19, 3 Maxwell: Filariasis in China 2907 
Treatment may be divided into that of the acute attacks and 
that of the general condition. In acute attacks, the best place 
for the patient is in bed, with his scrotum supported at a higher 
level on a pillow. This simple proceeding often gives great 
relief. Strict cleanliness must be observed, and the scrotum 
must be treated by either a dry or a wet method. In the former 
it is dried and powdered with any antiseptic powder. A powder 
composed of zinc oxide, or a mixture of this with boracic acid, 
suits well. If a wet dressing is to be used and sometimes it 
suits a case much better than the dry one, lint kept continually 
wet with cold water or lotio plumbi subacetatis may be used. 
Occasionally a little opium added to the lotion is of advantage. 
Each case, however, must be treated on its merits. 
Where the lymphorrhagia was very severe and mostly confined 
to a single spot, I have several times ligatured the lymphatic 
vessel, using a fine needle and horsehair, leaving the ligature in 
place for a day or two. 
The treatment of the general condition raises large questions ; 
for operation, though comparatively easy, involves the great risk 
of setting up trouble in some other part of the lymphatic area. 
Operation has been followed by the commencement of chyluria 
or elephantiasis of the leg. More than this, the wound is very 
large and takes a long time to heal, even if Thiersch grafting be 
employed. Six weeks to two months is not too long to estimate. 
Supposing that operation has been decided upon, what opera- 
tion should be performed? Manson(32) gives the following 
directions : 
The scrotum should be well dragged down by an assistant whilst the 
testes are pushed up out of the way of injury. A finger-knife is then 
passed through the scrotum and in sound tissues, just clear of the testes, 
and the mass excised by cutting backwards and forwards. No diseased 
tissue and hardly any flap should be left. Sufficient covering for the 
testes can be got by dragging on and if necessary dissecting up the skin on 
the thighs, which readily yields and affords ample covering. It is a very 
common but a very great mistake to remove too little. As a rule, the wound, 
if carefully stitched and dressed antiseptically, heals rapidly. 
I am not in favor of this method, as in many cases it will fail 
to remove the whole disease, and the bleeding may be serious. 
I prefer an operation similar to the one undertaken in the follow- 
ing case: 
A semicircular incision was made from side to side across and 
under the root of the penis and well up into each inguinal region. 
This incision was carried through the skin and underlying fascia, 
all vessels being clamped as cut. Two lateral incisions were then 
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