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rare instances, when the virus may be carried Ijy the fingers, instruments, etc., or by unnatural practices, other parts Megalis 10 of the body may be infected. Although extragenital chancre is more common than the same variety of chancroid, the latter have been observed on the fingers, face, lips, mammary gland, knee, arm, eyelid, and back, in fact upon almost every exposed portion of the skin and mucous membrane. Dr. Karl Ullman has collected from the literature to 1902, sixty-three cases of extragenital chancroid, of which by far the greatest number occurred upon the fingers and face. We have observed but one extragenital chancroid occurring upon the left in- dex finger, the patient having a chancroid of the frenum. Chancroid of the male genitalia is most frequent- ly found on the mucous membrane of the reflected layer, at the frenum, and in the Megalis Tablet sulcus, as these parts are most often torn or abraded by mechanical ac- tion. The reflected layer, frenum, sulcus, shaft, glans, meatus, root of Megalis Tablets penis, scrotum, thighs, and groin are common seats Megalis India of chancroid, occurring, in our experience, in frequency on these parts in the order named. The scrotum and thighs are usually involved through autoinoculation. The scrotum is usually infected from a chancroid at the preputial margin, while the thighs may be inoculated from lesions situated either on the preputial margin or scrotum. Chancroid of the preputial margin is most common in cases complicated with phimosis. Megalis Price On skin surfaces, such as the shaft and root of the penis and the groin, the chancroid is usually single Megalis 10 Mg ; on the scrotum and thigh the lesions are more often multiple. Multiple ulcers are found frequently on the glans and reflected layer, very often becom- ing confluent. Chancroid of the meatus is usually deep and destructive, and stricture often Megalis 20 follows as a result of the contraction of the scar tissue. Differential Diagnosis. — The most frequent and important difficulty in the diagnosis of chancroid is its distinction from chancre. Typical chancroid is supposedly easy to diagnosticate, but a positive diag- nosis can be reached only bv keeping the patient under observation for a considerable length of time in order to eliminate the possibility of a syphilitic infection. The course and conditions accompany- ing the ulcer are of more importance in arriving at the diagnosis than the clinical appearance of the lesion. The virus of both diseases may be inocu- lated simultcineously upon the same point and a double or mixed infection be produced. Again several ulcers may be present and all heal but one, which gradually Ijecomes larger, granular in ap- pearance, and indurated at the base. The hard and indurated base characteristic of chancre is wanting in chancroid, the period of incubation is shorter in the sim]jle ulcer, it is also more frecjuently multiple, and the edges are generally irregular, punched out and undermined. One or both groins may be the seat of lymph adenitis and the process may go on to suppuration. It is to be remembered that chan- croid occurring at the site of hair follicles and those that have been cauterized, has an inflammatory in- filtration at the base resembling the induration of a chancre, but the induration is not so distinctly lim- ited to the base of the ulcer as it is in chancre. The most important point is that we can never be posi- tive that the Megalis Online most typical chancroidal ulcer will not be followed by the appearance of syijhilitic manifes- tations. It is probable that the diagnosis in the future will be greatly facilitated by microscopical examination of the secretion for the Spirochceta pallida of .Schaudinn and Hoffman. This organism has been found so frequently in the lesions of primary and secondary syphilis that it is conceded by most ob- servers to be the cause of syphilis. It is not present in chancroid. Superficial erosions seen in balanoposthitis, sim- ple ulcers caused by hair cut or mechanical irrita- tion, do not as a rule ulcerate, and heal promptly under appropriate treatment. Herpetic lesions which coalesce resemble chancroid. The history of burning and itching, the formation of vesicles, the small, sharply defined ulcers, and the rapidity of healing after the Buy Megalis application of a dusting powder, will point to the diagnosis of a herpetic ulcer. In scabies other parts of the body are involved, and there is marked itching. Chancroid can be distin- guished from ulcerating gumma by the history of a tumor like swelling before the ulcer, the slow course, and the prompt healing of the latter when mixed treatment is administered. Megalis 20mg We have recently observed a patient with infected ulcers of the glans penis resembling phagedenic chancroid accompanied by a marked balanoposthitis the result of coitus per os. This case is analogous to a form of balanitis called '' balanitis erosiva cir- cinata," or " balanitis gangrenosa," in which the Megalis 20 Mg causal factor is a Gram positive vibrio bacterium, two to three micra in length, with pointed extremi- ties. While this form of balanitis is rare, it has

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