298 The Philippine Journal of Science 1921 
made from the extremities of this first incision on the lateral 
aspect of the scrotum from base to apex. The flap thus marked 
out was turned down, laying bare both testicles and their cords. 
These were freed and turned forward, the whole of the remainder 
of the scrotum being then cut away. The testicles were sewn 
in position to the wound in the perineum, and the skin from the 
lateral aspects of the thighs was drawn partially over them. 
Even though this was done, there still remained a wide, gaping 
wound which, in spite of Thiersch grafting, took six weeks to 
heal. The final result was very satisfactory, as the attacks 
of elephantoid fever ceased from that moment and had not re- 
curred two and a half years later. 
Many natives have asked for operation, but when they learned 
the time that they would have to stay in the hospital, they backed 
out, saying that the discomfort was not sufficient to make them 
give all that time to the cure. In the slight cases, it is not worth 
their while ; and in the severe ones, there is no chance of obtain- 
ing flaps, a condition which greatly delays convalescence. 
If it is decided not to operate, then the patient should be in- 
structed to keep the parts scrupulously clean, suspended, and 
protected from undue friction between the thighs. 
chyluria 
Fortunately for the subjects of filarial disease, chyluria is by 
no means common. It may begin in several ways. Sometimes 
it begins without warning and is the first indication to the patient 
that he is in any way out of health; but more often there are 
some premonitory symptoms, either in the form of dragging 
pain in the back or aching in the groins or hypogastric region. 
If the patient is at the same time the subject of one of the other 
forms of filarial disease, the onset may be heralded by the trouble 
pertaining to that form. For example, here is a man, the sub- 
ject of lymph scrotum. In his case the first onset of the 
chyluria was associated with an attack of elephantoid fever and 
scrotal lymphorrhagia — and this is only natural ; whatever raises 
the pressure in the already existing lymphatic varix is liable to 
precipitate the onset of chyluria. 
The pathology of the affection is quite clear. Given a lym- 
phatic varix in the wall of the bladder or in the region of the 
pelvis of the kidney, you have only to raise the pressure so that 
the dilated lymphatic ruptures in one or the other situation, and 
you have chyluria. This chyluria may be intermittent or per- 
manent. In the intermittent cases the chyluria only occurs 
