The primary syphilitic sore, called chancre, may be caused by the syphilitic poison to any surface, but they are most frequently found on the genitals: and, in men usually on the glans or in the angle by the fresenum, or between the glans and the foreskin. It is notorious that persons with a long foreskin, whose glans is habitually protected by it, and covered with a delicate membrane, are more likely to suffer than those whose glans is uncovered, and clothed with a denser skin.

Primary syphilitic ulcers present many varieties; these depend, 1st, On the peculiar sore from which infection was received; because every kind of sore has a tendency to reproduce its like. 2ndly, On the state of the constitution of the patient, and the degree of inflammation which is present. 3rdly, On the situation; and, lastly, on the local treatment.

The common chancre is most frequently found in the inner surface of the prepuce or foreskin. In its first stage it is a small itching pimple, which bursting, displays a foul, yellowish or tawny sore, attended with slight redness and swelling, and spreading circularly. It may or may not be covered by a dirty brown scab. In the third stage it throws out indolent fungous granulations;-except it be situated on the glans; (for the substance of the glans has no power of throwing out granulations, although its surface may;) and is usually stationary for a little time after it has ceased to ulcerate, and before it begins to heal. In the fourth stage it slowly heals. The cicatrix or scar is often red and hardened; swelled, if on the foreskin, but depressed, if on the glans, from want of granulations. It is exceedingly liable to ulcerate afresh. If the ulcer be situated near the froenum, it is almost sure to perforate it.

Phagedenic chancres are extremely rapid in their progress, and highly painful; their surface yellow and dotted with red streaks; their shape irregular, their edges ragged or undermined; and the discharge profuse, thin and sanious. The surrounding margin of skin usually looks puffy and swelled, but sometimes it is firm or of a vivid red. Sometimes these ulcers eat deeply into the substance of the penis; sometimes they undermine the skin extensively; but in general they spread widely but not deeply.

Simple or sloughing Phagedena may affect chancres or open buboes for two reasons. First, If the constitution be irritable or broken down by debauchery, night watching, exposure to cold and damp, or by the profuse administration of Mercury, or by confinement in an Hospital. Hence, it is likely to occur to soldiers, sailors, prostitutes and bakers; the last-named class of individuals being obliged to work in the night. The serpiginous variety is extremely apt to affect scrofulous individuals, or old men who have led a ' dissipated life, or men subject to the diseases of hot climates, and persons with skin diseases and constitutional complaints, whose health has been ruined by several courses of Mercury. Secondly, they may probably be produced by some peculiar acrimony of the venereal virus. There is reason for believing that intercourse between foreigners gives rise to a very destructive kind of poison. The venereal secretions of the Portugese women appear to have been horribly deleterious to the British soldiers during the Peninsular war, who gave the name of The Black Lion to the sloughing sores that resulted from connection with them.

Chancres may be affected with simple acute inflammation leading to gangrene, from local irritation, such as horse exercise, and excess in stimulating liquors.

Chancre In The Urethra

Ricord has satisfactorily proved that this is the cause of the secondary syphilitic symptoms, which were formerly attributed to Gonorrhoea. The existence of chancre in the passage may be suspected if, in a case of Gonorrhoea, the discharge is very capricious, sometimes thin, scanty, and bloody, sometimes thick and profuse; and if there is one painful, hardened spot.

Syphilitic ulcers in the female do not usually cause much distress as in the male, but they are very slow in healing, especially if interfered with by the urine. When situated high in the vagina they may cause no symptoms at all, except perhaps a mucous discharge, and can be detected only by the speculum.

Affections That May Be Mistaken For Chancre

First: an inflammation of the surface of the glans and the inside of the foreskin, with profuse purulent discharge, and excoriation of the skin. It generally affects dirty people with a long foreskin, and is caused either by the acrid secretions of the part, or by contact with unhealthy secretions in the female. Sometimes, however, it occurs to cleanly people whose health is disordered. The thick profuse discharge, the peculiar smell, the superficiality of the excoriations, and their appearance immediately after connection, distinguish this complaint from chancre; and a little opening medicine, common soap and water, and any mild astringent lotion, will suffice to cure it. Lime Water is the beet lotion if there is much inflammation, and a grain of Corrosive Sublimate to an ounce and a half of Lime Water if there is not. If the cure is not effected in two or three days, the excoriations should be touched with Lunar Caustic. Sometimes this complaint is attended with very great inflammation and fever, and the foreskin is much swelled and drawn over the glans. Repeated injections of warm water under the foreskin are necessary.

Secondly, minute thrushy-looking points, sometimes in clusters, sometimes surrounding the glans; some of them healing, whilst others break out. They are totally devoid of pain; and although they may last a long time, do not lead to ulcers. They are best treated by Black Wash or mere lime-water, and alteratives and aperients.

The third begins with extreme itching and sense of heat. The patient, examining the part, finds one or two red patches, about the size of a split pea. On each patch are clustered five or six minute vesicles, which being extremely transparent, appear of the same red colour as the patch on which they are situated. In twenty-four or thirty hours the vesicle becomes larger, milky and opaque; and on the third day they are confluent and almost pustular. If the eruption is seated on the inner surface of the foreskin, the vesicles commonly break on the fourth or fifth day, and form a slight ulcer with a white base and rather elevated edges. If this ulcer be irritated by caustic or otherwise, its base may become as hard as that of a chancre. If left to itself, it mostly heals in a fortnight; sooner, if situated on the external skin. The cause of this complaint is either some derangement of the digestive organs, or irritation within the urethra. It is very liable to recur in the same individual. Treatment-A little dry lint, or gold beaters' skin at first, and afterwards a very weak lotion (Goulard Water or Black Wash); with aperient and alterative medicines.