TESTIS AND ORCHITIS.
- The most important indication in the treatment of acute inflamma tion of the testis is to put the patient absolutely at rest. All stimu lation of the urethra by balsams, injections, and irrigations should cease. In some instances, however, the balsams may be given if they are found to be soothing to the inflamed membrane. Hot sitz baths, twice or thrice daily, should be prescribed. An absolute milk or other unstimulating diet should be adhered to. Alkalies in ternally are always in order. The author has found salicylate of sodium to be of especial advantage in some of these cases ; where the pain, fever, and nervous disturbance are marked, phenacetin or the bromides may be combined with the salicylate. It has occurred to the author that underlying many of these cases of acute inflamma tion of the testis a rheumatic or gouty diathesis exists as a predispos ing cause. Under such circumstances the action of the salicylic acid can be very readily explained. Whether this supposition be correct or not, free salicylic acid and its compounds will often be found to be extremely efficacious. Pulsatilla is occasionally beneficial, but its range of application is apparently more limited than its enthusi astic advocates seem to believe. The suggestion originally made by Dr. Piffard to give the drug in almost homoeopathic doses seems to be unsound. After considerable experimenting, the author has con cluded that while the drug is more or less efficacious, it must be given in doses sufficiently large to secure a certain degree of physiological effect. Gelsemium in combination with the bromides has appeared to be of special advantage in allaying irritability of the affected structure. Mercurial and saline cathartics are always in dicated. Opium should be administered, if necessary, to control pain. The local measures of treatment are by far the most important.
Narcotizing the testis by means of tobacco and linseed-meal poultices, originally recommended by the late Dr. William H. Van Buren, constitutes the most efficacious local application that can be made. When the inflammation is very acute and the pain severe, four or five leeches applied to the scrotum will be found to be of incalculable benefit as a preliminary to other local measures of treat ment. The testis should be supported by a pillow or roll of gauze
between the thighs so as to avoid the injurious influence of gravity.
Scarification of the scrotal veins, the bleeding being subsequently encouraged by warm fomentations, is very often beneficial. When the pain is severe, and marked acute hydrocele exists, Vidal's method of subcutaneous puncture of the tunica vaginalis sometimes relieves the symptoms almost magically. It has been the author's experience, moreover, that cases treated in this manner terminate much more rapidly than those in which less radical measures have been insti tuted. In case the testis proper is primarily or markedly involved, the question of subcutaneous incision of the tunica albuginea for the purpose of relieving tension must receive due consideration. Where it is inconvenient to apply poultices, the author has found the appli cation of the following narcotic and sedative ointment to be very efficient : It may be changed two or three times in the course of twenty-four hours. As soon as the tenderness in the testis has sufficiently sub sided, strapping the affected organ may be advisable. Great care is necessary in determining the precise period at which it is safe to begin strapping the organ, as gangrene of the testis has been known to occur from premature or careless strapping. It is advisable not to employ this method of treatment unless the patient is so situated as to be readily accessible to the surgeon.
• The internal use of mercury and the iodides es and the local appli cation of the faradic current are of great value in procuring resolu tion where the inflammation shows a tendency to become chronic. It is the author's opinion that counter-irritation, electricity, and alteratives should be employed in practically every case after the subsidence of the acute symptoms, for the purpose of preventing as far as possible permanent induration and occlusion of the epididymal tul)e.