of silk passing from one to the other. He describes the operation thus: " Eight stout silk threads were led upwards from the foot to a point in the iliac fossa just above Poupart's ligament. These were spaced out round the limb at intervals. Above they united to form a leash. The iliacus muscle was exposed by a short incision like that for ligature of the external iliac artery. Half the threads were passed through a portion of the iliacus muscle, and were knotted in pairs to the other four threads, thus fixing them securely to the tissues of the iliac fossa. The multiple small incisions through which the threads were introduced were closed by horsehair sutures, leaving the silk completely buried in the subcutaneous tissues." He claims a comparative success in one marked case of elephantiasis of the leg. Judging from the narrative of this case (Trans. Soc. of Trop. Med., vol. ii., p. 41) the operation is attended with considerable risk from sepsis. Others who have practised it do not report favourably on the results.
Lanz's operation aims at deep lymphatic drainage. A longitudinal incision is made through the fascia lata down to the femur, the periosteum of which is stripped and the bone trephined in several places; strips of fascia are then inserted into the openings thus made. Surgeons who have followed this method report excellent results; many have omitted trephining the bone and have contented themselves with incising the fascia lata.
Kondoleon's operation consists also of free incision of the fascia lata and removal of large sections of the aponeurosis; the removal of this tissue assists in the anastomosis of lymph channels and veins. This operation has been favourably reported on by Matas.
Elephantiasis of the scrotum (Fig. 120). Weight of tumours.— Elephantiasis of the scrotum, or "scrotal tumour" as it is sometimes called, may attain an enormous size: 10, 15, or 20 lb. are common weights for these tumours, and 40 or 50 lb. is by no means uncommon. The largest recorded weighed 224 lb.
