There are two or three classical varieties of chancre which deserve more minute description. As ordinarily seen upon the genitalia, a chancre may assume the following types:

A. Dry Papule.

—The dry papule commences as a small rounded area of redness, becoming infiltrated and rising above the surface, gradually developing into a nodule the size of a pea or larger, over which the superficial skin seems to be thickened. Should the summit of this nodule become abraded there will escape a serous fluid, which dries and forms a thin scab. This papule may disappear more slowly than it came, or may become more infiltrated, while its surface breaks down into an ulcer, whose area will be dropped a little below that of the surrounding tissue. In this case the induration is produced almost entirely by new round-cell infiltration, as in the other varieties; when it ulcerates these cells are the ones mainly to suffer, so that there is not much destruction of the original elements, and but little scar remains.

B. Superficial Erosion.

—The superficial erosion is the most common of the primitive sores, but is not often seen so early as to have its first appearance noted. It begins as a well-defined, dark-red area, which loses its epithelium and exposes a raw surface, with a trifling depression whose edges are usually on a level with the surrounding skin, while in the previous case the edges are generally characterized by an elevated margin. The base of this sore is also indurated, and partakes usually of the parchment-like character already described.

C. Hunterian Chancre.

—The Hunterian chancre, so named after John Hunter’s description of it, is the most distinct and typical of these primary lesions. It begins as a papule, with some erosion, increasing slowly in size, sharply outlined, with a somewhat flat top. As it grows larger it increases in firmness until its base is extremely dense. In color it is greenish or bluish red, and this color appearance is more distinctive than in the other forms. In from one to three weeks its surface epithelium is usually loosened by maceration, and serous discharge is the consequence, or else it becomes covered with a grayish exudate, which, by its location, is rarely allowed to form a scab. The centre of the ulcer becomes deeper, its edges more elevated, and in typical cases a minute crater is formed by a characteristic destructive process. While the Hunterian chancre tends in ordinary cases to slowly disappear of itself, this involution can be materially hastened by local and constitutional treatment, and usually heals, when properly treated, with but slight local evidence of its previous existence.

The Mixed Chancre.

—Chancroid will now be described, and its consideration will include the statement that it may be followed by true syphilitic chancre. Such a lesion is known as mixed chancre or mixed sore, and indicates a simultaneous infection by two distinct infecting agencies; it may easily cause confusion, for if seen early it will lack the characteristic induration of syphilis. This latter will only appear about the time that the chancroidal ulcers should be healed, if promptly and properly treated. Supposing this treatment to consist at least in part of caustics, the surgeon may be in doubt as to whether the induration is due to this agency or to developing syphilis. It seems justifiable to imagine causes of this kind while awaiting the further developments of the case, and to postpone vigorous antisyphilitic remedies until the diagnosis is established. It is a serious thing to condemn to a long course of mercurials a patient who perhaps does not need such drastic drugs. Instances arise where the situation is to be carefully considered in view of these possibilities. Should the healing and apparently healthy ulcer, however, take on an indurated base and develop the typical scleroses of chancre, it may be supposed that all doubt has been removed. The possibility of syphilitic infection being implanted upon a chancroidal base by subsequent exposure should also be taken into consideration. This will require an accurate history and a faithful narration of the same by the patient.