THE CHANCRE. 747 



as, owing to the copiousness of the discharge, and to the absence of 

 other conspicuous symptoms, inoculation is almost always neglected 

 In women, the most frequent seat of the common chancre is the vulva 

 upon the posterior commissure, and at the entrance to the vagina. In 

 very rare instances it appears in the vagina, and even upon the vaginal 

 portion of the neck of the womb. When the common chancre begins 

 to heal, the destruction ceases, and the lardaceous appearance of the 

 base of the ulcer disappears ("the chancre cleans up"), granulations 

 appear upon the base and edges of the ulcer, which gradually fill up 

 the loss of substance. After the chancre has healed, there remains a 

 cicatrix, more or less distinctly stellated, according to the depth of the 

 ulcer. The period at which the process of repair commences is very 

 variable. Some chancres become covered with granulations, and trans- 

 form into simple sores, which do not secrete inoculable pus in a week 

 or two, while others go on extending for months, and retain all their 

 characteristics; that is, ragged edges, lardaceous base, and virulent 

 discharge. 



The superficial chancre occurs most frequently upon the glans and 

 prepuce in men ; and between the labia and nymphae, and at the en- 

 trance to the vagina, and on the neck of the womb, in women ; and it 

 appears in both sexes with equal frequence on the skin. When situ- 

 ated upon the glans, an exact counterpart of the ulcer is usually found 

 upon the corresponding inner surface of the prepuce. The form of the 

 ulcer is irregular, and its surface looks as if the cuticle had been scald- 

 ed off. At its edge there is a white border. The destructive process 

 never extends deeply. When situated at the orifice of the prepuce, 

 cracks occur in its folds, which render retraction of the prepuce very 

 painful. The superficial chancre often results in phimosis and para- 

 phimosis. In the former instance it is almost indistinguishable from 

 balanitis, excepting by means of inoculation. When a superficial 

 chancre is situated upon the external integument, the scanty secretion 

 soon dries up into a thin crust, and it is not until after it has been 

 treated with a wet dressing that its raw, reddish-yellow surface, spar- 

 ingly covered with secretion, becomes visible. 



The follicular chancre develops from a sebaceous gland. Its sur- 

 face is very small, disproportionately deep, and long retains its regular 

 round form. 



The phagedenic chancre usually originates from the common 

 chancre. Its secretion is thin, ichorous, and very offensive ; its form 

 is irregular, its base is of a grayish-white or greenish color, consisting 

 of necrosed tissue and of infiltration ; its edges are livid, and sur- 

 rounded by coppery-red areola. It spreads rapidly, and in men it 

 sometimes destroys a large portion of the prepuce, glans, skin of the 



