FOLLICULITIS AND PERI-URETHRAL PHLEGMON.
These conditions are best treated upon conservative principles in the majority of cases. As soon as either of these complications manifests itself, injections and all stimulating methods should be stopped, and, if possible, the patient should be kept per fectly quiet. Hot applications will usually bring about resolution of the swelling after a time. Some cases are very stubborn, but, as a rule, the little tumors characteristic of folliculitis become absorbed; sometimes, however, they remain as small circumscribed inclumtions, and appear to keep up irritation. Under such circumstances they may be excised. Excision is recommended by some authorities as a routine practice, under the supposition that the tumors inevitably sup purate, and that there is great danger of rupture into the urethra, followed by extravasation of urine, etc. The author thinks, however, that, as a rule, when the inflammation of the urethra subsides to such an extent that the duct of the follicle becomes patent, the little tumor discharges its contents into the canal and the wall of the follicle eventually shrinks clown to its normal size; this discharge of its con tents being usually evidenced by a sudden increase in the urethral dis charge. The follicles may refill and again discharge an indefinite number of times and cause a succession of re-infections of the canal.
Should the swelling be marked or painful, or if fluctuation be evi dent in peri-urethral phlegmon, an incision must be made at once; this has not been necessary, however, in quite a number of cases which the author has seen. Conservatism, it is true, may be carried too far, but it is presumed that the intelligent surgeon will know when to cut, there being perhaps more danger in delay than in early incision.
Conservatism is not so applicable in case of peri-nrethral phlegmon in the perineal portion of the urethra as in cases the involving the pendulous portion of the canal. When the perineum becomes hard and brawny, it is best to make an early incision, the operation being in itself harmless. If in such instances an abscess has formed and opened into the urethra before the patient has came under observa tion, the case should be carefully watched and free incisions made. If at any time a marked increase in the perineal swelling, chills, hectic and general constitutional disturbance should occur, as evi dences of new purulent foci or urinary infiltration, or if the swelling in the perineum is extensive and there is a disposition to pointing of matter at any particular spot, external perineal section is required. In such cases a fistula results that is likely to heal spontaneously, but may require surgical attention later on.