i6i6 



THE FILARIASES / 



Treatment. — ^The treatment is removal, which is a very easy 

 operation, and very successful, following either Hanson's or 

 Charles's method. Manson says that the mortality need not 

 exceed 5 per cent. 



The most important feature of the whole operation is to have 

 the skin perfectly clean and aseptic, and to carefully choose the 

 parts of the skin which are to be used as flaps. 



An elastic tourniquet in a figure of eight is applied round the 

 pelvis and the neck of the tumour. The skin flaps are now marked 

 out and deepened, the vessels being carefully ligatured as they are 

 exposed. 



The testicles are then dissected by perpendicular cuts, and the 

 penis is set free by dissection, after cutting down the canal already 

 mentioned as formed by the prepuce. This is best done with a pair 

 of scissors. 



The general mass of elephant oid tissue is now cut away, gradually 

 ligaturing the vessels as the cutting process goes on, this preventing 

 any of the vessels being passed over. The tourniquet is now 

 loosened, and any bleeding spot secured. 



If there are hydroceles present, these are opened, and the sac 

 turned inside out, and after any redundancy has been removed, it 

 is stitched around the testicle in the inverted condition. The flaps 

 are now brought together and stitched over the testes, a drain of some 

 description being introduced at the lower portion of the wound if 

 this is considered to be necessary. Skin flaps should, if possible, 

 be made for the penis; failing this, the raw area must be covered 

 with protective, and allowed to granulate. The whole wound must 

 now be antiseptic ally dressed, and usually heals without difficulty. 



Sir Havelock Charles' Operative Method. — After the usual prep- 

 aration an incision is made in the median line from near the pubis 

 to the preputial mouth deepening it to the dorsum of the penis. 

 Enucleation of the organ is performed from the suspensory ligament 

 to its free extremity. There the glans is still separated from the 

 finger by the fining membrane of the prepuce. The head of the penis 

 is pulled up and this cap of mucous membrane is cut through in front 

 of the glans, which is easily palpable through it. The organ is now 

 free, with its head, covered with a sort of cap, which is next slit 

 up, and the parts thoroughly cleaned. Now the mass is pulled to 

 the patient's right, exposing the left side of the neck of the tumour. 

 Cut from above, near external abdominal ring, curving towards the 

 median line in front of the anus. Deepen this incision gradually 

 with finger and scalpel to near the bulb, avoiding hurting it. The 

 trunks of the vessels can be seized with pressure- forceps before 

 section or after cutting. The same procedure is repeated on the 

 right side of the neck of the tumour. The two incisions will meet 

 in front of the anus, all the main vessels will be seized and divided, 

 and the bulb almost cleared on both sides. 



Then the testicles are enucleated, and after wrapping them, as 

 well a$. the cords, in gauze, they are placed on the pubis. The 



