316 The Philippine Journal of Science 1921 
patient did well, then rapidly collapsed and died. It was not 
typical peritonitis, and the puncture holes into the bowel had 
been carefully closed with Lembert sutures; but as no post- 
mortem was possible, it was impossible to learn the precise cause 
of death. Probably it would have been better to have excised 
the bowel; but after the experience of these two cases it is clear 
that the complication of hernia may be a serious one, and one 
which should call for great care in prognosis. 
Hydrocele——As has been previously stated, the common thing 
is to find hydrocele, and sometimes it is very large. It does not 
complicate the case in any serious way and is treated by excision 
of the sac in the usual method. The thickness of its wall varies 
greatly, from the almost normal condition to one in which the 
whole sac is much thickened. Occasionally this thickening is 
irregular. 
Besides the ordinary form of hydrocele, there are found what 
are called hydroceles of the cord. When present these are to 
be treated by opening them and cutting away part of the wall. 
They are of little importance. 
Varicocele-—This is not common, but is occasionally met with; 
in such a case the veins should be tied, and a portion should be 
excised in the usual way. 
Cysts.—These are occasionally met with in the body of the 
tumor. They are generally smooth-walled, irregular spaces, 
and may commence in the rupture of some dilated lymphatics 
or may be the remnants of some old lymph abscess cavity. Ina 
case in which I found one, it was directly beneath the scar of an 
old abscess. They are merely curiosities and do not affect 
treatment. 
Complicated cases——Under this heading may be included a 
ease like the following: The patient came to the hospital in a 
miserable condition, with an elephantiasis scroti of some 10 
pounds (4.5 kilograms) in weight, a bad stricture of the 
urethra, a right scrotal hernia, and several urinary fistule. 
The procedure adopted by me was to operate on the hernia by an 
incision placed well up on the abdominal wall, accomplishing a 
radical cure, and tying and severing the cord and pushing down 
the lower end into the scrotum. A week later the patient was 
put into the lithotomy position, and the scrotum was amputated, 
the right testicle being removed with the mass, and the left one 
shelled out. The stricture was now divided by an external ure- 
throtomy, and a metal, full-sized catheter was tied in. All the 
fistulee were followed up to their origin, and the left testicle was 
