314 The Philippine Journal of Science 1921 
had to be evacuated. True secondary hemorrhage I have never 
seen in these: cases. 
(Edema of the glans penis.—This is very liable to occur if care 
is not taken in bandaging the organ; but, when it does, the band- 
age must be taken off and reapplied. 
Troublesome erections.—These sometimes occur, and they are 
a source of annoyance to the patient. If ice can be obtained— 
an impossibility in Fukien except in the coast ports—then an ice 
bag may be applied to the perineum. One useful plan is to in- 
sist on the patient emptying his bladder before sleeping, also 
whenever he wakes during the night, and to forbid him to sleep 
on his back. My experience of bromide and similar powders is 
distinctly disappointing. 
Irritation of the skin—This sometimes occurs as’ a result of 
the antiseptics used, helped also by the amount of scrubbing that 
the skin has had to undergo in order to make it anything like 
clean. It must be treated by powdering the surface with zinc 
oxide and changing the dressings for others that are less 
irritating. 
Fever.—There are four causes of fever for which one must 
always be on the lookout. The first is malaria. In the southern 
region, where practically every one carries the plasmodium 
about with him, it is wise to give the patient a course of quinine 
before the operation. If this has not been done, then it is not 
at all unlikely that the shock of the operation will bring on an 
attack, in which case Plasmodium malariz will be found in the 
blood. It is generally an atypical form of fever. 
, The second cause of fever is filarial. One of my cases had such 
an attack on the second day after operation. In this case the 
skin of the penis had been left untouched, and the erysipelatoid 
inflammation * of this part was well marked. Almost the whole 
wound healed by first intention, and the attack did not appear 
to have delayed convalescence. The patient’s blood was swarm- 
ing with filarie at the time. Such an attack should be treated 
on general principles. 
The third cause of fever is sepsis and need not be described, 
as it follows the usual course and presents the usual signs. If 
it occurs, a sharp lookout must be kept for an abscess or a sup- 
purating hematoma, and free drainage must be provided. 
''This typical erysipelatoid inflammation, if due to a streptococcal in- 
fection from the outside, should have produced much more serious results 
in this case. 
