advocated by Taylor), may be practised in these emergency cases; but the surgeon will always do well to remember that in the best of hands and with every precaution infection in these cases has occurred repeatedly.

The operative treatment of the bubo of chancroid is gradually receding into the class of reservations advocated in the management of the sore itself. Early surgical treatment of these complications, once indiscriminately advocated for all cases, has at last given place to a more judicial waiting for the evolution of the malady to the point where intervention is inevitable.

The abortive treatment of the bubo includes rest in the recumbent position (which is perhaps the best of all measures having this end in view); hot fomentations. with boric acid; cathartics and a restricted diet; the local application of leeches; and applications with a view to a resolvent effect, such as the tincture of iodine, mercurial ointment (1 part to 10 of lanolin), belladonna ointment, and salves containing the salts of iodine, as, for example, the compound iodine ointment. Pressure by a spica bandage and by the application of bags filled with hot shot is also of value. The common treatment by painting with tincture of iodine is by most experts practically abandoned as useless. The internal remedies. employed, such as sulphide of calcium and mercury, are of little, if any, value.

Injection of chancroidal buboes has been practised with hot solutions of boric acid, bichloride and benzoate of mercury, and carbolic acid. Dangerous results have followed some of these injections, and those containing the mercuric benzoate have in cases been found ineffective.

The operative treatment of bubo is by free incision, all antiseptic precautions being strictly observed, with excision of all glands wholly or partially implicated in the morbid process, subsequent curetting of the surface, and careful washing with hot borated solutions. The subsequent dressings are with iodoform gauze. These

operations, when carefully practised, are followed by exceedingly satisfactory results, the bubo being speedily converted into a healthy ulcer.

As the resulting scar is, however, both deep and indelible, and ever afterward points unmistakably to the nature of the original disorder, efforts are constantly being made to rob these procedures of some of their surgical severity. With special care many surgeons in private practice now succeed in penetrating the abscesscavity of the gland with a fine bistoury or a large aspirator needle. The evacuation of the contents by squeezing is followed by injection of a hot borated solution or, as White suggests, of iodoform ointment. Aspiration of the abscess with subsequent injection of hot borated water often suffices, without the production of a serious scar.

DISORDERS NOT INVARIABLY

VENEREAL.

BALANITIS AND BALANO-POSTHITIS.

BALANITIS is an inflammation of the mucous membrane covering the glans penis. It is usually accompanied by more or less inflammation of the prepuce (posthitis).

Etiology.-Balanitis frequently complicates gonorrhoea and chancre, but it may occur independently of these affections, and may be non-venereal in origin. It is caused by mechanical or chemical irritation of the mucous membrane, and it most frequently results from retention beneath a long prepuce of gonorrhoeal or other pus or of irritating vaginal or other secretions. Neglect to cleanse the parts, permitting the normal secretions to decompose and become irritating, may be a sufficient

cause.

Symptoms. In the beginning of the inflammation. the surface of the glans is slightly reddened and is covered with a thin, creamy layer of mucus and pus. The redness rapidly becomes more intense, the discharge thicker and more profuse. As a result of maceration the epithelium is destroyed in patches, leaving irregularly outlined excoriations; these excoriations are usually superficial, but they may become quite deep and simulate the early stage of chancroid. The inner surface of the prepuce usually participates in the process, thus producing a balano-posthitis. The entire body of the prepuce may be inflamed, with slight or extensive oedema and tumefaction. Inflammatory phimosis-or, more rarely, paraphimosis-may result. The inguinal glands may become somewhat enlarged and tender, but

they rarely suppurate. The subjective sensations are usually those of slight itching and pricking, most marked in the sulcus back of the corona; but in severe cases the glans becomes very sensitive, so that walking and other movements of the body are painful unless the penis be carefully supported and protected. Scalding on urination is usual, especially if phimosis be present.

With a long, tight prepuce balanitis may become. chronic; the surface is then red and velvety, showing granular or even warty elevations.

Diagnosis.-If the prepuce can be retracted, the diagnosis can usually be made without difficulty. The excoriations of herpes are preceded by distinct vesicles, and other portions of the glans are not inflamed. When balanitis follows herpes, the history of the disease furnishes the only means of determining its origin. Syphilitic chancre and chancroid are too distinct in their characteristics to be confounded unless they are complicated with balanitis. Careful examination will detect the induration of an initial sclerosis, even in the rare diffuse forms. The ulcers of chancroid are much deeper than the excoriations of balanitis, and the pus is autoinoculable. In severe cases of balanitis it is not wise to exclude the possibility of an underlying chancre or chancroid until a few days' treatment has reduced the redness, swelling, and infiltration of the parts. In gonorrhoea, when the prepuce is long, and especially if the preputial orifice be filled with cotton to catch the discharge, the pus works backward and covers the glans, producing an appearance that may be mistaken for balanitis. Cleansing and inspection of the parts will readily reveal the source of the discharge.

When balanitis is complicated by phimosis, an accurate diagnosis of the underlying conditions is more difficult (see Phimosis).

Treatment. The treatment of balanitis without phimosis is simple. The indications are to keep the parts clean and free from pus, and the inflamed surfaces dry

and separated from each other. The prepuce should be retracted and the parts be cleansed in simple warm water from two to four times a day. From 3 to 4 per cent. of boric acid or I per cent. of carbolic acid may be added to the water, but soap or other irritating substances should not be used. After washing, the parts should be dried gently by patting with antiseptic cotton or with a soft cloth, and covered with a fine dusting-powder. Over the powder is laid a thin film of the cotton or a piece of lint cut to a shape and size that will just cover the glans and leave the meatus free. The prepuce is now pulled forward to cover all, and the dressing is complete. The stearate of zinc or a powder containing I part of boric acid and from 2 to 4 parts of refined talc may be used in most cases. Other good powders are calomel, bismuth, or zinc oxide, each alone, or in combination with one of the others, or reduced with talc. In severe cases, when the surfaces are very sensitive, iodoform is excellent and gives relief. Before applying the powder the surface may be wiped gently with a solution of nitrate of silver (gr. xx to 3j in 3j), and deep excoriations may be touched lightly with the solid stick.

If the powders are not productive of comfort, the cotton or lint may be moistened with a mildly astringent and soothing solution before it is applied over the powder, or the latter may be omitted altogether. Solutions of carbolic acid (1 per cent.), boric acid (2 to 5 per cent.), dilute lead-water, red wine (3j to 3ss in 3), or the following may be used:

As the condition improves, powders will be more serviceable. For some time after recovery the parts must