Syphilis / by Sir Jonathan Hutchinson.

  • Hutchinson, Jonathan, Sir, 1828-1913
Date:
1909
Catalogue details

Licence: In copyright

Credit: Syphilis / by Sir Jonathan Hutchinson. Source: Wellcome Collection.

    46/718 (page 16)
    lchap. Leaving aside for the present the consideration of the non-infecting sores, we will now proceed to examine in more detail certain points in reference to the in- durated chancre. Is mi abrasion of' flic surface necessary to contagion?—The reply to this question must be that, although undoubtedly the existence of a wound, or the occurrence of laceration, very much facilitates the introduction of the virus, yet probably neither con- dition is essential, nor perhaps even frequent. There is nothing improbable in the suggestion that the virus can easily penetrate the unbroken, but soft, moist, and very delicate mucous structures of the parts on which chancres are usually seen. On the skin itself it may be more difficult, and the intervention of a wound or sore may be almost essential. Beneath the prepuce in the male, and on the vulva of the female, imbibition must be supposed to be the more common event. On these parts it is probably sufficient that the virus finds protection in a mucous fold or a gland orifice. The evidence of a very large number of patients is to the effect that no abrasion whatever was noticed at the time of infection. In not a few cases very careful inspections have been made, accompanied by ablutions, and repeated through many days, and yet no such sore has been observed. It is obvious, then, that it is, for practical purposes, useless to contend that an abrasion is essential, since all must admit that the breach of surface is often so small as to escape the most careful examination. In many of the cases in which surgeons suffer from midwifery chancres there is no history of previous breach of surface, the virus appearing to have simply found lodgment under the nail, or in a fold at its edge. On the most common positions of chancres. —In the male, the most frequent position for chancres is the roll of the prepuce (reverted), just behind the corona (“the furrow”). In this position, also, chancres assume their most characteristic features. Here in- duration is greatest, and is most easily estimated. The gristly, half-circular disc stands up conspicuously