CHANCROID.
THE chancroid is a local and highly contagious ulcer, very destructive in its course and usually followed by enlargement and suppuration of the lymphatic glands in immediate anatomical relationship with it. As a rule it is situated on the genital organs, though it may be reproduced by inoculation on any part of the body.
The chancroid is otherwise called the "soft chancre" in contradistinction to the "hard chancre" of syphilis. It is entirely a local affection, never producing constitutional after effects and not being transmissible to posterity. It does not usually endanger the patient's life, though it may terminate fatally from a concomitant erysipelas; or by deeply eroding the tissues it may cause a serious stricture. At the best it leaves compromising scars behind, and in severe cases it sometimes causes such extensive destruction of tissue that amputation of the penis may become necessary.
The pus from the primary sore, if inoculated on abraded surfaces, is capable of infecting the patient himself in a number of places, while the primary sore of syphilis has not this characteristic. One attack does not confer immunity, and an individual may have chancroids time and time again. Furthermore, the pus from a chancroid, in contradistinction to the virus of syphilis, is readily transmissible to animals.
These contrasts with syphilis are made because the two diseases were confused and erroneously interpreted until recent times.
Cause. It is now accepted by most authorities that chancroid is invariably produced by the inoculation of virus from another chancroid. Some authorities believe that the chancroidal ulcer is not due to a distinct virus, but that it is a hybrid and heterogeneous disease; that it may originate de novo from local uncleanliness, and that it may be caused by inoculation of various binds of pus-producing microbes staphylococci, streptococci, etc. on excoriated or abraded surfaces.
On the other hand Ducrey, Welander, Krefting and others maintain that there is a definite micro-organism, or bacillus, which has been satisfactorily demonstrated to be the specific cause. The clinical history, after experimental inoculations with chancroidal pus, argues strongly in favor of its being a distinct lesion and not a hybrid disease.
In almost all cases it is acquired during sexual intercourse, and is therefore commonly situated on the genitalia. But it may as readily be inoculated extra genitally whenever the virus is applied to an abrasion, e.g., on the lips, nose, eyes, thighs, abdomen, or any cutaneous or mucous surface. Surgeons are sometimes accidentally inoculated on the fingers, and the virus may be carried on towels, drinking cups, utensils and instruments of all sorts.
Mode of Onset. There is no period of incubation, but the ulcer is quickly developed after the deposit of the microbes on the abraded spot, usually on the head of the penis and on the prepuce. It may appear in twenty four hours, or may not be noticed by a careless patient for a week or so. The chancroidal ulcer, differing from that of syphilis, is soft, and presents sharply defined edges in a characteristic manner, as though the tissues had been cut out with a punch.
Frequency. It is more frequent in syphilitic patients because that disease predisposes to it. Therefore it is specially common among the lower class prostitutes, and among men who are ignorant and careless about all matters relating to sexual affairs. In many prostitutes it remains indolent and lingers for years.
Complications. Sometimes there is gangrene and considerable loss of tissue, resulting in great deformity. Sometimes the penis is destroyed, or the testicles may be laid bare by destruction of the scrotum. These severe cases, however, are seldom seen except in patients who are much debilitated by syphilis, or by other profoundly depressing diseases, such as diabetes, tuberculosis, diseases of kidneys, liver, etc. This gangrenous form sometimes lasts for years without healing.
The most frequent complication is a bubo, or glandular swelling. Supposing the sore to be on the penis, the poison is conveyed by the lymphatic vessels to the nearest group of glands, which are situated in the groins. Usually only a single gland in one groin is involved, though the whole packet of glands in both groins may become indurated and eventually break down into pus.
No micrococci are found in these buboes, but they are caused by toxins, or chemical irritants, produced by the organisms at the site of the lesion on the penis.
The pain of buboes is sometimes intense, and the extensive suppuration, with escape of the pus into the surrounding tissues, often leaves deforming cicatrices from the prolongation of the healing process.
Treatment. Many cases heal spontaneously, but surgical dressing or operation is usually necessary. It is very generally advisable to excise the enlarged gland, or bubo, while in other cases circumcision is indicated. In the severest cases it may become necessary to amputate the penis or to castrate the patient on account of the extensive destruction of the scrotum.