28 CLINICAL APPLIED ANATOMY. 



presents small excoriations, and in wet-nurses these may become 

 infected ; sometimes both nipples are invaded simultaneously in 

 this manner. A finger chancre is usually found by the side of 

 the nail, a spot very liable to slight laceration. The proclivity to 

 infection of the groove between the prepuce and the corona is 

 probably an example of the same natural tendency. 



It appears that the poison is carried from the point of infection 

 by the perivascular lymphatics, and so invades the nearest group 

 of lymphatic glands. These glands undergo a slow and painless 

 enlargement. Indurated lymphatics can sometimes be traced 

 from the chancre towards the glands involved. The glands 

 which first enlarge are those in direct anatomical continuity with 

 the part infected. With a genital chancre the horizontal set of 

 inguinal glands is usually affected first, with a central chancre 

 of the lower lip the supra-hyoid glands, and with a chancre 

 situated laterally the submandibular group. A finger chancre is 

 followed by swelling of the outer group of axillary glands, or, if 

 on one of the inner fingers, the epicondylar gland may first suffer. 

 An eyelid chancre will first infect the preauricular glands. The 

 occurrence of " crossed bubo," where the chancre is on one side 

 of the prepuce, and the bubo in the opposite groin, admits of an 

 anatomical explanation, for although the lymphatics of the skin of 

 the penis and of the prepuce, after following the course of the 

 superficial dorsal vein, pass mainly to the groin of the same side, 

 yet a decussation may occur, and as a rarity one trunk only 

 may be present, so that all the lymphatics converge to the same 

 groin. 



The lymphatics of the glans penis run with the deep dorsal 

 vein of the organ within the aponeurosis. Some of them pass 

 into the abdomen through the crural canal, having traversed the 

 row of lymph-glands round the femoral vein, whilst the rest 

 enter by the inguinal canal, and join the same vertical set of 

 lymph-glands at a higher level where it surrounds the external 

 iliac vein. 



When syphilis enters on its secondary stage, the phenomena 

 become generalised. The symmetrical distribution and wide 



