In giving the prognosis of a chancre, we always have to take into consideration the following two points:
1. The greater or less degree of curability of a given chancre; and
2. The greater or less danger that this chancre may terminate in constitutional syphilis.
As regards the first of these two points, it is an undoubted fact that a simple chancre is most curable; so is the Hunterian chancre, provided the treatment is properly conducted; for if mismanaged or neglected even ever so little, it is apt to terminate in chronic indurations or condylomatous growths, the appearance of which is inevitably followed by general syphilis. The simple chancre, if neglected, is very apt, on the other hand, to pass in two or three weeks into the Hunterian chancre, with all the danger accompanying this form of the syphilitic disease. If properly treated at the outset, both can be cured in ten to fifteen days; but if the treatment only commences fifteen days after their first appearance, it will take from twenty to thirty and even more days, to cure them. The ulcus elevatum, likewise heals very rapidly, if properly treated;
 |
| Chancre |
but, if badly treated, many readily assume the character of a phagedænic chancre. This is undoubtedly the worst form of the primary syphilitic ulcer, not only on account of the difficulties encountered in its treatment; on account of its ready termination in gangrene, and of the terrible destruction it may cause in the tissues; but likewise on account of the violence of the secondary phenomena by which it may be succeeded. If this chancre cicatrizes spontaneously, it always leaves behind it hard, uneven, rough cicatrices of a blue and brown-red color. The assertion that syphilitic erosions are easily healed, and that they often disappear of themselves, is incorrect; it is almost certain that those who offer these statements, have confounded the erosions with the harmless herpes intra-vulvaris, whose resemblance to erosions is exceedingly deceitful. According to my experience there are no more tedious, and hence no more deceitful or more dangerous phenomena, than those very erosions; for if they continue for any length of time, they may superinduce secondary syphilis, even while they are still out upon the skin. The danger of a primary chancre terminating in constitutional syphilis, not only depends upon the treatment, but likewise upon the age of the chancre. Chancres that are only treated externally, readily induce constitutional syphilis; neglected chancres produce this result in six or eight weeks. Ricord’s statement that an incipient induration is a sure sign that constitutional syphilis has already set in, may apply to all chancres that commence as simple or elevated chancres and afterwards become indurated; in the Hunterian chancre, however, where the induration exists at the outset, the danger only begins after the ulcer passes from the ulcerated stage into that of condylomatous growths, which, at the earliest period, takes place in from four to five, and, at the latest period, in from six to eight weeks. Regarding the promises which a physician can safely make to his patient when first taking charge of his case, it is of the utmost importance that the physician should first inquire of his patient how long the chancre has been in existence; if the chancre has been out four weeks, it would be rash to promise that secondary symptoms may not supervene inspite of the best treatment; if the ulcer has already lost the characteristic appearance of the primary chancre, or has been treated by external means exclusively, no promise of any kind can be made.