19, 3 Maxwell: Filariasis in China 309 
The nerves and their positions may be entirely disregarded. 
Nerves, however, should be cut short, and not left hanging in 
the large wound. 
The lymphatics, also, may be disregarded; but, if large and 
gaping, they should be tied. 
So much for the anatomy of the part. Now we must dis- 
cuss a most important question. Is a tourniquet to be used 
or not? 
Use of a tourniquet—Many urge the use of a tourniquet 
in order to save loss of blood, but the oozing in such cases after 
operation is frequently severe and troublesome. On the other 
hand, if a tourniquet is not used, the primary loss of blood may 
be severe. On the whole, I think the best advice is that if 
the surgeon is afraid of the primary hemorrhage he should use 
a tourniquet, but if he is familiar with the anatomy of the 
area and is a fairly rapid operator, he will do better without. 
In the earlier cases I always used the tourniquet, but in later 
cases I did not; and since discontinuing its use I have had none 
of the unpleasant after-bleeding that was experienced in one 
or two of the earlier cases. 
Another disadvantage in the tourniquet as applied by Mc- 
Leod’s(23) or Manson’s method is that there is a constricting 
band around the abdomen, a thing that is objectionable, as it 
probably increases the danger of the anesthetic. If a tourni- 
quet is to be used, it is best applied in the following way: 
Across the neck of the tumor is laid a long, sterile calico 
bandage from the right arm to the left foot. Behind, the same 
thing is done from the left arm to the right foot. The tumor 
and the two. lower ends of bandage are held up and a piece of 
quarter inch drainage tube is carried around the neck and the 
bandages in a circular manner and tied securely. The lower 
end of the bandage in front is then turned upward toward the 
left arm, and the lower end of the bandage behind is turned up 
toward the right arm. The two ends toward the left arm 
and the two ends toward the right arm are held by an assist- 
ant on each side and so maintain the tourniquet in position. 
The tourniquet and bandages are, of course, carefully sterilized. 
This method obviates the necessity of having a tight band 
around the abdomen. 
Incisions-—Hard and fast rules should not be laid down as 
applying to every case. For instance, in one case in which the 
