[Reprinted from The Medical News, December 29,1894,] 
THE OPERATIVE TREATMENT OF INFLAMMA- 
TORY PHIMOSIS AND THE USE OF THE 
SHARP CURET AND STRONG BI- 
CHLOR ID SOLD TION FOR 
CHANCROIDS.1 
By WILLIAM P. mViNN, M.D., 
PROFESSOR OF GENITO-URINARY DISEASES^AND CLINICAL SURGERY IN THE 
UNIVERSITY OF DENVER J GENITO-URI^AftT^SVRUHON TO THE 
ARAPAHOE COUNTY HOSPITAL, ETC. 
The treatment of chancroid located in the coronal 
sulcus and covered by a long prepuce has as a rule 
always been unsatisfactory. When the inflammatory 
reaction creates a practically irreducible phimosis, 
there has been felt the necessity for operative inter- 
ference, mingled with the dread of further chan- 
croidal infection of the whole of the fresh wound- 
surface. In so late a publication as Morrow's 
System of Genito-urinary Diseases and Syphilology, 
Dr. Edward Martin states that in five cases of cir- 
cumcision for inflammatory phimosis due to sub- 
preputial chancroid, in every case a complete 
circular chancroidal infection occurred. My own 
experience was until recently practically ip accord 
with his and that of other writers on the subject. 
Within a short time an opportunity has occurred in 
1 Read before the Denver and Arapahoe Medical Society, 
October 9, 1894. 2 
eight cases to put in practice a method the results of 
which have been eminently satisfactory both to 
myself and to the patients. 
The procedure is as follows: (i) anesthetize the 
patient, preferably with chloroform; (2) thoroughly 
irrigate the sub-preputial space with a strong mer- 
curic-chlorid solution, not weaker than 1 : 1000, 
and scrub the parts thoroughly with bichlorid gauze 
pledgets; (3) perform circumcision rapidly, immedi- 
ately grasping the raw surface left by the retraction 
of the skin, with one hand protected by bichlorid 
or iodoform-gauze; (4) slit the mucous membrane 
of the prepuce dorsally, back to the corona, and 
immediately scrub it thoroughly with a pledget of 
bichlorid gauze, which is at once thrown away; (5) 
with a sharp curet thoroughly scrape the chancroidal 
ulcer, removing all granulations clean down to 
healthy tissue ; (6) wash away the debris with a bi- 
chlorid solution, and then mop up the curetted surface, 
either with Monsell's solution, full strength, or with 
a 1 : 100 solution of bichlorid ; (7) trim the mucous 
membrane and suture it to the skin with silkworm- 
gut sutures placed rather close together; (8) rub 
aristol or iodoform into the line of coaptation and 
then into the curetted surface; (9) dress with a 
thick strip of iodoform-gauze held in place by a 
rubber band. 
In every case the results attained by this method 
have been practically perfect. The circumcision- 
wound has united throughout by first intention, 
with the exception, in two instances, of a trifling 
point of infection, which healed kindly when 
touched with pure carbolic acid. The original chan- 3 
croid in every case was converted at once into a 
healthy, rapidly granulating ulcer, almost entirely 
free from discharge. The first dressing, as a rule, 
has been allowed to remain in position three days, 
although in two instances it remained a week, and 
when removed healing was practically complete. 
In one case only was the dressing changed after 
twenty-four hours, mainly in order to inspect the 
glans penis, the integrity of which I feared might 
be destroyed, as the chancroid had eaten deeply 
into the body of the penis back of the corona. 
Inspection showed the deep ulcer filling up with 
healthy granulations with astonishing rapidity, and 
in a week the patient was practically well. 
This method seems of importance because: 
i. It indicates the uniform and satisfactory results 
to be obtained by the proper application of antiseptic 
measures in the treatment of a condition that has 
always been regarded as refractory and disappoint- 
ing, as well as disgusting. 
2. It indicates curettage as the ideal treatment 
of chancroid. 
To the latter conclusion there is the objection 
that few patients suffering from what they consider 
a trivial disorder will submit to anesthesia in order 
to permit of curettage. The objection is weighty 
as a practical consideration, but does not invalidate 
the correctness of the method as a surgical procedure. 
The uniform* rapidity of recovery stamps it as supe- 
rior to other usual methods of treatment for those 
patients who are willing to submit to it. 
I am impelled to notice the attitude of so eminent 
an authority as Jacobson, who, in his recent work 4 
on Diseases of the Male Organs of Generation, seems 
to have little fear of infection of the wound, but 
does not appear to accomplish primary union nor 
even to expect it in hospital-cases that have no 
infective complications. His treatment of the 
chancroidal sore with nitric acid is certainly radical 
and antiseptic; but while it destroys the specific 
infection, it causes sloughs and necessitates the use 
of warm fomentations and charcoal poultices, to 
which he advises resort, while at the same time it 
absolutely interdicts all hope of primary union. 
The thorough use of the curet followed by momen- 
tary application of strong bichlorid solution is open 
to none of these objections.