(h)  After  Suppuration. — When  the  glands  have  begun  to  sup-
purate it  is  no  longer  possible  to  close  the  wound  entirely  by  suture,
on  account  of  the  certainty  of  infection,  and,  instead  of  the  patient
being  able  to  walk  about  in  a  week  with  the  wound  closed  by  primary
union,  he  has  to  wait  from  four  to  six  weeks  for  the  slow  healing  by
granulation  of  the  open  wound.
The  indications  for  treatment  after  suppuration  has  occurred  are
to  evacuate  the  pus,  by  a  free  incision,  and  at  the  same  time  remove
completely  all  portions  of  the  glandular  structure,  by  means  of  careful
dissection  or  the  sharp  curette.  The  wound  is  left  open  and  packed
with  iodoform  gauze,  and  heals  by  granulation.  An  objection  to  ex-
tirpating the  glands  before  they  have  entirely  broken  down  is  tbat,
in  occasional  rare  instances,  a  permanent  oedema — resembling  ele-
phantiasis— of  the  penis,  scrotum,  and  inguinal  region  follows,  in
consequence  of  the  obliteration  of  the  lymphatic  vessels  in  the  process
of  wound-healing.^  For  this  reason  Krulle  advises  the  applications
of  hot  fomentations  till  the  gland  is  entirely  broken  down,  when  the
pus  is  evacuated  through  a  small  incision.     Every  second   day  tbe


'  Out  of  over  a  lumdred  cases  of  bubo  treated  by  dissecting  out  tlie  glands,
the  author  has  only  seen  this  complication  occur  once.
