It is a corroding ulcer, without hardness of the surrounding parts,
presenting no appearance of regeneration of the tissues which have
been destroyed. It may follow either upon a pustule or an abrasion.
Sometimes it destroys the prepuce and glans in a few days, or again,
when chronic, it spreads deceitfully, healing at one part and
destroying at another. The ulceration is often deep, penetrating the
corpora cavernosa, or the corpus spongiosum urethræ: in such cases
it is followed with violent hemorrhage, which often produces a great
and sudden improvement in the sore. After slow cicatrisation it not
unfrequently happens that the scar gives way, and the ulceration
returns.
Sometimes another character is given to the sore, by the rapid
sloughing of the parts. In this modification, a small black spot is
first observable, unattended with pain: it enlarges rapidly, and, after
no long time, the mortified part separates, exposing an unhealthy
surface, which is immediately attacked and progressively destroyed
by phagedena. The part may again slough, and, by an alternation of
mortification and phagedenic ulceration, the external organs of
generation, male or female, may be wholly destroyed. In the present
day, however, its ravages are much less extensive and more easily
combated than formerly, and it seldom, if ever, proves fatal. One very
troublesome case is in my recollection, where the patient suffered
two attacks at the interval of two years. During the progress of
the disease he was seized with delirium tremens; a bubo formed and
ulcerated; a violent hemorrhage occurred from the sore; sloughing and
phagedena alternated; and both prepuce and glans were entirely lost.
An eruption followed, accompanied with ulceration of the throat and
nostrils. He recovered much mutilated. Ulcers originally of a simple
character may become affected with phagedena, or sloughing, from the
state of the constitution, from mismanagement, or from exposure to an
unhealthful atmosphere. But in such cases, after the separation of the
slough, the exposed surface is found to be of a healthy granulating
character, contrary to what is observed in the originally phagedenic
disease. Buboes, when they occur, have the same malignant action as the
primary sore: the breach of surface is extended either by sloughing
or by phagedenic ulceration, and the edges of the sore are ragged and
undermined.
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