Several unusual types of chancre have been described. French authors describe a variety called the Therpetiform." This seems to be simply a lesion of herpes that becomes infected with syphilis and event ually indurates. In some cases the ra tionale of its formation is exceedingly simple. At the time of exposure to syph ilis the subsequently infected surface comes in contact with some local irritant. The patient being predisposed to herpes, one or more vesicles develop within a short time after exposure. The chan crous induration develops in the herpetic lesion later on, at the end of the period of incubation. Fournier describes a form of chancre that he terms "crus taceous." This, he claims, may be con founded with scabies. which latter dis ease may present pseudo-induration and inguinal adenopathy. This condition yields to sulphur, which chancre does not. Fournier claims, however, that expect ancy is the only recourse in the differ ential diagnosis of crustaceous chancre.
The symptoms of urethral chancre, when too deep to be seen without the urethroscope, consists in a discharge com ing on after the usual period of incuba tion, this discharge being thin, and per haps sanious, but sometimes creamy and thick. There is a painful spot in the
urethra that is especially noticeable dur ing micturition and erection, with pos sibly a lump in the course of the canal, plainly perceptible on palpation with the thumb and finger in some cases. The character of the discharge depends upon the degree and character of the compli cating urethritis. The characteristic symptoms of stricture may be present, produced by the pressure of the chancre upon the urethral lumen. By means of the urethroscope an ulcer may often be detected, and in a short time the gen eral enlargement of the glands and other symptoms clear up the diagnosis. Great caution is necessary in making a diag nosis until these confirmatory symptoms appear. The writer desires to call atten tion to a peculiar form of urethral chan cre that may lead to grave errors in diag nosis. This appears as a slight erosion of a milky color, just within the meatus. Induration is not perceptible and the lesion looks not unlike an intra-urethral herpetic lesion.