NEW TREATMENT 
OF O 
VENEREAL DISEASES 
AND OF 
ULCERATIVE SYPHILITIC AFFECTIONS 
BT IODOFORM. 
TRANSLATED FROM THE FRENCH OF DR. A. A. IZARD, 
BY 
HOWARD F. DAMON, M.D. 
BOSTON: 
JAMES CAMPBELL. 
1872. 
PRICE, FIFTY CENTS. NEW TREATMENT 
OF 
VENEREAL DISEASES 
AND OF 
ULCERATIVE SYPHILITIC AFFECTIONS 
BY IODOFORM. WORKS ON CUTANEOUS DISEASES, &c., 
BY 
HOWARD F. DAMON, A.M., M.D. 
THE NEUROSES OF THE SKIN: Their Pathology and 
Treatment. 8vo. 1868. 
THE STRUCTURAL LESIONS OF THE SKIN: Their 
Pathology and Treatment. Illustrated. 8vo. 1869. 
PHOTOGRAPHS OF SKIN DISEASES, tnken from life, 
under the superintendence of Howard F. Damon, M.D., &c. With Descrip- 
tive Text. 410. 1870. 
LEUCOCYTHEMIA: the Boylston Medical Prize Essay of 
Harvard University for 1863. 8vo. 
NEW TREATMENT OF VENEREAL DISEASES, and of 
Ulcerative Syphilitic Affections, by Iodoform. Translated from the French of 
Dr. A. A. Izard. 8vo. 187a. 
THE PASSIONS IN THEIR RELATIONS TO HEALTH 
AND DISEASES, LOVE AND LIBERTINISM, From the French of 
Dr. Bourgeois. NEW TREATMENT 
OF 
VENEREAL DISEASES 
AND OF 
ULCERATIVE SYPHILITIC AFFECTIONS 
BT IODOFORM. 
TRANSLATED FROM THE FRENCH OF DR. A. A. IZARD, 
BY 
HOWARD F. DAMON, M.D. 
BOSTON: 
JAMES CAMPBELL. 
1872. Entered according to Act of Con grew, in the year 187a, by 
JAMES CAMPBELL, 
In the office of the Librarian of Congreii at Well ington. 
CAMBRIDGE I 
RHEAS OR JOHN WILSON AND BOH. . TRANSLATOR’S PREFACE. 
This little volume seems to be a valuable contribu- 
tion to the therapeutics of syphilis. The distinctions 
between infecting and non-infecting chancres and 
their consecutive buboes, are drawn very clearly 
and illustrated by a number of interesting and 
instructive cases. The results obtained by iodoform 
in the treatment of the primary local lesions of 
syphilis are highly satisfactory. 
It was the intention of the translator to have 
given, from his own practice, some of the results 
obtained by the internal use of iodoform in syphilis. 
A careful examination of his cases warrants him in 
asserting its beneficial influence, especially in those 
severe neuralgias and periosteal pains which so 
frequently torment the sufferer from constitutional 
syphilis. At some future time, however, these 
results from the internal use of iodoform in syphilis 
may be expected. 
H. F. D. 
Boston, August, 1872. PREFACE. 
The few works which have appeared thus far on 
iodoform and its properties have induced us to 
direct our researches to this therapeutic agent. We 
do not pretend to exhaust the subject; for, inas- 
much even as it is a new one, there is still 
left for study a field, more or less extensive, to 
which it appears impossible for us to set the limits. 
We shall content ourselves with the exposition of 
the result of the observations which we were per- 
mitted to collect while interne at l'Hopital du 
Midi, on its employment in the treatment of infect- 
ing chancre and of several of the symptoms of 
syphilis, but chiefly in the treatment of soft chancre 
and of consecutive bubo. After having demon- 
strated all the advantages which this medicament 
presents, we shall formulate the rules according to 
which it should be put in use. TABLE OF CONTENTS. 
I. Iodoform applied to the Treatment of Infecting 
Chancre, Syphilitic Adenopathy, and several 
of the Secondary and Tertiary Symptoms of 
Syphilis. 
Chancres in general and their division 9 
Iodoform in the treatment of infecting chancre, 
syphilitic adenites, and ulcerative syphilides, 
RUPIAS, GUMMATA, ETC 12 
1. Infecting Chancre . . 12 
2. Syphilitic Adenites 14 
3. Ulcerated Syphilides, Rupias, Gummata .... 19 
II. Iodoform in the Treatment of Soft Chancre and 
of Consecutive Bubo. 
Action of iodoform on soft chancre 28 
Action of iodoform on buboes 41 
1. Simple Bubo 42 
2. Chancrous Bubo .45 
3. Syphilitic Bubo 50 
Phagedenic chancres 51 
Mixed chancre 52 
Soft chancres and buboes treated by iodoform . . . 53 
Buboes treated by iodoform 65 TREATMENT BY IODOFORM 
OF THE 
VENEREAL DISEASE AND OF SEVERAL OF 
THE SECONDARY AND TERIT4RY 
SYMPTOMS OF SYPHILIS. ( 
I. 
IODOFORM APPLIED TO THE TREATMENT OF IN- 
FECTING CHANCRE, SYPHILITIC ADENOPATHY, 
AND SEVERAL OF THE SECONDARY AND TER- 
TIARY SYMPTOMS OF SYPHILIS. 
CHANCRES IN GENERAL AND THEIR DIVISION. 
"VTOWHERE, perhaps, does there exist so exten- 
sive a field for observation as at l’Hopital du 
Midi, where, as interne, we have been permitted 
to study scrupulously the facts which we now pub- 
lish. All of our observations have been collected 
there; and there, we may say, are found demon- 
strated in a decisive manner, the immense advan- 
tages presented by specialties. In the wards of 
this hospital, hundreds of patients are treated by 
this or that medication, and the effects are the 
more appreciable inasmuch as, in contiguous 
wards, the line of treatment being different, terms 
of comparison can be established of the utmost  IODOFORM IN VENEREAL DISEASE 
value. It is in this asylum of the secrets of the art 
that Ricord has been able to collect the numerous 
observations and to perform the experiments which 
have conducted him to his most beautiful discovery, 
the duality of chancre. 
Before speaking of the action of iodoform on 
chancres, it is wrell to make known to what species 
jof chancre it should be applied by preference. 
The chancre, in general terms, is a contagious 
venereal ulcer developed upon any part whatever 
of the body directly infected. One of its most 
important characters is the faculty it has of being 
transmitted by inoculation and of producing a 
second ulcer or chancre absolutely identical with 
the first. Thus, if a drop of pus is taken upon the 
point of a lancet from a recent chancre, and intro- 
duced beneath the epidermis of a perfectly healthy 
person, there will be developed in the place of the 
operation an ulcer of the same nature as that which 
has furnished the inoculated virus, and the appear- 
ance of a new chancre will take place in one of 
two ways very important to notice. It will show 
itself either during the first five days, or during the 
third week which follows the inoculation ; and then, 
in this latter case, the chancre will present at its 
base, ninety-eight times in a hundred, an elastic, 
cartilaginous induration, a phenomenon never ob- 
tained in the first case. The first form of venereal AND IN SYPHILITIC AFFECTIONS. 
ulceration is limited to a simply local disorder, or at 
most to an adenitis, very often suppurative, of the 
corresponding lymphatic ganglions; the second, 
on the contrary, produces a local disorder and an 
adenitis almost always insignificant, whilst at the 
moment of its appearance a veritable poisoning has 
already taken place in the economy, which will not 
be tardy in manifesting itself by terrible conse- 
quences, the symptoms characteristic of constitu- 
tional syphilis. Such are the principles which have 
served as a basis for the division of chancres. The 
first, the action of which is entirely local, has been 
designated by the names of soft chancre, simple 
chancre, ordinary chancre, chancroid; the second, 
which is only the primary local manifestation of 
the syphilitic diathesis, has been called hard chan- 
cre or indurated, Hunterian chancre, infecting 
chancre. 
Finally, some authors admit of a mixed chancre, 
which is none other than a soft chancre grafted 
upon an infecting chancre; or, in other terms, the 
reunion in the same place of the virus of the two, 
one constituting soft chancre, the other the infecting 
chancre. The phagadenic, gangrenous, rodent, 
and serpiginous chancres are only more severe vari- 
eties of the other two chancres. 12 
IODOFORM IN VENEREAL DISEASE 
IODOFORM IN THE TREATMENT OF INFECTING 
CHANCRE, SYPHILITIC ADENITIS, AND ULCERA- 
TIVE SYPHILIDES, RUPIAS, GUMMATA, ETC. 
i. Infecting Chancre. 
We have few observations relative to infecting 
chancre treated by iodoform; not that infecting 
chancres are rare at I’Hopital du Midi, but we were 
diverted from the employment of iodoform in their 
mode of treatment by a consideration which we 
shall explain in a few words. 
The fact is evident to us that the medicament 
which forms the subject of our work has only a 
purely local effect; so that, applied to the soft 
chancre, it fulfils in the most complete manner the 
indications exacted by this purely local ulceration ; 
it calms the pains of which it is the seat, it dries 
up the secretions, and it hastens the cicatrization. 
What more can we demand ? 
As regards the bubo, the indications and utility 
are the same. Unfortunately, it is not the same for 
indurated chancre. The latter is only a local mani- 
festation of a general poisoning; at the moment of 
its appearance, the subject of its infection is already 
syphilitic, and we must not content ourselves with 
attacking the apparent local lesion. There is no AND IN SYPHILITIC AFFECTIONS. 
13 
advantage even here in employing the abortive 
method of Ricord, who moreover, at the present 
time, seems to us to have abandoned his old ideas 
in this respect. We know that if this abortive 
method has been credited with some success, it is 
because it has been employed at a stage of the dis- 
ease when the distinction between the two species 
of chancre was not yet established. Indeed, wrhen 
a cauterized chancre has not been followed by con- 
stitutional symptoms, this absence of general infec- 
tion has been attributed to the cauterization, whilst 
one had only to deal with a soft chancre. So iodo- 
form has seemed to us here to be of little utility, 
save in some particular cases. However, it can, 
without dispute, hasten the cicatrization, and above 
all calm the pains sometimes very severe in infect- 
ing chancre. But as the latter cicatrizes generally 
sufficiently rapidly, as it suppurates little and is very 
often indolent, the employment of iodoform appears 
to us to be only exceptionally indicated. 
Moreover, the ulcerated sur/ace of the infecting 
chancre is a precious way for the absorption of an 
agent which will attack the principle itself, under 
the influence of which the venereal ulcer has be- 
come implanted; we would speak of mercurials, 
which will act not only as topical agents, but which 
will be absorbed in part, and penetrate the circula- 
tory torrent without causing fatigue to the digestive 14 
IODOFORM IN VENEREAL DISEASE 
organs, and without our feeling ourselves obliged, 
as Lif*geois has done, to cause their penetration by 
extremely painful hypodermic injections. 
In conclusion, it does not seem proper to us that 
iodoform should be employed in the treatment of 
indurated chancre except when the latter is accom- 
panied by very severe pains. In such a case, the 
ulcerated surfaces should be freely washed with 
water, cleansed with care, either with simple water, 
or with chlorinated water, and afterwards iodoform 
powder should be applied once or twice daily. 
The anaesthetic properties of the latter a/e not slow 
to triumph over the local pains, and then recourse 
may be had to topical remedies having mercury for 
their base. 
2. Syphilitic Adenites. 
It remains at present for us to inquire in regard 
to the use which can be made of iodoform in the 
treatment of syphilitic adenites. By the name of 
syphilitic adenitis, we shall designate the gan- 
glionic inflammations which supervene under the 
influence of an infecting chancre, as the latter is 
ordinarily observed in the groin in consequence of 
chancres of the penis, in the submaxillary region 
when the venereal ulcer is developed upon the lips; 
or still farther, the adenites which supervene under 
the influence of several other syphilitic manifesta- AND IN SYPHILITIC AFFECTIONS. 
15 
tions, such, for example, as the suboccipital adeni- 
tes resulting from the lesion of the lymphatics of 
the scalp, in consequence of the development, in 
this region, of ecthyma or other syphilo-dermata. 
All these adenites seldom suppurate, and if they 
are painful, it is only exceptional. So, in their 
nabitual course, there is no need of iodoform in its 
full strength ; but it will render great service if it 
is employed in the form of an ointment, as is done 
by M. Bouchardat, or, after the manner of M. 
Gubler, dissolved in a mixture of alcohol and ether. 
The resolvent properties of the hydriodide of car- 
bon produce, in these cases, excellent results. 
We shall pass to a few particular cases and per- 
haps even a little exceptional. We will suppose a 
syphilitic and scrofulous individual (the case is 
not rare), the inflammatory susceptibility of whose 
ganglia is much developed ; the cellular tissue which 
envelops them not remaining a stranger to the 
inflammation, becomes indurated, and, uniting to- 
gether in the same mass the isolated ganglionic 
tumors, softening and suppuration will possibly take 
place. Here the intervention of iodoform will be 
very useful in all the cases where there shall not 
exist the exceptions that we will point out a little 
farther on, when studying the effects of iodoform 
in the treatment of simple bubo; for, under these 
circumstances, the suppuration will not be very  IODOFORM IN VENEREAL DISEASE 
abundant, the borders of the ulcer will not have a 
phagedenic tendency, and, the process of suppu- 
ration being localized in the lymphatic ganglia, 
there will be formed there just so many little sinuses 
very difficult to dry up, but over which iodoform 
will triumph in a few days. In this relation, we 
shall deem it proper to point out a fact which is not 
without interest for science and which has not yet 
been mentioned by syphiliographers. We will 
report an observation which we believe instructive 
in a double point of view, first because it is a very 
complete and quite rare example of the pathologi- 
cal condition of which we are speaking; then, 
because the cure, vainly exacted from a host of 
remedies, was only obtained by the use of iodoform 
powder. 
It is known that the existence of infecting chancre 
assures to the individual thus affected a complete 
immunity as regards chancre of the same kind, the 
exceptions to this rule being exceedingly rare; but 
it is a fact of which there is no longer ignorance, 
that persons who have been syphilized are not at all 
protected against soft chancres. All this being 
beyond discussion, we will suppose an individual 
attainted by infecting chancre; he will have in the 
groin multiple, indolent, hard, movable, ordinarily 
non-suppurating adenites ; the entire morbid process 
will remain circumscribed in the ganglionic en- AND IN SYPHILITIC AFFECTIONS. 
17 
velope, which will become thickened ; the ganglion 
itself will become infiltrated with plastic material, 
and, on section, it will be found pervaded by whitish 
and semi-solid products. These anatomical alter- 
ations explain to us perfectly how it happens often, 
long after the chancre is perfectly cured, that the 
adenites do not yet present any trace of retrocession. 
These alterations may also (and we have insisted 
on this point) account to us for the facts to which 
we have called attention. 
Let the syphilitic individual of whom we are 
speaking contract soft chancres; these chancres 
will have a ganglionic manifestation. Very well; 
a thing of importance and not pointed out, this 
manifestation, in place of being mono-ganglionic, 
phlegmonous, invading the peripheric cellular tissue ; 
this manifestation, we say, will seize upon many 
ganglia, it will intrench itself there without invad- 
ing the ambient cellular atmosphere, and we shall 
see a number of small buboes produced, isolated 
from each other, suppurating for the most part, but 
at different periods, the inflammatory process hav- 
ing followed its course in each of them separately 
without being influenced by the neighboring gan- 
glion. It is here that iodoform will possess an 
incontestable utility. Nothing, moreover, could 
demonstrate this in a more eloquent manner than 
the following observation : — 18 
IODOFORM IN VENEREAL DISEASE 
D . . . entered the H6pital du Midi the first of 
May, in the ward for paying patients; he declares 
that he had an infecting chancre three years ago; 
at very nearly the same period, -plaques muqucuscs 
and a general exanthematous syphilide. Every 
thing had disappeared under a mercurial treatment; 
there remained only a few swellings in the groin. 
Such was the state of the patient, when, the 15th 
of April, he contracted two soft chancres, one on 
the edge of the prepuce, the other in the balano- 
preputial furrow. The application of iodoform 
powder caused them soon to disappear. Neverthe- 
less the enlargements that he had had for two or 
three years in the fold of the groin commenced to 
become painful and to swell. At this point the 
patient resolved to enter the hospital; until then he 
had been satisfied with the attentions given him at 
gratuitous consultations. On the left side, below 
the femoral arch, three ganglionic tumors are seen, 
the greater axis of which is parallel with the arch 
itself; above the ligament there exist five others in 
different degrees of development, but all perfectly 
isolated. On the right side there exist three 
similar ones. 
These tumors are, for the most part, painful; 
they have contracted adhesions with the skin ; but, 
save one or two exceptions, they are independent 
of each other, red and considerably developed; AND IN SYPHILITIC AFFECTIONS. 
their mean volume is that of a very large hazel- 
nut. Soon they become fluctuating ;• the most ad- 
vanced are opened, whilst the others are painted 
with tincture of iodine or covered with vesicatories 
to try to prevent suppuration. Nothing answers ; 
all suppurate, and, notwithstanding the cauteri- 
zation with the nitrate of silver, notwithstanding 
the dressings with aromatic wine, and detersive or 
astringent injections, still there did not exist on the 
first of June any indication of the commencement 
of cicatrization. Iodoform powder was then ap- 
plied to four of the openings only, whilst the ordi- 
nary dressings were continued upon the others. 
At the end of three days, we perceived such an 
amelioration in the buboes treated by iodoform that 
we hastened to submit the rest to the same treat- 
ment. The cure was nearly complete on the tenth 
of June, at which time the patient left the hospital. 
3. Ulcerated Syphilides, Rupias, Gummata. 
There will be in our work a regretted lacuna 
which time does not permit us to fill; it is the 
action which iodoform may have, administered in- 
ternally against syphilis ; but we hope to return a 
little later to this important point. 
In a country hostile to our own, several physi- 
cians have employed iodoform against certain dis- 20 
IODOFORM IN VENEREAL DISEASE 
eases of the skin : eczema, impetigo, &c. ; but they 
have never directed its use against syphilitic mani- 
festations, whether cutaneous, as plaques mu- 
queusesy rupias, or profound, as the gummata, 
the periostoses. Indeed, we possess on this point 
many observations which are not wanting in inter- 
est. We can affirm in a general manner that the 
result has been preferable to that obtained by the 
plaster of Vigo cum mercurioy by powdered starch, 
and washings with chlorinated water. We can 
even add that we have taken all the desirable pre- 
cautions to enlighten ourselves in this respect, 
knowing how difficult is the sound interpretation of 
facts, when it concerns the more or less short dura- 
tion of a disease under the influence of such or 
such medication. We have taken three patients 
attainted with ulcerated syphilides, disseminated 
over different points of the body ; in each of the 
patients we have chosen by preference the most 
extensive patches, the most deeply ulcerated, and 
upon these only have we applied the iodoforrp 
powder; the others have been treated by the plas- 
ter of Vigo cunt mercurioy starch powder, and 
chlorinated water; finally some have been aban- 
doned to themselves. We shall see, by the result 
of observations, how iodoform is preferable to other 
means. , AND IN SYPHILITIC AFFECTIONS. 
21 
Observation. — L. S. . . . , aged sixteen years, 
enters the Hopital du Midi, April n, ward 2, num- 
ber 16. An indurated chancre has escaped atten- 
tion. Towards the middle of March, the patient 
begins to have trouble,with the throat, and a few 
days afterwards his body becomes covered with 
papules constantly multiplying in number. These, 
at first disseminated, unite on certain points where 
they form broad patches of from an inch and a 
half to two and a half inches in diameter. They 
are seen some of them on the face, the scalp, the 
most extensive on the chest; and the others, equally 
large, on the legs and on the thighs. No treatment 
until the nth of April, the time of entrance of the 
patient into the hospital. 
The next day, the 12th of the same month, a 
solution of the biniodide of mercury is given in- 
ternally. 
Upon three patches, the largest we can find, 
situated one in front of the right loin, the other in 
the epigastrium, and the third on the left deltoid 
region, we employ the iodoform powder. 
The plaster of Vigo cum mercurio is applied to 
the three patches developed upon the thigh. 
The head and face hre powdered with starch, 
whilst the patient himself washes his forearms 
and legs with water slightly chlorinated. Very 
soon even the chlorinated water being borne with IODOFORM IN VENEREAL DISEASE 
difficulty, we are obliged to employ only pure 
water. 
Such was the treatment established and con- 
tinued until the first of May. At this time, the 
three patches treated by iodoform were completely 
dessicated and very much diminished: they were 
hardly more than an inch in diameter. The mar- 
gin presented that coppery tint peculiar to cicatrized 
syphilides : between the points cured and the centre 
of ulceration is found a circle of large white epi- 
dermic scales; finally, in the middle were parts still 
red, and others covered with crusts. 
The plaster of Vigo has not obtained so satis- 
factory results : two patches suppurated abundantly, 
whilst upon the other the cicatrization had scarcely 
begun. As to the patches on the head, the patient 
of his own accord had applied the iodoform powder 
upon them in order to quiet, he said, the very sharp 
pains of which they were the seat; this mixture of 
iodoform and starch had not had any bad results. 
The patches of the legs and forearms were in full 
suppuration. 
May 20th, the parts treated by our medicament 
by preference were entirely cured, whilst the others 
still suppurated, although in different degrees. So, 
yielding willingly to the desires of the patient and 
judging the experiment sufficiently well tried, we 
employed the iodoform powder on all the patches 
which remained in suppuration. AND IN SYPHILITIC AFFECTIONS. 
23 
May 30th, the patient left the hospital; he was 
cured of all of his syphilides; but he was not evi- 
dently protected from relapses, which were to be 
prevented by the continuance of the internal treat- 
ment. 
This observation demonstrates clearly the supe- 
riority of iodoform as a topical agent; it shows not 
only the powerful influence of this medicament 
over cicatrization, but still more the rapid sedation 
which it exercises over excoriated surfaces ; it is 
a happy union of the properties of iodine and of 
chloroform. 
The following observation is not less conclusive 
than that which we have just given : — 
A. J. . . . , aged 20 years, enters the hospital 
April 5th, ward 7, bed No. 6. He has had an 
infecting chancre which appeared January 10th, 
after an incubation of seventeen days. Ten days 
after the appearance of the chancre, numerous 
■plaques muqueuses showed themselves in the mouth 
and back of the throat. Finally, in the commence- 
ment of March, a cutaneous eruption was produced, 
which constitutes, at the time' when the patient pre- 
sents himself to us, large patches of rupia scattered 
over the whole surface of the body. The chancre 
had been cauterized, covered with lint soaked in 24 
IODOFORM IN VENEREAL DISEASE 
aromatic wine, and had entirely disappeared tow- 
ards the end of March. After the entrance of 
the patient into the hospital, we chose the largest 
and most ulcerated patches, and covered them with 
small poultices of linseed meal, in order to detach 
the crusts from them ; the next day and the days 
following we powdered them abundantly with iodo- 
form. These patches, to the number of four, are 
situated upon the left leg, one in the popliteal space, 
two others on the posterior region of the leg, and 
the fourth on the inferior and anterior region of the 
tibia. On the patches of the left leg are applied 
from the first day strips of the plaster of Vigo cum 
mercurio, which are renewed every six or seven 
days. Finally, the smallest patches, invading the 
rest of the body, are abandoned to themselves. 
May 15th, the patches dressed with iodoform are 
completely cured; in their place there remains only 
a purplish spot and much more restricted in size 
than the surface previously ulcerated. The patches 
treated by the Vigo did not present the same de- 
gree of cicatrization until eight days later, although 
smaller; and the patches abandoned to themselves 
are still covered with dry crusts on the 30th of May, 
the day on which the patient leaves the hospital. 
He is recommended to continue for some time still 
the internal treatment; but, at the end of eight days, 
believing himself definitely cured, he abandons it 
entirely. AND IN SYPHILITIC AFFECTIONS. 
25 
June 20, the same patient presents himself at the 
gratuitous consultations with a new eruption of rupia 
upon the head and on all the points of the body where 
no local treatment had been employed. The patches 
treated by iodoform and the Vigo present the same 
aspect that they did on the day the patient left the 
hospital; but the new patches are larger than those 
at first. Liquor of Van-Swieten internally ; iodoform 
powder on the cutaneous ulcerations. 
July ist, all of the small patches are dessicated, 
and the tenth of the same month, the large ones 
are equally so. 
This observation, like the preceding, does not 
leave any doubt of the real efficacy of iodoform in 
the treatment of ulcerated syphilides; its action is 
evidently much more rapid than that of the plaster 
of Vigo cum mercurio, and, consequently, than that 
of all the topical remedies generally employed in 
such cases, the Vigo cum mercurio being already 
considered as the most active of all others. 
We do not hesitate to advise by preference the 
iodoform powder in all similar or analogous cases. 
The following observation goes to support what we 
say. It relates to a case of suppurated gummous 
tumor, cured with an astonishing rapidity, in com- 
parison with a great number of others which we 
have seen treated by all other topical remedies ex- 
cept iodoform powder. 26 
IODOFORM IN VENEREAL DISEASE 
D. . . aged 46 years, enters l’Hdpital- du Midi 
the 20th of March. He is affected with several 
gummous tumors, of which the two most voluminous 
have their seat, one on the right cheek, appearing 
to have for its point of departure "la bottle graisseuse 
dc Bichat,” the other on the anterior tibial region. 
The fluctuation is nearly equal in the two cases. 
The patient is made to take the iodide of potassium 
in the dose of one drachm daily. At the end of 
eight days, the gumma developed on the leg ulcer- 
ates, the opening which forms increases in size dur- 
ing several days, its borders become everted, and 
an extensive ulcer of angry appearance extends 
from the anterior tuberosity of the tibia towards the 
middle part of the fibula. The whole ulcerated 
surface is carefully washed and covered with iodo- 
form powder every morning. At the end of five 
to six days, the ulcer becomes cleansed and assumes 
a very satisfactory aspect. The same treatment is 
continued until the 10th of April, when the patient 
leaves the hospital completely cured. Several fric- 
tions with the ointment of iodoform on the gumma 
of the check had sufficed, with the internal treat- 
ment, to prevent suppuration on its part. 
We have still further employed a great number 
of times, and always with success, the powder of 
iodoform, and above all the solution of this agent 
in glycerine and alcohol, in order to combat plaques AND IN SYPHILITIC AFFECTIONS. 
27 
muqueuses of the vulva, of the vagina, of the anus, 
and of the scrotum. The solution has appeared to 
us above all preferable when the discharge was 
abundant: in a very few days, we obtained a per- 
fect cure; but we have always recommended to 
patients not to neglect the internal treatment, for it 
is only in these cases that we have never seen re- 
lapses. II. 
IODOFORM IN THE TREATMENT OF SOFT CHANCRE 
AND OF CONSECUTIVE BUBO. 
ACTION OF IODOFORM ON SOFT CHANCRE. 
JN order to set forth properly all the advantages 
which iodoform presents in the treatment of 
simple chancre, it appears to us indispensable to 
resume, in a few words, the means generally em- 
ployed against it. The simple chancre is a local 
affection, and, as such, it demands, says Ricord, 
only a local treatment. What would, indeed, he the 
use of a general medication directed against a dia- 
thetic principle which does.not exist in the economy? 
Why depuratives? Why antisyphilitics, unless we 
would give ourselves the easy satisfaction of curing 
cases of syphilis that never existed? Mercury, here, 
is not only useless: it is very often injurious, or at 
least very dangerous. Administered internally, it 
can react in a bad manner upon the ulceration ; and, 
externally, applied as a topical remedy in the form 
of an ointment, it can favor and even determine 
phagedenism. " I can assure you,” says Ricord, 
"that the administration of mercury, during the ex- IODOFORM IN VENEREAL DISEASE. 
29 
istence of a simple chancre, is one of the conditions 
most apt to favor phagedenism.” And still farther: 
" The most part of those horrible rodent ulcers which 
come to us at this hospital (du Midi), after having 
destroyed a portion of the penis, are simple chancres 
on which mercury has been lavished in all its forms. 
Judge of the utility and the opportunity for a treat- 
ment which endangers the loss of a part of your 
penis in order to cure you of a syphilis, that you 
never had ! ” 
Thus we are plainly convinced, and we could 
support our affirmation by hundreds of observations, 
that the soft chancre requires only a local treat- 
ment, and after its cure no appearance of the least 
syphilitic symptom is ever seen; but we are equally 
convinced that most physicians, and even certain 
specialists, while recognizing the existence of soft 
chancre, treat it in a deplorable manner. With 
them, topical remedies, whatever they may be, are 
only accessories; their specific is the crayon of 
nitrate of silver, and, impelled by this idea, they 
cauterize always, they cauterize without cessation. 
The patient who suffers these atrocious pains does 
well to cry aloud, to roll on the ground, to fall into 
syncope, — a circumstance of which we have been 
many times the witness, — the terrible crayon does 
not continue the less its pitiless action; and, painful 
to say, very often all these sufferings are useless. 30 
IODOFORM IN VENEREAL DISEASE 
Happy the patient if he was spared it for once, and 
the duration of the chancre was not increased! 
We do not wish to say, however, that it is neces- 
sary to definitely exclude* cauterization from the 
treatment of simple chancre ; it is necessary only to 
use it with much prudence and discernment. We 
will also add that the cases where it is necessary 
are extremely rare when the treatment by iodoform 
is adopted. We have seen hundreds of patients 
cured in a very short time without having had to 
undergo the slightest cauterization. 
What is, in effect, the end proposed in cauteriza- 
tion? It is to transform the specific venereal ulcer- 
ation into an ordinary wound, that is afterwards 
treated by appropriate means. Indeed, to obtain 
this result, it is necessary to have recourse to an 
energetic cauterization, profound and thorough. "It 
is necessary,” says Ricord, ”to kill the chancre 
upon the spot, and substitute for it forcibly a simple 
wound, an eschar. Do not then ask of catheretics 
what they cannot do; direct your attention to the 
most violent escharotics. I repeat it, in order to 
obtain from this method the most success it can give 
you, it is necessary that you should employ it in 
all its severity. Then, no slight cauterization ; what 
you seek to produce is an energetic and deep cau- 
terization, a veritable destruction.” (Lemons sur le 
chancre.) AND IN SYPHILITIC AFFECTIONS. 
31 
As is seen by the few lines which precede, 
M. Ricord, a partisan of cauterization, applies the 
most severe caustics; and amongst all those that 
he makes use of or enumerates, we shall not meet 
even with the name of the crayon of nitrate of 
silver. How does it happen, then, at the present 
time, that there are so many physicians who do not 
know how to take care of a chancre without having 
the nitrate of silver in their hands, and that as 
much for indurated chancre as for soft chancre? 
This practice is truly disastrous. Indeed, without 
speaking of the sufferings of the victims, which are 
renewed at each cauterization, the nitrate of silver 
could not produce that profound eschar which should 
transform the specific ulcer into an ordinary wound. 
Besides, the solid state of this caustic renders it 
little adapted to penetrate into all the anfractuosi- 
ties in which the specific virus intrenches itself; 
so that, in the hypothesis even where this species 
of cauterization should be efficacious, the effects 
would be very often annulled by a new and almost 
immediate inoculation; for this takes place infalli- 
bly every time there exists a single point, however 
small it may be, which has not been subjected to 
the action of the caustic. We shall go even farther ; 
accepting the theory of Ricord, we believe that the 
cauterization by the nitrate of silver, to the end of 
destroying the chancre on the spot, is always and 32 
IODOFORM IN VENEREAL DISEASE 
completely nugatory. "In fact," says this author, 
"the specific poison does not exist alone in the 
ulcerated area of the chancre, but extends a little 
beyond it; so that the neighboring tissues, sound 
and intact in appearance, bear in them the germ of 
the virulence. This suspected little peripheric zone 
should then equally be attacked by the caustic." 
Indeed, there is no need of demonstration that the 
nitrate of silver cauterizes the surfaces only very 
superficially ; but, on the contrary, it irritates, it 
inflames the ulcerated parts and prolongs thus the 
duration of the disease, so far from abridging it. 
We banish then entirely the nitrate of silver from 
the treatment of chancres during the first two 
stages, that of increase and when they become sta- 
tionary. If it can render any service, it is only 
during the period of reparation, in order to repress 
the exuberance of florid granulations, or to make 
more active the languid process of cicatrization. 
If we insist at so much length on the bad effects 
of nitrate of silver, it is because there come to us 
daily, at l’llopital du Midi, patients from all parts 
of Paris, who have already been subjected for the 
most part to the untimely use of nitrate of silver. 
What then is the line of conduct to be pursued 
in presence of a soft chancre to the treatment of 
which we wish to apply iodoform? 
As a general rule, iodoform can be applied in all AND IN SYPHILITIC AFFECTIONS. 
33 
cases with very great advantage ; but its application 
should be subordinated to certain local pathological 
conditions which determine its fitness, augment or 
diminish its therapeutic effects. These pathological 
conditions of which we speak are relative : ist, to 
the suppuration, more or less abundant, of the 
chancre ; 2d, to its situation externally or internally. 
I. In all of the treatises on venereal diseases, the 
soft chancre is represented generally as furnishing 
an abundant secretion, in a contrary manner to in- 
durated chancre, of which the ulcerated surface is 
almost always dry. This assertion is exact; the 
simple chancre, in reality, has a great tendency to 
suppuration, not only by itself, but still more in its 
ganglionic manifestations. However, we have met 
with numerous exceptions to this rule ; and, to com- 
mence with the most simple cases, we will suppose 
a patient presenting himself with one or many 
soft chancres, external, furnishing but little or 
no suppuration. Here the dressing is of extreme 
simplicity : washing with ordinary water, a pinch 
of iodoform, previously reduced to powder, and a 
dry piece of linen over it to hinder the fall of the 
iodoform by frictions. The linen moreover is com- 
pletely useless when, the chancre being situated 
upon the glans or internal surface of the prepuce, 
the latter, restored to its normal position, can keep 34 
IODOFORM IN VENEREAL DISEASE 
the iodoform powder upon the ulceration. The 
same operation, repeated twice in the twenty-four 
hours, suffices to cure in a few days chancres which 
have resisted for a long time touchings with the 
nitrate of silver and applications of aromatic wine 
or others of a similar nature. 
II. When the soft chancre is accompanied by an 
abundant suppuration, it seems advantageous to us 
to delay the application of iodoform. We com- 
mence by detersive washes, either with chlorinated 
water, or with a solution of the sulphate of zinc, or 
nitrate of silver, &c. ; then comes the iodoform. 
Nevertheless, if the patient experiences severe pains, 
it is necessary to employ it immediately, notwith- 
standing the abundance of the secretion ; for the 
iodoform possesses local anaesthetic properties which 
render its use still more valuable. The local irri- 
tation and the inflammation do not constitute a 
contra-indication ; far from that: the sedative action 
of this medicament is added to the antiphlogistics em- 
ployed in such a case, — baths, cataplasms, fomenta- 
tions, &c. The less utility of iodoform in cases of 
abundant suppuration appears to us to be simply 
the result of the difficulty experienced in maintain- 
ing it in contact with the diseased surfaces. It is 
found to be carried away by the pus or the mucus 
before having been able to exercise its action. • For AND IN SYPHILITIC AFFECTIONS. 
35 
it is not the same with iodoform as with caustic 
substances; the latter produce a rapid effect which 
follows immediately their application, instead of 
which, iodoform on the contrary requires many 
hours to exercise its influence. These results ap- 
pear to us to be at least those of experience. 
It has happened to us many times to replace the 
chlorinated water advantageously by a solution of 
2 or 3 grammes of iodoform in 30 grammes of gly- 
cerine, to which are added 10 grammes of alcohol. 
This solution is used to cleanse the ulcer ; but it has 
appeared preferable to us to soak a piece of cotton 
or a dossil of lint in it and apply it to the wound 
precisely as in dressings with aromatic wine. 
This mode of treatment has been preferred even 
by certain patients whom the odor of the iodoform 
alone disturbed. It could be still further utilized for 
persons who do not like to be attended in society by 
this odor. This solution, besides, can be more or 
less concentrated, according to need. 
III. Thus far, we have supposed the chancre to 
be exterior, that is to say on parts such as can be 
powdered with iodoform without difficulty as soon 
as the patient presents himself; such are the chan- 
cres situated upon the whole external surface of 
the penis, on the thighs, the scrotum, the hypogas- 
trium, &c. ; but there exist interior chancres, or 36 
IODOFORM IN VENEREAL DISEASE 
those rendered such in consequence of anomalous or 
accidental anatomical dispositions. Amongst the 
first, we find chancres of the meatus, urethral chan- 
cres, chancres of the anus, chancres of the neck of 
the uterus and of the vagina; amongst the second, 
are sub-preputial chancres with phymosis more or 
less complete. 
ist. Chancres of the meatus, and urethral chan- 
cres.— When the ulceration is situated at the en- 
trance of the meatus, the treatment is absolutely 
the same as that of external chancre, the iodoform 
powder being easily deposited on its surface; but it 
is not the same if the chancre is found to be situated 
deep in the canal. In this case, we believe that injec- 
tions with the solution that we have just indicated 
would produce an excellent result. These kinds of 
chancres being have never had occasion, it 
is true, to practise this treatment; but we have many 
times experimented with this solution on chancres 
and suppurated buboes, and we have always ob- 
tained as good effects, often even better, than with 
the iodoform powder. These results have not as- 
tonished us; we can say even that we had in some 
sort foreseen them, expecting that the action of the 
glycerine and of the alcohol would give addition 
without doubt to that of the iodoform. 
2d. Chancres of the anus. — It is here that we 
are able to proclaim the advantages of our method AND IN SYPHILITIC AFFECTIONS. 
37 
over all others, and in particular over cauterization. 
The latter, indeed, besides being very difficult, be- 
comes very dangerous from its consequences; it 
can give rise to so-called cicatricial tissue and con- 
sequently to a constriction of the sphincters of the 
anus. The other methods, which consist in apply- 
ing a dossil of lint soaked in aromatic wine, or 
any solution whatever, present great disadvantages. 
Thus, the patient is obliged to take an injection each 
time he wishes to go to stool, — an indispensable 
precaution, if he does not wish to see fissures pro- 
duced and the chancres enlarged in consequence 
of a little too much dilatation of the anus. Be- 
sides, the stools are always accompanied by more 
or less severe pains. Our method protects us from 
all these inconveniences. We simply place upon 
the chancres of the anus a little dossil of lint cov- 
ered with glycerate of iodoform, and we have at 
once a suppository and a topical remedy. As a 
suppository, the action of iodoform is such that the 
patient, according to the expression of Trousseau, 
has no longer the sensation of defecation ; as a 
topical remedy, we unite the effect of the glycerine 
and of the iodoform without having to fear the acci- 
dents which are the reproach of ointments in general. 
The patient, after each stool, has only to wash him- 
self well and replace a second dossil like the first. 
The cure is not long delayed. 38 
IODOFORM IN VENEREAL DISEASE 
3cl. Chancres of the vagina and of the neck of 
the uterus.—"Since the invention and populari- 
zation of the speculum,” says Ricord, "chancres 
situated in the depths of the vagina and those of 
the neck of the uterus have entered into the class 
of exterior chancres, and, as such, the same treat- 
ment has become applicable to them. You could 
then, and with the same success, cauterize with 
the carbo-sulphuric paste the specific ulcerations ot 
the os uteri and of the vagina, as you would do for 
a chancre of the labia majora or of the glans; and 
this cauterization would be so much the more useful 
as it would prevent the danger of inoculations of 
the neighboring parts. You can in the same man- 
ner convey to these parts the ordinary topical reme- 
dies and let them remain there, with this difference 
only that the renewal of the dressings must, in a 
rigorous manner, be trusted only to the hand ot 
the physician.” 
Without having the pretension to combat the pre- 
cepts of M. Ricord, we believe cauterization, in the 
cases of which we speak, of extreme difficulty, and 
above all of very great danger, principally for 
chancres of the recto-vaginal wall and for those 
situated in the culs-dc-sac which surround the uter- 
ine neck. For this reason we always choose topical 
remedies, and amongst these iodoform, conforming 
ourselves to the rules previously indicated. If the AND IN SYPHILITIC AFFECTIONS. 
39 
suppuration is not abundant, we introduce into the 
vagina as far up as the situation of the chancre, 
tampons of wadding or of cotton charged with the 
iodoform powder. If the suppuration is abundant, 
or accompanied by vaginal secretions, we at first 
make use of injections of nitrate of silver and apply 
the iodoform afterwards as in the first case« 
4th. Sub-preputial chancres. — When the sub- 
preputial chancres can be exposed to view, we 
treat them as if they were exterior, that is to say 
by powdering them with iodoform. But it happens 
very often that in order to expose them it is neces- 
sary to pull back the prepuce, to exercise manipula- 
tions more or less violent, which will have for a 
result to produce fissures, or at least augment the 
irritation; at other times, there exists a complete or 
almost complete phymosis, which does not permit 
in any way the chancres to be exposed to view. 
In the two cases, which besides are frequently 
accompanied by balano-posthitis, no manipulation 
should be made. An injection of ordinary water 
is given five or six times a day, which is followed 
immediately by a second injection of nitrate of 
silver (4 grammes of this salt in 200 grammes of 
distilled water). If, at the end of a few days, the 
chancres can be exposed without difficulty, they 
are treated by iodoform ; on the contrary, injections 
are employed with the iodoform solution, or it is 40 
IODOFORM IN VENEREAL DISEASE 
decided to perform circumcision. This operation 
once done, iodoform is employed as for exterior 
chancres. 
Now, it will be objected perhaps that a great 
number of topical remedies, such as aromatic wine, 
chlorinated water, the nitrate of silver, the potassio- 
tartrate of iron, &c., can control the venereal ul- 
ceration as well as iodoform. The latter is true 
in a general manner; but in no case can all these 
different topical remedies offer the advantages of 
iodoform. The latter, as a local anaesthetic, pos- 
sesses at first the immense advantage of calming 
in a few hours the very severe pains which fre- 
quently accompany the venereal ulcer. In the 
second place, it can and it ought to be applied di- 
rectly upon the chancre without either linen or lint, 
a circumstance of little importance apparently, but of 
real utility, if it is thought that with the aromatic 
wine, and all solutions in general, we are obliged 
to employ pledgets or dossils of lint; a thing which 
irritates more or less the diseased parts, adheres 
there with the products of secretion, and is only de- 
tached by producing a slight hemorrhage. The 
latter can, it is true, be avoided, but it is neces- 
sary for that to use precautions which the patient 
almost always neglects; from which there results, 
if not an aggravation of the disease, at least a pro- 
longation in its duration. The employment of iodo- AND IN SYPHILITIC AFFECTIONS. 
41 
form removes all these complications ; it suffices, in 
proportion as the secretions are abundant, to apply 
a quantity of powder sufficient to absorb them. 
Finally, a third advantage which iodoform presents, 
is to shorten the duration of the chancre. It re- 
sults, in fact, from a comparison of all of our obser- 
vations, that venereal ulcerations, treated by our 
method, cicatrize ten, fifteen, and twenty days 
sooner than those which are treated by other 
methods. 
Action of Iodoform on Buboes. 
In order to well establish the action of iodoform 
on buboes, it appears indispensable for us to divide 
them as we have done chancres; for buboes show 
themselves under very diverse circumstances, under 
the influence of very varied causes, and it would 
hardly be rational to treat them all in the same 
manner. 
The word bubo (from Bovfiojv, the groin) desig- 
nates, in general, a ganglionic tumor of the fold of 
the groin, developed under any specific, diathetic, 
or virulent influence; such are venereal buboes, 
syphilitic, scrofulous, those of glanders, pestilential, 
&c. As for us, we have only to occupy ourselves 
here with venereal buboes, whether syphilitic or 
resulting from a simple sexual relation. 42 
IODOFORM IN VENEREAL DISEASE 
For a very long time all of the venereal adeno- 
pathies have been designated under the general 
denomination of bubo, considering them as differ- 
ent manifestations of one and the same disease, of 
one and the same virus. Ricord was the first who 
dissipated this confusion and showed the necessity 
of distinguishing the syphilitic bubo consecutive to 
indurated chancre, from the chancrous bubo con- 
secutive to soft chancre, and from the inflammatory 
adenitis or simple bubo resulting from an accident 
less grave, although of venereal origin. 
i. Simple Bubo. 
This bubo, which is only a simple inflammatory 
adenitis, is very frequently developed in the course 
of a blennorrhagia, in consequence of erosions, 
abrasions of the penis; it is observed equally as a 
complication of a balanitis, of a balano-posthitis and 
consecutively to all of the excitations or mechanical 
irritations of the penis resulting from sexual inter- 
course. Indeed, this species of adenitis shows itself 
furthermore during the evolution of soft chancre, 
not at all as a specific complication of this ulcer, 
but as the result of a simple wound, of an ordinary 
irritant independent of every virulent principle. 
"The simple chancre,” says Ricord, "constitutes 
at once for the lymphatic glands a common cause 
of irritation, and a source of specific virulence. It AND IN SYPHILITIC AFFECTIONS. 
43 
is susceptible of acting upon them after the manner 
of a simple wound, of any excitant or even in the 
quality of a virulent ulcer. In the first case, the 
bubo which it produces is a simple adenitis, which 
presents in its development and its course the char- 
acteristics peculiar to non-specific adenitis; it is a 
ganglionic inflammation which follows the phases 
of all inflammations, which may terminate by reso- 
lution, which may suppurate, but of which the pus 
never presents any characteristic of specific viru- 
lence. In the second, that which it determines, is 
a bubo of entirely different nature, virulent far ex- 
cellence, not susceptible of resolution; it is a chan- 
crous bubo, a veritable ganglionic chancre.” Let 
us add to what Ricord says, that the simple bubo 
suppurates very rarely, and that, if suppuration 
sometimes takes place, the pus which results is in- 
flammatory, not virulent, not specific, not susceptible 
of converting into a chancrous ulcer the focus 
which contains it and the peripheral tissues. (Alf. 
Fournier.) 
What part, then, shall iodoform play in the treat- 
ment of simple bubo ? 
During the whole duration of the inflammatory 
period, the patient is made to take a bath every 
morning, and, on leaving the bath, an application 
is made to the bubo of a thin layer of iodoform oint- 
ment (two grammes of iodoform for thirty grammes 44 
IODOFORM IN VENEREAL DISEASE 
of lard), over which is placed an emollient cata- 
plasm. At the end of a few days, the resolvent 
properties of the iodoform generally triumph over 
the ganglionic tumor. 
If suppuration, however, makes its appearance, it 
is necessary immediately to suspend the use of the 
ointment and to open the bubo as soon as fluctua- 
tion announces the presence of a purulent focus. 
The use of the emollient cataplasms is resumed for 
two or three days, after which the dressings are 
made with the iodoform powder. In the cases in 
which the suppuration becomes abundant, it will be 
more advantageous to employ the solution of iodp- 
form in glycerine and alcohol. 
In practice, there is frequently the habit of apply- 
ing leeches to buboes. This treatment appears to 
us to be often dangerous, and we oppose it as such. 
What shall we do, indeed, in the case of a soft 
chancre, in order to distinguish from the outset 
whether we have before us a simple adenitis or a 
specific bubo? This distinction is impossible until 
the moment of suppuration, and when this manifests 
itself, if we have had to do with a virulent bubo, 
each puncture of the leech may be inoculated and 
transformed into a veritable chancre; hence arises 
a new complication the whole danger of which can 
be easily understood. AND IN SYPHILITIC AFFECTIONS. 
45 
2. Chancrous Bubo. 
This bubo is due to the transport, into a lym- 
phatic ganglion, of the venereal virus itself, derived 
from tire chancre by the corresponding lymphatic 
vessels. So the bubo itself possesses all the qual- 
ities of the venereal ulcer: its borders are sharp- 
cut like those of chancre, and the pus which it 
furnishes, inoculated upon any part whatever of the 
body, produces a chancre of the same nature as that 
which has given rise to the bubo. This species of 
bubo belongs properly and exclusively to simple 
chancre. It is never observed either with infect- 
ing chancre, or with blennorrhagia, or with any 
affection either venereal or of other nature. It is in 
some sort the property, the apanage of a special mor- 
bid entity, the simple chancre. (Alf. Fournier.) 
It is not necessary, however, to believe that, every 
time there exists a soft chancre, a bubo should nec- 
essarily supervene; very often the contrary is the 
case. We can calculate on the average one case 
of bubo for three cases of chancre; and this pro- 
portion is even much less in women. It is very 
difficult, impossible even, to diagnosticate, from the 
outset of a ganglionic engorgement, whether we 
have to do with a simple adenitis or with a specific 
bubo. The inflammatory symptoms are absolutely 
the same in the two cases; it is not until after the 
formation of the abscess, by the qualities of the 46 
IODOFORM IN VENEREAL DISEASE 
pus and the aspeot of the ulcer which furnishes it, 
that we can recognize certainly the nature of the 
bubo. We can, however, have a presumption in 
favor of the specific nature when the adenitis goes 
on rapidly to suppuration; for it is certain that the 
simple inflammatory adenitis rarely suppurates and 
is of slow progress, whilst the specific hubo sup- 
purates always, and as if fated, whatever may be the 
means employed to prevent this termination. “ With 
the chancrous bubo,” says Ricord, " resolution is 
impossible; suppuration is its fate ; it is necessary : 
it is in tine the exordium even of the disease, it is 
that which constitutes its essential and primitive 
manifestation. The chancrous bubo is less an 
adenitis than a ganglionic chancre. Its point of 
departure is an inoculation of the gland; it is a sup- 
puration established in the ganglion.” 
It will be necessary, then, to wait for the suppu- 
ration and opening of the bubo to know in a definite 
manner whether we have to do with a simple aden- 
itis or a chancrous bubo. The latter presents itself, 
at the end of a few days, with the following char- 
acters : sanious pus, not homogeneous, inoculable 
on the who bears the bubo, and every other; 
the borders of the ulcer sharp cut, jagged, thinned, 
rolled upon themselves within the wound ; unequal 
ulcerated surface, grayish or grayish brown, often 
covered by pultaceous or pseudo-membraneous de- AND IN SYPHILITIC AFFECTIONS. 
47 
posits; abundant suppuration, sometimes reddish, 
of a bad appearance, not presenting the character 
of inflammatory pus except at the period of repar- 
ation. 
Treatment. — The treatment of chancrous bubo 
may be divided into three periods, corresponding 
to different phases which its evolution presents : ist, 
inflammatory period; 2d, period of suppuration; 
3d, the period of ulceration consecutive to the 
opening of the abscess. 
Iodoform cannot be employed except during the 
first and the last period. From the first days of the 
appearance of a ganglionic tumor in the inguinal 
region, during the evolution of a soft chancre, it is 
impossible, as we have said above, to recognize the 
nature of the bubo which will become developed; 
and this uncertainty will persist until the moment 
of suppuration. Will it be a simple adenitis? Will 
it be a chancrous bubo? In the latter case, iodo- 
form would be completely useless as a resolvent, 
since suppuration must inevitably take place. But 
in the doubt in which we find ourselves, we are 
perfectly right in attempting resolution by all pos- 
sible means. Indeed, the iodoform ointment ap- 
pears to us, under these circumstances, to fulfil this 
object much better than vesicatories and unctions 
with the tincture of iodine. This ointment pos- 48 
IODOFORM IN VENEREAL DISEASE 
sesses all the properties of iodine to a degree 
possessed by no other preparation of this drug. 
Besides, the use of the iodoform ointment does not 
exclude that of superimposed emollient cataplasms, 
and it does not produce that kind of thickened 
parchment-like layer of the integuments which 
masks and prevents the early determination of the 
presence of a purulent collection. Finally, as a 
sedative, the iodoform is superior to chloroform lin- 
iment. Numerous observations authorize ns in 
giving the first place to iodoform amongst the oint- 
ments called resolvent. 
The second period of evolution of the bubo com- 
mences with the formation of the abscess and ends 
at the moment of opening of the latter. The 
treatment corresponding to this period is simple, 
rapid, expeditious: as soon as we determine the 
presence of pus it is necessary immediately to evac- 
uate it. Each day of delay augments the gravity 
of the disease and causes the future cicatrization to 
be prolonged in its duration. Finally, starting 
from this principle, that the resolution of chancrous 
bubo is absolutely impossible, it is evident that when 
suppuration is once established it will every day 
gain ground; it will not remain imprisoned only 
in the ganglionic investment: it will invade all the 
neighboring tissues, which it will infect in its turn, 
producing solutions of continuity and sloughs more AND IN SYPHILITIC AFFECTIONS. 
49 
or less considerable. These complications, always 
bad, will always be avoided whenever the suppurated 
bubo is opened at an early period. The bistoury is 
preferable to all the caustics for the purpose of open- 
ing the abscess. 
When once the purulent collection is evacuated, 
there will remain a chancrous ulcer, not differing 
from ordinary chancre except by its greater extent. 
Here iodoform plays its most important part; here 
it could not be replaced by any agent of the materia 
medica. We know how hopelessly slow buboes 
often are to become completely healed. This slow- 
ness is due to a multiplicity of causes of which the 
specific nature of the virus is not perhaps the most 
important; for the difficulties in the way of cure 
are connected above all with the anatomical dispo- 
sition of the parts. On the one side, we have a 
region submitted to almost incessant strains, in view 
of the difficulty of constraining a patient to an 
almost absolute repose during two or three weeks; 
on the other side, the gland inflammation has by 
itself less tendency to cicatrization than a simple 
inflammation and the ordinary wounds of the ingui- 
nal region, and nevertheless these latter cicatrize 
very slowly ; as, for example, that which results from 
the operation for strangulated hernia. Finally, 
in proportion as the evolution of the bubo has been, 
sub-acute, the ganglionic investment is found thick- 50 
IODOFORM IN VENEREAL DISEASE 
ened, and when the pus has opened a way, it re- 
mains open, not permitting the bringing together 
of the opposed walls. Indeed, what should be our 
mode of action under such circumstances? 
The first condition of cure is, that the patient 
preserve as absolute a state of rest as is possible for 
him. Then comes the local treatment that we will 
establish in the following manner: if the suppura- 
tion is abundant, and above all if there exist sinuses 
or purulent depots, injections repeated many times 
daily with the solution of iodoform in glycerine and 
alcohol; after the injection a pledget or dossil of 
lint soaked in the same solution is introduced into 
the ulcer. Under the influence of this treatment, the 
pus is not slow to dry up, and then the wound is 
powdered only with iodoform twice a day. This mode 
of dressing ought to be continued until complete 
cicatrization ; but it does not dispense with surgical 
interference when particular circumstances exact it. 
3. Syphilitic Bubo. 
We have only very little to say on the subject of 
syphilitic adenopathy, for the treatment of which 
iodoform appears to us to be of very questionable 
utility. This bubo, indeed, which accompanies 
almost always the infecting chancre, only excep- 
tionally terminates in suppuration. It appears or- 
dinarily during the first or the second week from AND IN SYPHILITIC AFFECTIONS. 
the ddhut of the chancre ; its volume hardly exceeds 
that of a hazel-nut; it is hard, indolent, without the 
least inflammatory phenomenon, invading almost 
always many ganglions to form what have been 
called specific Finally, suppuration hardly 
takes place once on the average in one hundred and 
fifty times, and the pus inoculated on the infected 
subject does not reproduce any species of chancre. 
Its course is extremely slow and is not modified by 
any treatment; the general treatment itself has only 
a very slight action upon it. The only case where 
iodoform could be employed with any utility is 
that in which the suppuration having made its exit 
through the walls of the abscess, there remains an 
ulcerated surface, pale, languishing, and to which 
we are often obliged to apply the caustic. The 
syphilitic bubo terminates almost always by resolu- 
tion ; but this is very slow, whatever be the means 
employed to provoke it. 
Phagedenic Chancres. 
In order to terminate our work, relative to the 
employment of iodoform, within the limits which we 
have set for ourselves, but a word more remains for 
us to say on the subject of phagedenic chancres. 
As soon as we notice the invading course of a chan- 
cre, whatever be its nature, we must have imme- 
diate recourse to caustics, and to the most energetic 52 
IODOFORM IN VENEREAL DISEASE 
caustics: the Vienna paste, the paste of Canquoin, 
the acid nitrate of mercury, the carbo-sulphuric 
paste, &c.; in a word, it is necessary to destroy the 
virulent principle under the influence of which the 
phagedenism is developed, and to produce a pro- 
found eschar, at the fall of which the wound should 
be dressed either with the solution of iodoform in 
glycerine and alcohol, or only with the iodoform 
powder. 
Finally, the mixed chancre, in the exceptional 
cases in which it is met, can be treated without 
inconvenience by iodoform, according to the rules 
which we have indicated previously for the other 
chancres. 
Below are a series of observations taken entirely 
at l’Hopital du Midi, and going to confirm the as- 
sertions which we have advanced on the subject of 
iodoform. We would have been able to multiply 
these observations, and to have given them by hun- 
dreds, but we should have only uselessly extended 
our work without giving it more scientific value. 
The several cases which we give will be amply 
sufficient from which to draw our conclusions. 
Mixed Chancre. AND IN SYPHILITIC AFFECTIONS. 
53 
Soft Chancres and Buboes treated by Iodoform. 
Observation I.— L. . . ., aged twenty-two 
years, enters the Hopital du Midi on the 15th of 
May, in the service of M. Simonet, Ward 1, bed 
No. 3. No antecedent venereal disease. During 
the first part of May, the patient discovers a slight 
excoriation on the edge of the prepuce; three days 
before, he had seen a woman. No treatment for 
ten days ; the ulceration increases ; suppuration quite 
abundant, development of two other chancres in the 
preputial groove. The 16th of May, after a bath 
and a detersive wash with chlorinated water, the 
chancres are powdered with iodoform. The next 
day, the patient declares that the pains have disap- 
peared during the night. The 20th of May, under 
the influence of the same treatment, the discharge 
disappeared : there forms, during the following days, 
a slight crust upon each little wound, and the pa- 
tient goes out cured on the 29th of thQ same month. 
The duration of the treatment was twelve days. 
Observation II. — D. . . . enters the hospital 
the 12th of May, Ward i, No. io. He was attacked, 
on the ioth of April, with a venereal ulceration 
upon the glans, near the corona; it showed itself 
five or six days after coition. Treated at first in 
the city by the employment of nitrate of silver and 54 
IODOFORM IN VENEREAL DISEASE 
two washes, the nature of which cannot be exactly 
ascertained, the patient saw the ulceration not only 
remain refractory to the use of these remedies, but 
still increasing daily and burrowing into the penis 
in a troublesome manner. There is produced a pain- 
ful inflammation in several ganglions of the groin, 
but which is promptly calmed under the influence 
of repose and of several frictions with the iodoform 
ointment. The next day after the entrance of the 
patient into the hospital, all of the anfractuosities 
of the wound are carefully washed with chlorinated 
water, and afterwards iodoform is applied abun- 
dantly. The next day the severe pains which the 
patient before experienced had completely disap- 
peared. 
We do not wish at all to ignore entirely the 
importance which complete repose, baths, and 
regularity of living possess in the treatment of the 
affection which occupies our attention ; but, even 
granting them a large part, we believe that we must 
attribute to iodoform the remarkable sedation, the 
immediate relief which patients experience under 
its influence. Thus, the patient who for a month 
had suffered much, sees his pains calmed almost 
immediately, the venereal ulceration cease to pro- 
gress, and, the 29th of May, he leaves the hospital 
completely cured, having experienced, nevertheless, 
a loss of substance of the glans. We do not doubt AND IN SYPHILITIC AFFECTIONS. 
55 
that, if the iodoform had been employed sooner with 
this patient, he would have escaped this deformity. 
We cite this fact, for, ordinarily, iodoform has not 
given us what we have expected in cases where the 
chancre has had a tendency to become complicated 
with phagedenism. 
Observation III.—T. . . ., aged twenty years, 
without venereal antecedents, enters the hospital on 
the 15th of May, having a soft chancre contracted 
the first of the same month; the incubation had a 
duration of six days. The 8th of May, a second 
chancre became developed, by contact, upon the 
raphe of the scrotum ; the first being situated on 
the edge of the prepuce. Until the 16th of May, 
the patient had not followed any treatment; from 
this day, iodoform is applied to the two chancres 
until the 28th of May, when the cure was complete. 
The treatment had a duration of twelve days. 
Observation IV.—L. . . aged twenty-one 
years, enters on the 15th of March, Ward 2, No. 
17. He has had, for more than a month, many 
soft chancres developed, some on the prepuce, others 
on the glans; their size is moderately large. For 
two weeks before his entrance into the hospital, 
the patient had followed the treatment with aromatic 
wine, without having perceived the least ameliora- 56 
IODOFORM IN VENEREAL DISEASE 
tion. From the 16th of March, he is treated daily 
by iodoform upon the chancres, and by iodoform 
ointment upon a painful adenitis in the left groin. 
The 25th of March, the chancres are cicatrized; 
the tumor in the groin has diminished in volume 
and lost its morbid sensibility: the treatment had 
then lasted ten days. 
Observation V. — R. . . ., aged seventeen 
years, enters the 25th of March, Ward 1, bed 15; 
he has a chancre on the edge of the prepuce de- 
veloped four days since, and the nature of which 
appears doubtful to us. Inoculation is immediately 
performed in the hypogastric region ; it gives rise to 
a new chancre. The iodoform powder is immedi- 
ately applied upon the two venereal ulcerations; 
but a bubo tends to become developed in the fold 
of the left groin ; the iodoform ointment is immedi- 
ately applied, and the adenitis terminates by reso- 
lution ; at the same time, the two chancres become 
cicatrized, and the patient goes out, completely cured, 
the 7th of April, after a treatment of twelve days. 
Observation VI.—P. . . aged sixteen years, 
enters the first of April, Ward i, No. 21 ; he has 
a soft chancre developed five days since on the dor- 
sal surface of the penis ; no ganglionic engorgement; 
abundant suppuration of the venereal ulcer; lotions AND IN SYPHILITIC AFFECTIONS. 
with chlorinated water, iodoform powder. Cure 
complete the 14th of April. The treatment lasted 
fourteen days. 
Observation VII. — D. . . . , aged twenty-one 
years, enters the 31st of March, Ward 1, bed 23; 
he has a series of soft chancres developed a month 
since in the preputial groove and on the frenum ; 
ganglionic engorgement dating fourteen days : pow- 
der and ointment of iodoform. The 12th of March, 
the chancres are cicatrized, but the bubo persists 
until the 17th, on which day it had completely dis- 
appeared by resolution. 
Observation VIII. — M. . . . , aged twenty- 
nine years, enters the 7th of April, Ward 1, bed 
29; he has on the right labial commissure a very 
well-developed chancre which has existed two 
months; on the penis are noticed the cicatrices of 
many other chancres cured a few days since. The 
labial chancre appears suspicious to us; in order to 
remove all doubts, we practice inoculation upon the 
hypogastric region where a new chancre is soon 
developed. The latter dries up rapidly under the 
influence of iodoform ; but, as for that of the lips, 
the incessant movements of this region and the con- 
tact of the saliva retard the cicatrization until the 
17th of April. 58 
IODOFORM IN VENEREAL DISEASE 
Observation IX. — B. . . . , aged seventeen 
years, enters the 25th of April, into Ward 1, bed 7 ; 
he is attacked, nearly a month since, by a soft 
chancre on the right edge of the prepuce, as well 
also, with a very intense balano-posthitis. No treat- 
ment previous to his entrance into the hospital. A 
few injections of nitrate of silver soon control the 
balano-posthitis, and the chancre yields at the end 
of eight days to the influence of iodoform. The 
patient goes out cured the 3d of May. 
Observation X.—J. . . . , aged nineteen years, 
enters the 25th of April, Ward 2, bed No. 15 ; he is 
attacked with balano-posthitis and intense blemon- 
hagia fifteen days since; the ganglia of the groins 
are tumefied and very painful; on the internal face 
of the prepuce two ulcerations exist, which are taken 
at first for soft chancres, on account of the abun- 
dance of suppuration and of a slight induration 
which is attributed to the effect of several cauteriza- 
tions which had already been practised in the city 
with the nitrate of silver. However that may be, 
the iodoform powder is applied during more than 
fifteen days; the balano-posthitis and the chancres 
have nearly disappeared, when there appears a very 
confluent roseola, plaques muqueuscs, &c. Mercurial 
treatment is immediately administered internally, and 
the iodoform continued upon the chancres which AND IN SYPHILITIC AFFECTIONS. 
59 
cicatrize five days later. The patient goes out the 
20th of May. The indurated chancres had not taken 
twenty days to cicatrize, that is to say four or five 
days more than the soft chancres. 
Observation XI.—L. . . . , aged thirty-two 
years, enters the 14th of April, into Ward 1, No. 
19; he has several soft chancres which have ex- 
isted nearly a month and a half upon the internal 
surface of the prepuce. The application of aromatic 
wine and cauterizations with the nitrate of silver have 
remained without effect. The patient is treated by 
the iodoform powder as soon as he enters the hospi- 
tal, and five days afterwards, the 19th of April, he 
goes out perfectly cured. 
Observation XII.—B. . . . , aged twenty-seven 
years, enters the 7th of April into Ward 2, bed No. 
17. For more than a month he has been attacked 
by two soft chancres situated one on the penis, the 
other on the edge of the prepuce. No treatment 
until then; a bubo even has commenced to be de- 
veloped some days since. Iodoform powder is 
applied to the chancres, the cicatrization of which 
is rapidly obtained. Iodoform ointment to the bubo, 
the hardness of which augments each day; never- 
theless the morbid sensibility disappears, and the 60 
IODOFORM IN VENEREAL DISEASE 
patient, cured, leaves the hospital the 20th of April, 
after thirteen days of treatment. 
Observation XII.—D. . . . , aged fifty-five 
years, enters the hospital the 1st of May, Ward 1, 
bed No. 22 ; he has had for two months an immense 
chancre, on the dorsal surface of the penis, which 
has resisted repeated cauterizations with the crayon 
of nitrate of silver, and mercurial ointment. A 
bubo has become developed in the left groin. 
The diagnosis of chancre is not possible by the 
sole consideration of its physical characters, so 
much they appear to us to have been modified by 
the previous treatment; nevertheless, the absence, 
at this period of the disease, of all syphilitic mani- 
festation, and, moreover, the existence of a very 
advanced bubo, lead us to believe in the existence 
of a soft chancre. Application of iodoform powder 
upon the chancre, which is not slow,to cicatrize; 
but the bubo suppurates. It is opened, covered at 
first with poultices of linseed meal and then with 
iodoform powder. The patient, completely cured, 
leaves the hospital the 31st of May, after a month 
of treatment. 
Observation XIV. —J. ...» aged twenty- 
eight years, enters the 24th of March, into Ward 
1, bed No. 17; he is attacked, since the 15th of AND IN SYPHILITIC AFFECTIONS. 
61 
March, by several soft chancres on the edge of the 
prepuce; a bubo is developed in the right groin ; 
it is attended by very severe pains. The 24th of 
March, spontaneous opening of the bubo. Iodo- 
form powder upon the chancres and on the inguinal 
ulceration ; rapid cessation of the pains; cure of 
the chancres on the 27th, cicatrization of the bubo 
the first of April; the patient goes out cured at £his 
time. 
Observation XV. — B. . . . , aged twenty-five 
years, Ward 2, No. 14, enters the 3d of March and 
goes out cured the ninth of the same month. Soft 
chancre on the internal surface of the prepuce; 
bubo in the left groin, all developed since four or 
five days. Iodoform powder on the chancre, the 
cicatrization of which is almost complete on the 7th ; 
iodoform ointment on the bubo, which already con- 
tains pus. The pains are quieted, but the fluctua- 
tion increases, and the abscess opens on the 5th. 
After having carefully evacuated the pus, made use 
of a few detersive injections, the ulcer is covered 
with iodoform powder; a crust forms on the wound, 
the lips of which become approximated, and, the 
9th of March, the patient wishes to leave the hos- 
pital, because he calls himself cured : the cicatriza- 
tion was, in fact, almost complete. The treatment 
had not lasted more than six days. 62 
IODOFORM IN VENEREAL DISEASE. 
Observation XVI. — T. . . . , aged eighteen 
years, enters the 3d of March, Ward 2, No. 4. 
He has several soft chancres on the inner surface 
of the prepuce, developed for the past fifteen days. 
He has also been afflicted with a bubo for five days. 
The chancres are treated by iodoform and cicatrized 
the 15th of March; the bubo is opened the 12th, 
treated by iodoform, and cured the 25th ; the patient 
leaves the hospital the next day. 
Observation XVII.—B. ...» aged twenty- 
eight years, enters the 10th of March into Ward 2, 
No. 26. He has been attacked by soft chancres 
developed eight days ago on the glans and on the 
internal surface of the prepuce; the suppuration is 
very abundant. The chancres have been treated 
in the city by aromatic wine and cauterization with 
the nitrate of silver; they have resisted the treat- 
ment for three weeks. During the first three days 
after his entrance into the hospital, the patient only 
uses frequent lotions of chlorinated water; from the 
13th to the 20th of March, these are replaced by 
iodoform powder, and the cure is complete at this 
period. % 
Observation XVIII. — B. . . . , aged thirty 
years, enters the hospital the 25th of February, 
Ward 2, No. 19. He is attacked by a soft chancre 63 
AND IN SYPHILITIC AFFECTIONS. 
on the dorsal surface of the penis, near the pubes, 
developed towards the 15th of February; no pre- 
vious treatment; double bubo for two days previous 
to his entrance into the hospital. Iodoform powder 
on the chancre, which is completely dried up tow- 
ards the third day of March. Iodoform ointment 
on the buboes, one of which, that of the left groin, 
disappears by resolution. The second is opened 
the ioth of March, dressed with iodoform and cured 
the 30th of March. 
Observation XIX. — P. . . . , aged twenty- 
nine years, enters the hospital the ioth of March, 
Ward 2, No. 16. He has a soft chancre developed 
eight days since on the prepuce. Notwithstanding 
a very energetic cauterization with the chloride of 
zinc, practised four days previous, the progress of 
the venereal ulceration is not arrested. Fearing a 
new application of the caustic, the patient avoided the 
day of consultation, and is admitted for treatment 
the ioth of March. A bubo commences to be de- 
veloped. Employment of poultices on the bubo and 
iodoform powder on the chancre, the cicatrization 
of which is nearly complete the 22d of March. The 
bubo suppurates : it is opened, covered by poulti- 
ces, and afterwards powdered with iodoform. The 
patient, goes out cured the 6th of April. 64 
IODOFORM IN VENEREAL DISEASE 
Observation XX. — J. ...» aged fifty-one 
years, enters the 4th of April, Ward 1, No. 4. Five 
weeks ago he w as attacked by a soft chancre on the 
corona of the glans. There exists great loss of sub- 
stance and a bubo for three weeks. Cauterization 
w ith the nitrate of silver and the aromatic wine have 
not been able to check the progress of the ulcer. 
On the entrance of the patient into the hospital, 
lotions of chlorinated water are used and the iodo- 
form powder on the chancre. The bubo is incised, 
and, after two days of poultices, the internal sur- 
face is covered with iodoform, whilst to the exterior 
the iodoform ointment is applied, in order to resolve 
the induration w hich exists in the inguinal region ; 
the same treatment is continued until the 1st of 
June, when the patient goes out completely cured. 
Observation XXI. — B. . . . , aged twenty- 
seven years, enters the 28th of February into Ward 
2, No. 27. Me is attacked by a soft chancre in the 
preputial furrow, and a second on the dorsal sur- 
face of the penis, both dating from the 15th of Feb- 
ruary ; there exists, besides, a bubo for five days. 
Iodoform powder upon the chancres, which are 
dried up towards the 20th of March. Poultices to 
the bubo, which suppuration forces to open the 20th 
of March. Poultices, chlorinated water, iodoform AND IN SYPHILITIC AFFECTIONS. 
powder; cure complete the 3d of April, the day on 
which the patient leaves the hospital. 
Observation XXII.—T. . . . , nineteen years, 
Ward 2, No. 18 ; enters the 31st of March with a soft 
chancre on the glans, developed five days since. 
Lotions with chlorinated water, iodoform powder. 
A crust forms which becomes detached five days 
after, leaving beneath it a perfect cicatrization. The 
patient goes out the 6th of April. 
Observation XXIII. — P. . . . , twenty-six 
years, Ward 2, No. 27 ; enters the 24th of March; 
has a soft chancre developed ten days since on the 
inferior part of the penis, in the neighborhood of 
its root; bubo for four days. Opening of the bubo, 
poultices the first days, then iodoform powder; the 
cicatrization is complete the 6th of April. 
Buboes treated by Iodoform. 
Observation XXIV. — P. . . . , enters the Hopi- 
tal du Midi, Ward i, bed No. 2, the 15th of May. 
Towards the 15th of April, a month before, a chan- 
cre presenting all the characters of soft chancre is 
developed on the right side of the penis. No treat- 
ment : incessant enlargement of the chancre which 
is still the seat of severe pains. On the 16th of 
May, application of iodoform powder to the chan- 66 
IODOFORM IN VENEREAL DISEASE 
ere; immediate cessation of the pains; discharge 
diminished very rapidly, and, the 28th of May, 
there remains only a flat cicatrix, still covered in 
certain places by a hard and dry crust. But, dur- 
ing its evolution, the chancre had, towards the com- 
mencement of May, provoked the development of 
a bubo which, by an irregularity quite common, 
however, had invaded the ganglion of the left groin, 
the chancre being situated on the right side of the 
penis. The peculiarity, which is explained by the 
inter-crossing of the lymphatic vessels, has been, as 
is known, designated by Ricord under the name of 
chasst-croisi. However that may be, no treatment 
had been directed against the bubo until the 16th 
of May. Opened the 18th, it was covered for two 
days by poultices of linseed-meal, then iodoform. 
On the 29th of May, the cicatrization was complete, 
save a very little separation between the lips of the 
wound, perfectly dry otherwise. 
Observation XXV. — B. . . . , aged twenty 
years, enters the hospital the 15th of May, Ward 1, 
No. 7. He unites, in his case, phymosis, balano- 
posthitis, soft chancres, blenorrhagia, bubo ; except 
syphilis, this patient is attacked by almost all of the 
venereal affections. The infection dates from the 
20th of April, and no treatment has been pursued 
since then. On the day of his entrance poultices AND IN SYPHILITIC AFFECTIONS. 
67 
are applied and injections of the nitrate of silver 
given on account of his balano-posthitis. The pains 
are severe. Beginning from the 23d of May, iodo- 
form is employed in powder upon the chancre, in 
ointment on the bubo, and this application is fol- 
lowed by a sensible amelioration ; the pains above 
all are so much appeased that, of his own accord, 
the patient introduces the iodoform ointment into 
the preputial groove, where the remains of inflam- 
mation are still found. However,-on the 25th the 
fluctuation of the bubo becomes evident; an in- 
cision is made and the iodoform powder applied 
between the lips of the wound, which is found al- 
most cicatrized the 30th of May; it is the same with 
the chancre. The patient goes out cured on the 
3d of June. 
Observation XXVI. — R. . . . , aged sixteen 
years, enters the 25th of April, Ward 1, bed No. 
8. Pleiad of soft chancres on the internal surface 
of the prepuce and the corona of the glans, de- 
veloped towards the 10th of March, after an incu- 
bation of four days. No treatment until the 25th 
of April. On the 1st of April a bubo commenced 
to appear which has but augmented in volume from 
da)7 to day. The 26th of April, iodoform powder 
upon the chancres, which appear, by reason of their 
number, to be engendered by successive inocula- 68 
IODOFORM IN VENEREAL DISEASE 
tions. The bubo opens during the night, after very 
severe pains. The suppuration is very .abundant; 
notwithstanding that, the iodoform powder is tried ; 
during eight to ten days it does wonders; the cica- 
trization advances at a rapid pace; then this happy 
influence disappears; the suppuration is re-estab- 
lished more abundant than ever, the borders of the 
bubo slough, become cut into regular fringes. The 
lips of the wound become chancrous, and the exten- 
sion of the ulcer shows us that we have to do with 
a case of phagedenism. In the presence of this 
complication, we abandon the iodoform in order to 
have recourse to the paste of Canquoin. After the 
fall of the eschar, we resume the iodoform ; but, at 
the end of a few days, the patient leaves the hospital 
without being willing to wait for the complete cure. 
Observation XXVII. — Here is an observation 
which has particularly fixed our attention, because 
it is very rare. It is relative to the smalljymphatic 
ganglia situated in the course of the lymphatic ves- 
sels of the penis, in the sub-cutaneous cellular tis- 
sue. These ganglia, appreciable above all in their 
pathological condition, comport themselves, in cases 
of venereal ulceration, absolutely like the ganglia 
of the fold of the groin. They remain hard, mov- 
able, indolent, when the virus which has penetrated 
into their cellular investment is of syphilitic nature. 69 
AND IN SYPHILITIC AFFECTIONS. 
They are soft, painful, complicated with inflamma- 
tion of the neighboring cellular tissue, when the 
point of departure of their affection is a soft chan- 
cre ; after the same manner, in this case, they are 
ordinarily seen to suppurate. It is this which has 
taken place in the case which we here report. 
L. . . . , aged thirty years, enters the 12th of 
May into the Hopital du Midi, Ward 1, bed No. 9. 
Towards the 10th of April, after an incubation of 
five days, a soft chancre is developed on the exter- 
nal and dorsal surface of the prepuce; it is covered 
with lint imbibed with chlorinated water; then, in 
presence of the inutility of this medication, it is cau- 
terized with the nitrate of silver. Severe pains, in- 
flammatory swelling of the penis. The 5th of May, 
the patient notices a little enlargement on the dor- 
sal surface of the penis, very near the pubes ; it rolls 
under the finger; painful to pressure, it seems to be 
connected with the chancre by an indurated cord. 
The patient compares this enlargement to a pea, to 
a gland. In two days, it loses its mobility, it be- 
comes very painful, the skin is red. The 12th of 
May, the day of the arrival of the patient at the 
hospital, fluctuation is evident. The adeno-phleg- 
mon is opened with the bistouri, and iodoform is 
applied to the abscess, as well as to the chancre. 
The amelioration is very rapid, and, the 30th of 
May the patient leaves the hospital completely 
cured. 70 
IODOFORM IN VENEREAL DISEASE 
We could still multiply the number of soft chan- 
cres and buboes; but we believe that the exam- 
ination of those which we have given and which 
presented themselves during the same period of two 
months, April and May, is suflicient. We are alone 
intent on not committing the error, a little volun- 
tary, of persons who, enthusiasts in such or such a 
method of therapeutics, seek carefully for cases 
pleading in favor of their Ciiuse, and thus offer 
wonderful statistics. This is the custom of many 
persons who busy themselves with statistics, and it 
is unfortunately this which takes much of the value 
from works of this nature which a greater scientific 
probity would give them. 
Nothing, for example, had been more easy for us 
than to group observations demonstrating that iodo- 
form cures soft chancres in five or six days: we 
should only have received, at our consultations, 
patients attacked with simple soft chancres; but 
these patients are not excepted by us. A soft chan- 
cre, under these conditions, covered with a little 
iodoform, does not hinder them from giving them- 
selves to their habitual occupations, in confining 
themselves, it is well understood, to some precau- 
tions destined to prevent the development of buboes. 
Indeed, when, three days later, these patients re- 
turn to us to obtain a new dose of iodoform, the 
cicatrization is very often in an advanced condition. AND IN SYPHILITIC AFFECTIONS. 
It may be asked of us, however, what we mean 
by a soft chancre aired. Is it when it no longer 
suppurates? Is it when the process of cicatrization 
being very much advanced upon the periphery, 
there only exists a centre of suppuration, the pus 
having moreover lost its virulent properties? Is it 
necessary that the crusts should be already de- 
tached? Is it necessary, finally, that there remain 
no longer any traces of the ulcer? 
For ourselves, we consider as cured a soft chan- 
cre covered with dry crusts, the borders of which 
are raised and detached easily. The patient leaves 
the hospital when, the crusts having fallen, there no 
longer remains the slightest moisture beneath them. 
We see, then, that the exact appreciation of the 
time which it takes for a soft chancre to cicatrize 
under the influence of a medication is somewhat 
difficult to determine. And furthermore, what ele- 
ments foreign to the chancre itself should enter into 
the appreciation of the importance of such or such 
a medicament ? 
Then even, although not submitted to any treat- 
ment, the simple chancre will have the tendency to 
cicatrize; but, in such an individual, this process 
will be accomplished in a few weeks, in another in 
many months, and without our being able, in the 
actual state of science, to explain this delay ; finally, 
in a third subject, the soft chancre not only will not 72 
IODOFORM IN VENEREAL DISEASE 
have a tendency to become cured, but it will invade 
successively the neighboring regions ; it will destroy 
the cellular tissue, it will disorganize the skin; it 
will be, in a word, phagedenic. How many times 
have we seen chancres which, during entire months, 
had been uselessly treated by the aromatic wine, 
the nitrate of silver, and which yielded with the 
greatest facility to the application of iodoform ! How 
many times have we seen subjects with soft and 
lymphatic tissues, in whom chancres always cica- 
trize slowly, cured nevertheless after a dozen or 
fifteen days of our treatment! 
However that may be, and notwithstanding the 
difficulties we have encountered, there results from 
all of our observation, — 
ist. That iodoform is a therapeutic agent produc- 
ing more certainly and more promptly than all the 
others ordinarily employed the cicatrization of ulcer- 
ative syphilids in general, under whatever form they 
present themselves. 
2d. That, in the treatment of soft chancre, iodo- 
form is in some sort a specific by the promptness 
with which it produces cicatrization without pain. 
3d. That, in the treatment of simple or virulent 
buboes (non-syphilitic), iodoform can be employed 
in the form of an ointment, as a resolvent, during 
the early stage, with more success than the blister 
and tincture of iodine ; during the period which sue- AND IN SYPHILITIC AFFECTIONS. 
73 
ceeds to the opening of the bubo, no other medica- 
ment can be compared with it for the rapidity with 
which it brings about the cure. 
4th. In all the preceding cases, when the suppu- 
ration is abundant, it is preferable to commence the 
treatment by the solution of iodoform in glycerine 
and alcohol; iodoform in powder ought to be em- 
ployed in the second place. 
5th. Iodoform acts not only as a topical agent, 
but still farther as a local anaesthetic. The rapid 
cicatrization which takes place is due, 1st, to the 
simplicity of the dressing which does not irritate the 
diseased parts; 2d, to the absorption of the secre- 
tions by the iodoform powder; 3d, to the antiseptic 
properties of the medicament, above all, when it is 
dissolved in alcohol and glycerine; 4th, to the pres- 
ence of iodine, which acts favorably on all venereal 
ulcerations in general. 
6th. Iodoform appears to us to be completely in- 
capable of arresting the progress of phagedenism. 
7th. The employment of iodoform in cases of 
syphilitic affections should never dispense with in- 
ternal treatment. 
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p]pologial an!) f lnrapeutital 
OF THE 
Bromide of Potassium, Bromide of Ammonium, 
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By EDWARD H. CLARKE, M.D., 
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AND 
ROBERT AMORY, M.D., 
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[From the Doctor, London, June, 1872.] 
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For Sale by all Booksellers. 
JAMES CAMPBELL, Publisher, 
Boston, Mass. SURGIQAL CLINIC OF LA CHAklTE. 
LESSONS 
UPON THE 
DIAGNOSIS AND TREATMENT 
OF SURGICAL DISEASES, 
Delivered in the month of August, 1865, by Prof. Velpeau. 
COLLECTED AND EDITED BY A. KEGNARI), INTERNE DEH HO»- 
PITAUX. REVISED BY TIIE PROFESSOR. 
Translated by W. C. B. FIFIELD, M.D. 
1 volume. i6mo. Cloth. $i oo. 
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Contusions, Affections of the Genito-Urinary Organs, Affections of the Aural Region, 
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