THE GLANDULAR CHANCRE. 751 



tion of the chancre. The first symptom of this troublesome complica- 

 tion consists in a feeling of pain at a circumscribed point in the groin, 

 not far from the genitals. Upon examination, we find a small lump, 

 which, already even, is sensitive to the slightest pressure, and which 

 corresponds to a moderately enlarged inguinal gland. The dispropor 

 tion between the severity of the pain and the smallness of the swell- 

 ing, the proximity of the latter to the genitals, the fact that one or two 

 only of the glands are enlarged and never a large number of them, 

 make us aware, even thus early, that we have to deal with an acute 

 virulent bubo, and not with the so-called sympathetic bubo, or with 

 the syphilitic glandular enlargements hereafter to be described. The 

 further course of the virulent bubo varies. In very rare instances the 

 inflammation is resolved, and the pain and swelling of the affected 

 gland gradually subside. In such cases it is not improbable that it is 

 merely the inflammation which has spread along the lymphatic vessels 

 to the gland, but that the chancrous virus has not been absorbed with 

 it, or, in other words, that the bubo is a sympathetic one. . The process 

 above alluded to, namely, the extension of an inflammation along the 

 lymphatics to the lymphatic glands is a very common occurrence also 

 among non-specific ulcers. Far more frequently, and probably always, 

 in the case of a virulent bubo, the inflamed gland suppurates. In 

 favorable cases the pus soon perforates the capsule of the gland and 

 the adherent skin which covers it. In other instances, the connective 

 tissue about* the gland becomes the seat of an extensive inflammatory 

 exudation, the tumor becomes much enlarged, and is no longer mova- 

 ble. It becomes very difficult for the patient to walk, and, in spite of 

 the efforts which he usually makes to conceal it, we can perceive that 

 he favors the affected side as he steps. In persons with a tendency to 

 fever, there is also an elevation of temperature, acceleration of the 

 pulse, general malaise, and other febrile symptoms. Considerable time 

 elapses thus, ere the skin begins to redden, and ere the circumscribed 

 point of fluctuation makes its appearance. If a puncture then be made 

 at this point, or if the skin assume a dark-red hue and grow thinner 

 and thinner, until the matter is discharged spontaneously, a small 

 portion only of the swelling subsides, and it is often as large as a 

 man's fist, and of an irregular, knobby form. By-and-by fluctuation, 

 followed by escape of matter, occurs at other points ; but, in spite of 

 the numerous abscesses, weeks and months often pass by without any 

 diminution in the size of the tumor in which they form. The course 

 of a virulent bubo is equally tedious and intractable, if the matter 

 which has escaped from the inflamed gland into the surrounding 

 areolar tissue have formed sinuses and fistulous tracts, as well as 

 when the accumulation of matter within the gland is slow to point and 



