CHANCROID (SOFT CHANCRE).—A \vide-spread, infectious, sexual disease, to be distinguished from hard chancre, or syphilis. It is a com paratively mild affection, inasmuch as its duration is limited ; permanent cure may always be expected, and a general infection is not associated with the essentially local disorder. In most cases of soft chancre, a spreading of the process takes place by way of the lymph-channels to the neighbouring lymph-glands, leading to the formation of painful buboes which often suppurate, and then again become chancrous. See BUBO. The infection is brought about almost exclusively by sexual intercourse, when an existing injury of the skin, or of the mucous membrane, or one ever so small occurring during the act, comes in contact with the secretion of a soft chancre existing in the other person. The cause of the affection is probably known (Ducrey's bacillus).
Soft chancre appears 24 to 4S hours after infection in the form of a minute postule or pimple, which soon broadens and breaks down, developing into an ulcer. This ulcer usually extends into the deeper layers of the infected site, with finely serrated and often undermined borders. The base of the ulcer is covered with a dirty, yellow membrane, which appears as if pierced by worms ; the ulcer, which spreads rapidly, assuming the most various forms, is very painful to the touch. Proliferations occasionally form upon the ulcer, projecting like moulds over the surrounding tissue. In other cases the rapid spread of the ulcer is combined with gangrenous disintegra tion (gangrenous chancre) ; or a refractoriness in healing manifests itself even after the chancre has been present for only a brief time. Uncleanliness often causes a spreading of the poison, leading to 'the formation of several new ulcers in the immediate or more remote neighbourhood of the primary chancre. The favourite sites of the affection are the frcenum and the lateral pouches of the internal leaf of the prepuce beside the frxnum. Complete destruction of the latter sometimes leads to considerable hemorrhage. After several (sometimes six to eight) weeks, the ulcer usually begins to become cleaner, ultimately healing completely, with the formation of a scar.
Any pustule appearing upon the genital organ a few days after a dubious sexual intercourse is suspicious, and requires examination and treatment by a physician. Until the latter has inspected the sore, it is advisable to keep quiet, observe scrupulous cleanliness, and apply antiseptic cotton and a cooling compress. Earliest possible treatment by a physician may essen tially shorten the course of the affection ; it may cause rapid recovery and may thereby prevent the disagreeable consequences of an inflammation of the lymph-glands. With the increasing knowledge among all classes of people of the importance of cleanliness, the forms of gangrenous chancre, which lead to considerable disturbances and destructions, have become very rare.
In order to prevent this affection it is essential to avoid exposure to danger if there is present the slightest injury of the skin or of the mucous membranes of the genital organs. A small abrasion, a blister, or an inflam mation, be it ever so small, of the glans of the penis, may serve as the portal of entrance for the poison. The only safe method to avoid this, as well as
other venereal diseases, is to abstain from all illegal intercourse.
CHEESE.—An exceedingly important foodstuff, which combines cheap ness with great nutritive value. Its bad reputation of being indigestible is largely due to the foolish habit of swallowing it Nvi thout chewing it and breaking it into small pieces. Cheese may be called pure milk-extract. This is absolutely true of cream-cheese, which is obtained from unskimmed milk and which, therefore, contains the fat of the latter ; it is true to a lesser degree_ of skim-milk cheese, in the manufacture of which, partly or completely, skimmed milk is used. Milk contains an average of 89 per cent. of water ; and after the loss of this Nva t er and of some salts, cheese represents the actual nutritive constituents of milk. It nmst, therefore, be placed in the front rank of foodstuffs for the healthy as well as for the sick ; especially as cheese, if properly masticated, or grated in Italian style, and stirred into soups, does not make any increased demands upon the digestive organs. Soups which contain flour, and those prepared from grain products (groats, rice, farina, etc.) can be easily improved in taste as yell as in nutritive value by the addition of grated cheese. Such food is especially to be recom mended for children and weak individuals.
The epicure, it is true, demands different qualities of cheese ; he insists that it should be ripened by special bacteria, whereby digestion is relieved of part of its labour ; and he prefers cheese which has been rendered more palatable by moulds ; for instance, Roquefort, Stilton, and Gorgonzola, which are profusely streaked with the green swards of moulds, such as are found also on old bread. In addition to the green moulds there occur also red ones (likewise harmless) on the surface of certain kinds of cheese ; whereas the varieties of bacteria that ripen the cheese are lunch more numerous. .•1s these are of importance to the taste, a more exact knowledge of them will some day contribute greatly to improve the manufacture of cheese. In some varieties of cheese (as Swiss cheese) the bacteria manifest their pres ence by the formation of holes, due to the decomposition of milk-sugar with the development of gas.
Hard cheese owes this quality in part to the abundance of phosphorated lime which it contains, and which is almost entirely absent in soft cheese. White cheese, or whey-cheese, differs from all others in that it is made from sour milk, Nv he r eas other kinds of cheese are made from milk which has been curdled by the addition of rennet. The following varieties of cheese may be mentioned : Skim-milk : Parmesan and Liptau ; medium cream : Edam, Emmenthal (Swiss), and Cheshire ; cream : Limburger, Roquefort, and Brie. The average composition of cheese is 25 to 3o per cent. of proteids, S to io per cent, of fat, and 3 to 5 per cent. of milk-sugar. Artificial cheese prepared from oleomargarine is not to be recommended.