ABLATION OF SCIRRHOUS CORDS 309 



the incision of the scrotum tightly to retain it. This pack- 

 ing should be done piece by piece, so that pledgets may be 

 packed into every recess where they will exert direct pres- 

 sure to the bleeding vessels when the incision is sutured. 



AFTER-CARE. — The packing is removed at the end 

 of twenty-four hours and the cavity irrigated thoroughly 

 with lysol, phenol or sublimate solutions twice each day 

 until the ligatures have sloughed off. Exercise, good food, 

 and clean surroundings must be insisted upon. 



SEQUELiE AND ACCIDENTS. — Shock, haemor- 

 rhage, septicaemia, paraphimosis and recurrence of the 

 growth are the untoward results of the operation. 



( Shock and Haemorrhage.— The loss of blood, which is 

 always considerable, the pain of a tedious dissection, and the 

 terrible agony of crushing the peduncle of the growth, com- 

 bine three very likely causes of post-operative collapse, — 

 a sequel of the operation that may always be expected when 

 the growth is large, when the disease is bilateral, and es- 

 pecially when the patient is none too robust at the begin- 

 ning. The symptoms of this unfortunate accident mani- 

 fest themselves immediately after the operation by the in- 

 ability of the patient to rise after'having been released from 

 the restraint. The body is bathed in perspiration, the pu- 

 pils, are dilated, the respiration accelerated and jerky, and 

 in spite of frequent urging the patient, makes no effort to 

 rise, and then after becoming delirious finally dies several 

 hours later from syncope. In milder forms tihe patient 

 rises half exhausted, shows colicky symptoms, and then 

 either sinks into the severe state of the disease or else re- 

 vives and then improves during the succeeding two or three 

 hours. 



The prevention consists of (i) the administration of chlo- 

 roform, (2) the proper control of the bleeding vessels to 

 forestall a serious loss of blood, and (3) the proper prepara- 

 tion of the enfeebled patient. 



The treatment consists of ammoniacal stimulants inter- 

 nally, strychnia hypodermically and the intravenous and 

 subcutaneous injections of normal salt solutions. 



Septicasmia follows unclean methods of operating, es- 

 pecially when the resulting sepsis is predisposed by sys- 

 temic weakness or by the ligation of large vessels.which, by 

 depriving certain areas of tissues of an adequate supply of 

 blood, leave them prey for the microbes deposited in the 

 course of the operation. The prevention consists of ex- 

 ceptionally good antisepsis while operating and of good 

 drainage and irrigation during the first three to six days 



