INFECTIOUS GRANULOMA 163 



These growths are friable and bleed freely upon the 

 slightest manipulation. 



They are most commonly situated in close prox- 

 imity to the urethral opening. The presence of 

 these infective venereal tumors is usually unsus- 

 pected until a sanious, muco-purulent discharge is 

 noticed at the vulva, when an examination reveals 

 their presence. 



In severe cases the whole vagina may become 

 blocked up, rendering coition painful and parturition 

 impossible. After about three months retrograde 

 changes take place in the tumors which break down 

 and disappear but invariably leave the vaginal wall 

 inelastic by reason of cicatricial contraction, so that 

 if numerous parturition is attended with grave dif- 

 ficulties. 



Treatment. — The growths should be removed by 

 dissecting them ofif the vaginal walls, their bases 

 freely curretted and painted with tincture of iodine. 

 Hemorrhage is easily controlled by 'packing the 

 vagina with aseptic gauze. 



Symptoms in the Male. — Hemorrhage after co- 

 ition, refusal, to serve and sometimes difficulty in 

 urination (if the growth involves the urethral open- 

 ing) should lead to an examination for venereal 

 warts. Exposing the penis by drawing back the 

 prepuce of course reveals the condition. 



In the male the infective tumors, in the early 

 stages of the affection, appear as small yellowish- 

 white raised patches about the size of a mustard 

 seed. Later on the growths take on the character- 

 istic cauliflower-like appearance and bleed readily 

 when touched. They may be situated at the ex- 

 treme end of the penis, upon the sides or at its 

 -base. 



Treatment. — Secure the patient in the dorsal po- 



