19, 3 Maxwell: Filariasis in China 307 
narrow-necked, is an easy one on which to operate, whereas 
the broad-necked tumor requires considerable skill. 
In considering the treatment to be advised for a patient suf- 
fering from elephantiasis scroti, it must be remembered that 
in many instances these scrotal tumors never reach a large size 
and, provided they are giving little trouble, are quite as well let 
alone. If they are growing or if they interfere with the per- 
formance of the sexual act, removal should be undertaken. In 
calculating statistics of mortality, the cases of small tumors 
should be placed by themselves, for the mortality from mere 
decortication of the scrotum, in which the portion removed 
weighs only a few ounces (grams) ought with reasonable care 
to be practically nil; whereas the removal of a large scrotal 
tumor, which in many instances cannot be properly disinfected, 
is by no means devoid of risk. 
In the case of the larger tumors, including those with compli- 
cations such as hernia, which sometimes are very serious, the - 
mortality in competent hands should not be above 2 per cent. 
We will now discuss the most suitable form of operation. 
Careful local preparation is essential. This is carried out as fol- 
lows: The parts are shaved, and then soap and water are lib- 
erally applied with the aid of a nailbrush. As dirt is generally 
much in evidence, this should be done several days in succession. 
Any open sores and sinuses have to be dealt with. On large 
tumors these are of common occurrence, the sinuses being the 
remnants of old abscesses and sores, the result of the itching of 
eczema or ringworm which has led to scratching. If eczema or 
ringworm is at all severe, the operation should be delayed until 
this condition is improved. 
On the night before operation a final scrubbing is given, fol- 
lowed by scrubbing with turpentine to remove fatty matter, 
and by careful washing with 1 to 500 biniodide of mercury 
lotion in weak spirit. This again is washed off with biniodide 
of mercury lotion, 1 to 4,000, and a dressing of gauze soaked 
in the same solution is applied, covered with protective, and kept 
in place with a bandage. | 
Another method is to allow the parts to get thoroughly dry 
after the preliminary preparation and then to employ either an 
iodine solution or one of the newer dyes, such as methyl violet 
and brilliant green, for the final disinfection before operation. 
At the operation the greatest care should be taken, by means of 
sterilized towels, to isolate the operation area and the instru- 
ments, and ligatures should be most carefully prepared. 
