; the first or primitive stage being that of ulceration, the second or consecutive stage constituting that of reparation or cicatrization. The practical bearing of these points will be more especially apparent in this class of primary sore, when speaking of the choice of topical applications, and the precise period at which their use will be demanded. It will also serve to guide us in the selection of a certain description of constitutional remedies, which the management of this ulcer will imperatively demand. The therapeutical appliances, therefore, resolve themselves into local and constitutional.

Treatment.-(a) Local applications. Having previously observed that the danger of constitutional infection is proportioned to the duration of the local disease, it must be self-evident that in order to anticipate, as it were, the natural process of absorption, and thus prevent the diffusion of the poi