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In the more virulent forms of chancroid the spread must be checked by cnntery, curette, or nitric acid, np])lied in general narcosis, and the wound treated with strict antisepsis: in some cases, indeed, a continuous corrosive mercuric chloride bath is re- quired to limit the spread of infection. methotrexate cream The opera- tions to be considered in the treatment of chancroid are those arising from necessity. Excision of the chancroid cannot be recommended as a curative measure, as the healthy tissue invariably becomes infected with a greater destruction of tissue than if Nature's method had had its way. If phimosis is present lateral or dorsal splits should methotrexate 17.5 mg be made and antiseptic dressings applied ; if paraphimosis exists it should either be reduced by one of the various mechanical methods or, methotrexate india this failing, the constricting band must be divided. In all cases, especially the virulent forms, attention must be given to the gen- eral health and hygienic surroundings of the pa- tient. Complications. — The complications of chancroid are those resulting from the destructive action of the pharmacology of methotrexate ulcer or those depending upon the spread of the infection to the lymphatics and the lymphatic glands draining the same. Those resulting from its methotrexate pharmacology de- structive action depend upon the part involved and the virulence of the infection. These cannot be con- sidered in detail within the scope of this methotrexate 2.5 mg tablet paper. Suf- fice it to say that they may vary on the one hand, from insignificant loss of portions of the genitalia, to the most severe destructions, such as the loss of the entire glans or the penis itself, deep ulcera- methotrexate usp tions of the scrotum and abdominal wall, and death from toxremia and exhaustion, methotrexate sodium 2.5 mg on the other. The complications resulting from the involvement of the lymphatics can be understood only from a knowledge of the lymphatic supply of methotrexate for ms the penis. According to G. Delamere. P. Poirier and B. Qoneo in their work on Lympliatics: " I. The lymphatics of the penis comprise (i) lymph- atics of the cutaneous covering of the penis; (2) lymphatics of the glans; (3) lymphatics of the penile portion of the urethra; (4) lymphatics of the erectile tissue. " The cutaneous lymphatics are divided into two groups : Lymphatics of the sheath of the penis and lymphatics of the prepuce. The lymphatics of the sheath of the penis are fairly numerous ; in this situa- tion also appear the collecting trunks. These are four or five in number, and the more anterior their origin, the longer they are. They turn around the lateral sur- face of tlie penis and methotrexate b12 then run on its dorsal surface, passing directly backward to the root of the organ, where they make a sharp bend outward to the inguinal glands. The lymphatics of the prepuce arise in a very fine network, which follows in its plicature the skin of the prcpucial fold. In the balanitic portion of the prepuce the network is continuous with the lymphatic network of the glans penis. The small trunks of this network end cither in a dorsal median collecting trunk or in two juxtamcdian. or in multiple collecting trunks. Contrary to the views of Sappey. Brulius regards this latter arrangement as the rule. In any case, whatever their number, these vessels run in the middle of the dorsum of the penis alongside of the superficial vein, and anastamose with each other by branches which are more or less developed in ditTcrent subjects. When several trunks are present they divide into two methotrexate 12.5 mg groups at the root of the penis; when topical methotrexate only one trunk exists, it usuallv methotrexate and ms divides into two branches, which are frequently unequal in size. This trunk may even remain undi- vided and end in the inguinal glands of one side. " In a case of neoplasm of the integument of the pe- nis we nnist regaril all tlie superficial glands as liable to infection, rurther. by the intercrossing or the bifurca- tion of the collecting trunks, there is a strong prob- ahilitv that a lesion which methotrexate canada is quite clearly unilateral will affect the glands of the ojiposite side UHLE AND MACKINNEY: CHANCROID. " 2. The lymphatics of the glans penis arise methotrexate generic name from a network with very fine meshes, wliich has been per- 6 mp methotrexate fectly described by Sappey. This network is partly continuous with the network of the prepuce, and that of the balanitic portion of the urethra. From this net- work a series of small collecting trunks arise. The direction of these latter is remarkable; all run from be- fore backward toward the frenum of the penis, which invariably represents the centre of their convergence ; on the methotrexate 7.5 mg right and left of the frenum they receive two or three trunks coming from the mucous membrane of the urethra. They then bend backwards and arrange them- selves around the corona of the glans, mounting upward as far as its median line, where the two sides anasto- mose. According to Sappey they bend into a single trunk, which ends in the superficial inguinal glands. The researches of Kuttner, I.rubus, Cuneo, and methotrexate rxlist methotrexate injection cost Marcille have not confirmed the description of Sappey. They

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