19,3 Maxwell: Filariasis in China 313 
After treatment.—The patient must be placed in bed, and his 
knees should be tied together. There is no need to keep him 
absolutely at rest on his back; he may be allowed to lie in any 
way most comfortable. For the first twelve hours he should 
have nothing but a little very hot water to sip; rice water may 
be given for the next twenty-four hours, and after that whatever 
food he likes, within reason. The English method of after 
operative feeding does not suit the Chinese, and as a rule they 
flatly refuse such things as beef tea. Under the treatment given 
above they do very well. Usually they do not suffer severely 
from shock, but it is not true to say that this can be excluded, 
for occasionally severe shock may manifest itself; this shock 
is to be treated in exactly the same way as in England by 
strychnine, pituitrin, warmth, stimulants, posture, and saline 
infusion if necessary. 
As has been previously said, the drain of gauze is to be re-. 
moved from the lower part of the wound at the end of from 
twelve to twenty-four hours. If the flaps have been sufficient 
to cover everything, and all goes well, the wound need not be 
touched for seven days, when it will be found to be healed. The 
gauze about the penis should be removed by careful soaking, and 
the surface should be grafted, if need be, by Thiersch’s method. 
Great care must be taken to avoid the binding down of the penis 
by cicatricial bands. The bowels should be opened by a laxative 
on the third day. Under favorable circumstances, healing 
should be complete within the month. Complications that may 
attend the convalescence are discussed in the following para- 
graphs. fae 
Retention of urine—This generally occurs at once, if it is 
going to occur at all. It is best treated by the passing of a soft 
rubber catheter, and after the first twelve hours the patient 
may be allowed to stand up to pass water. Occasionally, if the 
wound becomes septic, there may be a little difficulty, but it 
rarely needs instrumental relief. : 
Recurrent hemorrhage.—This is a most troublesome complica- 
tion when it does occur, and it is interesting to note that it hardly 
ever occurs except in patients in whose cases the tourniquet 
has been used. On one occasion I had to get up in the middle 
of the night, open the wound, and tie no fewer than twelve bleed- 
ing points. It is true, however, that this man had been un- 
usually restless. In another case a hematoma that had formed 
over the upper part of the right cord and was becoming septic 
