primary lesion is not so typical or so easily
recognised as in men; it is usually met with on the labia; the
induration is rarely characteristic and does not last so long. The
primary lesion may take the form of condylomata. Indurated oedema, with
brownish-red or livid discoloration of one or both labia, is diagnostic
of syphilis.

The hard chancre is usually solitary, but sometimes there are two or
more; when there are several, they are individually smaller than the
solitary chancre.

It is the exception for a hard chancre to leave a visible scar, hence,
in examining patients with a doubtful history of syphilis, little
reliance can be placed on the presence or absence of a scar on the
genitals. When the primary lesion has taken the form of an open ulcer
with purulent discharge, or has sloughed, there is a permanent scar.

_Infection of the adjacent lymph glands_ is usually found to have taken
place by the time the primary lesion has acquired its characteristic
induration. Several of the glands along Poupart's ligament, on one or on
both sides, become enlarged, rounded, and indurated; they are usually
freely movable, and are rarely sensitive unless there is superadded
septic infection. The term _bullet-bubo_ has been applied to them, and
their presence is of great value in diagnosis. In a certain number of
cases, one of the main _lymph vessels_ on the dorsum of the penis is
transformed into a fibrous cord easily recognisable on palpation, and
when grasped between the fingers appears to be in size and consistence
not unlike the vas deferens.

_Concealed chancre_ is the term applied when one or more chancres are
situated within the sac of a prepuce which cannot be retracted. If the
induration is well marked, the chancre can be palpated through the
prepuce, and is tender on pressure. As under these conditions it is
impossible for the patient to keep the parts clean, septic infection
becomes a prominent feature, the prepuce is oedematous and inflamed, and
there is an abundant discharge of pus from its orifice. It occasionally
happens that the infection assumes a virulent character and causes
sloughing of the prepuce--a condition known as _phagedaena_. The
discharge is then foul and blood-stained, and the prepuce becomes of a
dusky red or purple colour, and may finally slough, exposing the glans.

_Extra-genital or Erratic Chancres_ (Fig. 38).--Erratic chancre is the
term applied by Jonathan Hutchinson to the primary le