THE TREATMENT AND CURE OF CHANCRE WITH PEROXIDE OF HYDROGEN. BY Willard Parker Worster, a.m., m.d. reprinted from JOURNAL OF CUTANEOUS AND G E NTTO - U RIN A R V DISEASES. For February, 1894. Reprinted from the Journal of Cutaneous and Genito-Urinary Diseases for February, 1894. THE TREATMENT AND CURE OF CHANCRE WITH PEROXIDE OF HYDROGEN. BY WILLARD PARKER WORSTER, M.D. New York. The subject of the best treatment of the primary sore of syphiiis has occupied the minds of investigators of late years to such an extent that almost every surgeon has a different method, and the general practitioner is somewhat at a loss to know which is the best treatment to employ as the most expeditious means of relieving the anxiety of the patient and curing the lesion. The special purpose of this paper is to draw attention to a particular method of treat- ment, which not only relieves the anxiety of the patient and places him in a delightful buoyancy of mind, but cures the chancre in the shortest possible time, without pain or de- tention from business, and with less scar and less destruc- tion of tissue than any other method. The chancres of the following cases, selected from a good many recorded, were of the large Hunterian variety, embracing the worst forms of sloughing and phagedena. Case I.-Mr. K., aged 38 years, came to me, January 29th, 1891. with a large sloughing single chancre, situated on the right side and at the base of the glans penis, at the junction of the prepuce and very deep ; incubation about thirty days; penis large and soft. Sprayed it with full strength solution (15 volumes) of peroxide of hydrogen medicinal (Marchand's), at 60 pounds pressure, and dressed 2 with lodol powder, and continued the same treatment every morning at 7 o'clock. February 20th, sprayed it as above; sore now only skin deep, and continued till February 23d; sore healed; dura- tion of treatment twenty-five days. Case II.-Mr. W. B. came to me, September, 6, 1892, with a single sloughing chancre on left glans penis, and corresponding ulceration on prepuce; incubation about thirty days; sprayed with peroxide of hydrogen, full strength, 60 pounds pressure, and dressed with iodol; con- tinued same treatment every evening at 7:30 o'clock, for sixteen days. September 23d, sore almost healed. September 25th, sprayed for the last time to-day ; dura- tion of treatment, nineteen days. Case III.-Mr. L., aged 28 years, came to me, August 23, 1893, with a phagedenic chancre, thirty-five days' in- cubation, situated immediately at meatus urinarius, and sloughing its way very rapidly into the urethra ; sprayed it with peroxide of hydrogen, full strength, 60 pounds press- ure, and dressed with iodo] powder. Continued the same treatment every evening at 7:30 o'clock. August 30th. Sore almost healed up, only some granu- lations left. Continued the same treatment every evening till September 4th. Sprayed it to-day for the last time ; there only being the surface of the sore about the size of pin's head. Considered himself cured and said he would not come again. Duration of treatment, eleven days. 3 The above cases, selected from many recorded cases, on account of their possessing the worst features of the initial lesion, serve as good examples of the treatment by the per- oxide of hydrogen method. I treated Mr. K., of Case I., on two different occasions, for the same disease, in exactly the same manner, and the two cases are about identical in regard to length of time of treatment and as to details, and he got well in about the same manner. The case of Mr. L. presented the worst features of pha- gedena, which was so virulent that I think he would have lost the greater part of the glans penis, if he had been treated by the nitric acid or caustic method, and, as it was, the ulcer healed with a very small scar, scarcely no- ticeable. The pressure of the spray (GO pounds), which is one of the most important factors in the whole method, not only cleanses and produces thorough asepsis of it, killing the germs of the disease at the very bottom of the ulcer, but the oxygen of the peroxide aerates the blood through the -capillaries, and arrests the progress of the disease at the nearest possible point, allowing the process of repair to commence as soon as possible, according to the severity of the disease, with the least loss and destruction of tissue and consequent scar. It must be particularly understood that in using this treatment, all instruments, spray-tubes and bottles, must be made of either glass or hard rubber, for the reason that metals, with one or two exceptions, coming in contact with the peroxide, will destroy its com- ponent parts and render it useless, and I have found also a great difference in the results if the peroxide is fresh or 4 otherwise. The first effect of a spray of peroxide upon the ulcer is to deposit upon it a thick film of albumen ; this should be allowed to remain for about half a minute or less ; then continue the spraying till a large tubefull has been used (one ounce) ; as the sore progresses the spraying causes a good flow of rich arterial blood upon it, which merely shows returning healthy conditions. The treatment is entirely painless, and the patients do not experience any annoyance or inconvenience whatever while carrying the disease, and freely express themselves as well pleased with its effect. No internal medication during this stage is given. The iodol powder is used only as an antiseptic, to protect the sore from external influences until it is sprayed again the next day, keeping the sore in as good a condition as it is left by the spraying, which must be done once every day until the ulcer is healed. This method of the treatment of chancre has been, in my hands, the best and most successful of all methods that 1 have heretofore adopted. 120 West Forty-ninth Street.