Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


It cannot be emphasised too strongly that the induration of the primary
lesion, which has obtained for it the name of "hard chancre," is its
most important characteristic. It is best appreciated when the sore is
grasped from side to side between the finger and thumb. The sensation on
grasping it has been aptly compared to that imparted by a nodule of
cartilage, or by a button felt through a layer of cloth. The evidence
obtained by touch is more valuable than that obtained by inspection, a
fact which is made use of in the recognition of _concealed
chancres_--that is, those which are hidden by a tight prepuce. The
induration is due not only to the dense packing of the connective-tissue
spaces with lymphocytes and plasma cells, but also to the formation of
new connective-tissue elements. It is most marked in chancres situated
in the furrow between the glans and the prepuce.

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