312 The Philippine Journal of Science 1021 
ligatures may give trouble. The number of vessels requiring 
ligatures is often very great, from forty to sixty ligatures being 
sometimes needed. 
All bleeding having been arrested and clot sponged away, the 
testicles should be fixed in place by a stitch or two to the 
perineum. If the cord is very long, this too is secured in its 
proper situation by the same method. The flaps are now drawn 
over the testicles from each side and are fastened together by 
stitches of silkworm gut. If they do not come easily together, 
this may be facilitated by freeing the skin flaps at their 
attachment to the thigh, using knife and finger for the purpose. 
A gauze drain should be inserted from the region of the base 
of the penis, bringing the end out at the lower extremity of 
the wound. This drain is removed in from twelve to twenty- 
four hours from the time of operation. 
The penis is now drawn well forward, and the skin of the 
flaps is stitched to its base, the sutures going deeper than the 
cellular tissue and getting hold of the fibrous coat beneath. 
The lining membrane of the prepuce is also turned back and 
is used to cover a portion of the penis. The rest of the wound 
is sewn together with silkworm-gut sutures, and the operation 
is complete. , 
When using a tourniquet, it is well to commence with the 
median incision, then separate out the two testicles through two 
incisions down the front of the scrotum and, lastly, make the 
flaps and join the incisions. 
Dressings . — Sterile gauze soaked in biniodide of mercury 
lotion, 1 to 4,000, is a good dressing. This is wrung out and is 
allowed to fall and arrange itself on either side of the penis, 
which is bandaged separately with gauze of the same kind. 
Oiled silk is extremely difficult to keep in good condition in the 
East. The dressing must be large, pass out on to both thighs, 
and fit well around the root of the penis. 
The bandaging is an important and difficult matter. A band- 
aging block is an advantage. Calico is too stiff a material for 
the bandage ; it should be made of a softer substance. What is 
called a water bandage does admirably. It must be put on in 
the form of a double spica, crossing and recrossing the perineum, 
and must be firmly fastened at the dangerous angles with safety 
pins. Especial care should be taken of the penis and the part 
just in front of the anus, which are the most liable spots for 
septic infection. 
