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Dcscri('tion. — The shape and size of the ulcer at first corresponds to those of the abrasion upon which the virus has been deposited. The form is usually round or oval, with a punched out, irregu- lar tA^t which is undermined. The base is uneven and covered with a gray or yellowish exudate. The buy maxalt online secretion is profuse and purulent, the surface bleeds is there a generic for maxalt rather easily, and the neighboring tissue is red and infiltrated maxalt mlt generic especially when the infection in- maxalt mlt price volves the coronary sulcus. It spreads upon the surface by the process of ulceration and maxalt mlt tablets is frequent- Iv painful. Autoinoculation is usual, and multi- plicity of ulcers is therefore the rule ; a feature of diagnostic importance is noted in the fact that all of the ulcers do not appear at the same time. In from one to four weeks, price of maxalt under proper treatment and care, the stage of destruction is passed, the base of the ulcer l)ccomes covered with healthy granula- tions, the discharge ceases, and the ulcer is no long- er inoculable. Repair rapidly follows with a re- sulting scar. Chancroid on the skin surface is usually deeper than the lesion found on the mucous membrane. Skin chancroid, excepting those of the thigh and scrotum, is ustially single ; of the nine hundred cases forty-nine occurred on skin surfaces, of which forty-four were single and in five two ulcers were present. Differences in location maxalt melt frequently influ- cheap maxalt ence the size and form of the ulcer. Chancroid situated on the frenum is generally linear, extend- ing toward the meatus and frequently causing de- struction of the frenum. When located on the side of the frenum the chancroid may perforate it by ul- ceration, leaving a bridge of loose tissue. When the hair follicles are involved multiple pustules form which break down and coalesce, forming the deep, crater like " follicular chancroid." Granulations from the base of the ulcer may become exuberant and appear above the surface, resembling warty growths, and not infrequently the scar tissue of a healed chancroid becomes the seat for the future development of warty vegetations. Division. — Chancroid may be divided into classes according to the amount of tissue destruction and to the clinical appearance and course of the ulcer. The gangrenous, phagedenic, diphtheritic, and ser- piginous varieties are recognized. Constitutional diseases, poor hygienic surroundings, lack of cleanli- ness, excesses, and careless treatment are usually regarded maxalt tablets as being responsible for the virulency of the infection. We believe that while these factors may act as indirect causes the real virulency is de- pendent upon a mixed infection. In the gangrenous chancroid the base of the ulcer becomes gray or maxalt mlt coupon black, the ulcer spreads rapidly and penetrates deep- Iv, the tissue becomes necrotic, and large areas are destroyed, the order maxalt online surrounding tissue appears dark red, is infiltrated and painful, haemorrhage may be pro- fuse and great and serious defects remain after the ulcer has healed. • In the phagedenic variety the ulcerative process remains more localized, the necrotic areas being much more limited than in the gangrenous form. The base of the ulcer is covered with a gray slough, and the neighboring tissue infiltrated and inflamed. It is frequently seen in cases complicated with phi- mosis and at times in paraphimosis. In phimosis the maxalt rpd 10 ulcer is usually found on the inner surface of the reflected layer or on the glans penis. The ulcer may perforate the maxalt canada prepuce, the glans being exposed through the opening. In paraphimosis the ulcer is generally found on the constriction, this being the point of election owing to maxalt melts the circulatory disturb- ances. When the ulcer is located on the shaft of the penis it may ulcerate through the spongy body with a resulting urinary fistula. Cases maxalt 5 mg have been reported in which the ulceration penetrated into the cavernous body followed by considerable haemor- rhage. The serpiginous and diphtheritic v.irieties are verv rarely encountered. Neither of these forms have been observed at the dispensary, nor have we seen them in the patients maxalt melt 10mg under treatment at the Philadelphia General Hospital, where the most vir- ulent forms of chancroid are met with. The diph- theritic form is described as a superficial ulcer cov- ered with an adherent dry, brown or maxalt rpd 10mg gray mem- brane, spreading on the surface but not penetrating to the deeper tisfues. In the serpiginous variety the process cost of maxalt of ulceration and extension is slow and without local reaction. It spreads slowly in a ser- piginous manner, one part healing maxalt cost as another part is involved. It is very chronic and may last for months. /.on skin surfaces coming in direct relation to it, as the thighs, groin, and pnbes. In UHLE AND MACKINNEY: CHANCROID.

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