TREATMENT 97 



serious troubles. Careful bandaging, massage, and the 

 use of high-laced boots will do much to prevent the 

 increase in the elephantoid condition. Enlarged glands, 

 if superficial, should be excised. The worms may pos- 

 sibly be removed, and in any case the glands are so 

 changed as to be useless. 



Tumours of the scrotum and vulva, if of large size, 

 lead to much inconvenience, and the removal of the 

 tumours is advisable. The operation consists essentially 

 in the removal of a large mass of skin and subcutaneous 

 tissue. In the operation on the scrotum, the penis, sper- 

 matic cords, and testicles must first be isolated and pro- 

 tected from injury, and then the bulk of the tumours 

 can be removed. 



The risks of the operation are septicaemia and haemor- 

 rhage. It is difficult to get the irregular mass of skin 

 aseptic, but every endeavour should be made to do so. 

 Haemorrhage is variable. There are usually no large 

 vessels, but there may be an enormous number of small 

 ones. These vessels do not contract readily when divided 

 and therefore should be tied. 



In the actual operation it will often be found that the 

 skin at the base of the tumour is healthy, but it is 

 dragged down from the abdomen by the weight of the 

 tumour. It is well to mark the line of the proposed 

 incision as a preliminary. If this is not done the effect 

 of a tourniquet will be to make it difficult to see the 

 exact line. 



In order to diminish the loss of blood it is better to 

 place a tourniquet round the base of the tumour before 

 isolating the testicles and penis. The bleeding during 

 this process is then easily controlled. 



If a catheter can be passed it is well to do so at once, 

 but it is usually necessary to slit up the elephantoid tissue 

 to find the meatus. When this is found the catheter 

 should be passed and the incision extended through the 

 skin, so as to expose the penis up to the symphysis pubis. 

 An oblique incision should then be made on each side 

 7 



