MIXED CHANCRE. — When a chancre becomes inoculated with chancroid, its ulceration deepens and it gradually as sumes the general characters of chan croid; but, unless phagethena occurs, in duration usually still persists. Oftener than is usually supposed, however, the chancroidal process inhibits the develop ment of chancrous induration, or initial sclerosis; as a consequence, syphilis often times follows an apparently typical soft sore. Slight sclerosis is very apt to he melted away, so to speak, by the chan croidal infection, and thus escape atten tion. When chancroid develops prima rily—from typical mixed infection—it generally runs its usual course until the incubation period of syphilis has elapsed, when induration occurs. The secretion of the mixed sore is autoinoculable, and capable of transmitting either disease alone, or both together, to a healthy per son. In some cases chancroid appears and rapidly heals, or the incubation period of syphilis is long, and induration develops in the cicatrix of the chancroid after it has soundly healed.
The test for mixed chancre is auto inoculation. Any indurated sore, the secretion of which is autoinoculable in the true sense of the word, and which is followed by constitutional syphilis, is a mixed chancre. By the term autoinocu
lable is meant a sore the secretion of which, inoculated in a new situation in the diseased individual, will produce typical chancroid.
The methods of contraction of mixed chancre are two, viz.: (1) both poisons may be contracted simultaneously, or (2) either variety of genital lesion may de velop primarily and subsequently become inoculated with the other form of dis ease.
Typical syphilitic chancre—initial scle rosis—may undergo marked transforma tions: e.g., a chancrous induration, par ticularly when situated in a moist local ity, such as a mucous or quasimucous surface, may lose its hardness and at the same time become transformed into a quasimueous patch by becoming covered with a characteristic whitish pellicle. In some instances the sore acquires the form of the mucous patch, yet retains its char acteristic induration. Morrow has de scribed a "diphtheritic" variety of chan cre. It is possible that this may some times be the mucous transformation just described, and not a special variety of lesion, but the author has met with cases corresponding exactly with Morrow's de scription.