19, 3 Maxwell: Filariasis in China 317 
sewed in position and covered by a flap from the thigh. The 
penis, which was little affected, was let alone. The patient 
made an excellent recovery and left the hospital with one tiny 
fistula in the scrotum and was able to pass his water by ‘the 
proper channel. He had been taught before discharge to use 
a full-sized, metal sound. A year later he had completely 
recovered. 
What is the result of operations for elephantiasis scroti? 
It can be definitely stated that the results are very satisfactory. 
As a rule, the disease, if effectively treated, shows no tendency 
to recur. The first patient I treated has had two children since 
the operation. One of these was premature and only survived 
its birth a few hours, but the second was a healthy, full-term 
child. , 
In another case the patient unfortunately was left with a 
lymphatic fistula at the root of the penis. In this case the 
patient was old (63 years), and the elephantoid disease had 
affected the skin of the abdomen as far as the umbilicus, so that 
part of the operation had to be carried out through diseased 
tissues. Under these conditions it is hardly surprising that a 
fistula should be left. 
These favorable results are corroborated by the experience 
of others. 
ELEPHANTIASIS VULVA 
Elephantiasis vulve is a rare disease. It may attack the 
whole of the external genitals or some one of their various parts. 
In the latter case the labia majora or the labia minora or the 
prepuce may be affected. There are two main types to be 
distinguished. In the one case the disease is sessile, corre- 
sponding to the broad-necked form of elephantiasis seroti. In 
the case illustrated (Plate 22, fig. 2), the disease had lasted for 
some ten years. The patient had acquired it in the coast belt 
and when seen was also suffering from malignant disease of the 
base of the bladder. Sometimes it involves the two labie, and 
as a rule the sessile form, if it needs operation at all, can be 
removed by an incision going clear of the growth on both the 
outer and inner side. It must be borne in mind that a form of 
elephantiasis vulve, having nothing to do with filarial disease, 
is by no means so rare. This is due to venereal infection and 
is generally small in size; its etiology is not obscure. 
The other type is a rarer one, where, a portion of the vulva 
being affected, this local trouble is accentuated by posture, and 
‘the whole forms a pendulous mass from the region of one or the 
