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been found to follow coitus per os, and one case of experimental inoculation of the glans penis from a case of mouth ulceration giving positive results has been reported. At times it is difficult to distinguish between a phagedenic chancroid and an epithelioma. The his- tory, course, artificial inoculations, and microscop- ical examinations must be relied upon for a diag- nosis. Prophyla.vis. — It is surprising to see so little men- tion made of circumcision as a prophylaxis against uncleanliness and disease. This operation is gen- erally advised after the mischief has been done. It is rare to see venereal ulcers on the penis of an in- dividual who has been properly circumcised. The reason for this is self evident. The preputial pocket is filthy under the best of conditions and naturally favors the retention and cultivation of infectious organisms contracted through intercourse. With the removal of the prepuce there is less likelihood of abrasions resulting from mechanical irritation, as the skin like mucous membrane becomes less tender. Such diseases as herpes, simple infected wounds, chancre and chancroid would occur less frequently, and chapters on phimosis, paraphimosis and balanoposthitis could be excluded from geni- tourinary textbooks, if the operation of circumcis- ion, jaroperly performed, is done generally, in child- hood. Other prophylactic measures include the use of a ])rotective luliricant, the use of the condom, and the careful ablutiim with ;nilisr])lic solnticjns after intercourse. Treatment. — Chancroid should be cauterized ' when seen early before much (edema is present. July 20, 1907.1 UHLE AND MACKINNEY: CHANCROID. Tlie object of cauterization is to destroy the organ- ism causing the infectious ulcer and to transform the chancroid into a simple healthy ulcer. Many cauterants have been employed to accomplish this object, among which inay be mentioned the Paque- lin cautery, the galvanocautery, carbolic acid, nitric acid, formaldehydeethyl chloride, etc. Under or- dinary circumstances the Paquelin and galvanocau- teries should not be used, as they e.xcite too much fear on the part of the patient. In our experience for- maldehydeethyl chloride has given too much pain to be recommended. Nitric acid, judiciously em- ployed, gives the best results, but should not be used indiscriminately or carelessly. When using nitric acid the entire area should be thoroughly cleansed with soap and water and washed with a solution of corrosive mercuric chloride 1-2000. The part should be thoroughly dried and the ulcers co- cainized with a 5 to 10 per cent, soli.uon. If co- cainization is not complete, cauterization cannot be accomplished, as the pain consequent upon the ap- plication of nitric acid will prevent the patient re- maining quiet during the process. After thor- oughly drying, the nitric acid should be applied upon a pointed orange wood stick, and not by a blunt instrument such as a glass rod, as the drop is too large and cannot be controlled. Every part of the ulcer should be thoroughly cauterized and care taken that no undermined edges are overlooked. A dusting powder should then be applied, and if the ulcer is on the glans or Generic Mesterolone on the inner surface of the reflected layer a pledget of absorbent cotton should be interposed between the mucous membrane and surfaces. This should be changed as often as the quantity of the secretion demands, the parts being carefully washed with corrosive mercuric chloride and dried before the dusting powder and dressing is reapplied. Chancroid should not be cauterized when the ulcer is located near the meatus, or when phimosis or paraphimosis is likely to follow the use of a cauterant. It is also contraindicated when the ulcer has a healthy granulating surface, or in the presence of painful glandular enlargements. As dusting powders many drugs, such as aceta- nilide. boric acid, bismuth subnitratc, and iodoform, with its various substitutes, have been advocated. In mild cases any of the bland powders will suffice. In obstinate cases, Buy Mesterolone iodoform is the best powder to em- ]jloy, notwithstanding the great objection to its odor, wliich cannot be disguised. When objection is made to the telltale odor of iodoform tlie finger may be ban- daged to divert the attention of suspicious individ- uals. In susceptible cases iodoform causes a der- matitis witii consideralilc inflammation and oedema, and its use must be dispensed with. The various substitutes for iodoform have been highly lauded, l)Ut they are nq better than the ordinary Mesterolone Tablets bland pow- ders, .'silver nitrate sliould never be Mesterolone Online apjilied to a chancroid, as it invariably aggravates tlie condition, and its use is only indicated when the granulations are healthy, but need stimulation.

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