98 TROPICAL MEDICINE AND HYGIENE 



in order to expose the cords and testicles, which are then 

 dissected out. If a hydrocele is present the tunica 

 vaginalis may be excised. The possibility of a hernia 

 must be carefully kept in mind, and this possibility finally 

 excluded by examination of the abdominal rings through 

 the incision. Any vessels are secured and the tourniquet 

 relaxed and removed and the bleeding stopped. 



The penis and testicles, wrapped in warm sterilized 

 towels, must be secured on the anterior wall of the 

 abdomen, and a tourniquet applied tightly round the base 

 of the tumour. When the tumour is removed this would 

 almost certainly slip unless secured. The simplest method 

 is to transfix the healthy skin at the base of the tumour 

 with two long skewers at right angles to each other, and 

 apply the tourniquet above them. The tumour can then 

 be removed, boldly following the lines already mapped 

 out. All vessels that can be seen should be tied, and the 

 tourniquet gradually relaxed, and other bleeding points 

 as they appear secured. The testicles should be covered 

 with any available skin, and the penis should be covered 

 as much as possible. In some cases the skin round the 

 glands, though inverted, is quite healthy and should be 

 retained. 



One assistant at least in addition to the anaesthetist is 

 advisable in this operation. 



Results are very good, but the penis is frequently bound 

 down by cicatricial tissue. The testicles usually appear 

 to be distorted and atrophied, but in some cases are less 

 so in reality than they appear to be, as after the opera- 

 tion connection and procreation are possible. 



Pendulous tumours can be removed in a similar manner. 

 In any tumours of the scrotum, about the groin, and even 

 the vulva, the possibility of hernia as a complication must 

 be remembered. 



Elephantiasis of the limbs in the early stages can be 

 checked by the use of elastic bandages and by massage. 

 In more advanced cases the question of operation may 

 arise. In many persons the limb, though enormously 

 swollen, is quite useful and no operation is necessary. 



