integuments, elephantoid fever, which before may have been frequent, ceases to recur.
Treatment preliminary to operation.— If the tumour is of considerable size, the patient should keep his bed for a day or two before operation, the mass being suspended so as to drain it of fluid and blood. It is thus rendered lax, and the operator is enabled to ascertain by palpation the position of the testes and, if such chance to be present, of hernia a not very unusual complication. The possibility of undescended testes should not be overlooked.
Operation.— Before making provision for the prevention of hæmorrhage the operator should mark out by shallow cuts the line at which he proposes to separate the tumour, care being taken that these guiding incisions run through and include only absolutely sound skin. If the latter precaution be neglected, disease is very liable to recur in the scar or flaps. First, the tumour is turned up and a shallow transverse cut is drawn in sound skin across the perineum in front of the anus. The tumour being allowed to fall down, a similar shallow cut is made across the pubes. The corresponding extremities of these two cuts are then united either by a straight cut or, if there be a little sound skin on the thigh aspects of the tumour, by semilunar incisions.
Assistants then firmly draw down the scrotum as far as possible, and the surgeon, if he deem it desirable, applies elastic webbing over the mass so as to expel the blood it contains. Next, a stout rubber cord is wound, figure-of-eight fashion, round the neck of the tumour, well above the guiding incisions, and over the pelvis, and firmly secured (McLeod) (Fig. 122). Or the rubber cord is wound round the neck of the tumour only, being kept in place by four strips of bandage passing under this cord, one on each side of the scrotum before and behind, and firmly tied over another strip of bandage encircling the waist.
The testes and spermatic cords are first dissected out through long perpendicular incisions made in front, the remains of the gubernacula testes being hooked up with the finger and snipped through with scissors. The
