308 The Philippine Journal of Science 1921 
As to the position of the patient, the lithotomy position main- 
tained by a Clover’s crutch or leg-rests should be used. This is 
by far the most convenient. When operating on a patient the 
subject of hernia, the hernia is best dealt with first by the usual 
incision, with the patient lying on his back. Thereafter the 
patient is put into the lithotomy position for the removal of the 
scrotum. During the general preparation of the patient, the 
bowels should be well cleared out with an effective purgative, 
best given on the second evening before operation, so as to 
ensure the patient’s getting an undisturbed night before the 
event. Any cough should be treated, and the heart and urine 
examined in the routine way. It is difficult to give definite 
advice about operation on opium smokers, such a habit adding 
considerably to the risk of any large operation. Those who 
smoke heavily should be compelled to break it off before oper- 
ation; otherwise the operator will have no end of trouble with 
them afterward. Patients who are the subjects of malarial 
cachexia should. be guarded from unnecessary danger by pre- 
vious suitable treatment. 
I never kept the patient in bed before the operation, believing 
that the gain in the reduction in size of the tumor is little com- 
pared with the depression arising from the concentration of 
the patient’s mind on his complaint and on the operation, which 
he naturally dreads. So he is allowed to do as he likes until 
the night before the operation. 
Anatomy of the parts in question.—It must be borne in mind 
that all the vessels are greatly increased in size, and for this 
reason vessels that are otherwise quite unimportant may become 
serious sources of hemorrhage. 
The important vessels are the following: 
Superficial vessels: Superior external pudic vessels. 
Deep or inferior external pudic vessels. 
Sciatic vessels, muscular branches. - 
Superficial perineal vessels. 
Cremasteric vessels. 
Dorsal vessels of the penis. 
Artery of the frenum. 
Inferior hemorrhoidal vessels, if the skin has to be removed to near 
the region of the anus, 
Deep vessels: Branches of the internal pudic vessel. 
These should be looked for and found in their proper 
situations. The dorsal vein of the penis should not be cut. 
