SYPHILITIC ORCHITIS. — This condi tion usually occurs as a complication of the third stage of syphilis. The testicle is hard, indurated, somewhat irregular, and painless. Both testicles are often involved.
Treatment.—Mixed treatment, binio dide of mercury, grain, with 20 grains of iodide of potassium, should be administered thrice daily. Locally, in unctions of mercurial ointment should be used.
Tumors of the Testicles.—Tumors of the testicles are rather uncommon, but cysts, adenomata, fibromata, chondro mata, myxomata, carcinomata, sarco mata, and dermoids are occasionally met with. Cancer is by far the most com mon tumor affecting the testicle.
— Carcinoma is usually unilateral, making its appearance about middle life as a uniform swelling, which grows rapidly, becoming nodular and irregular, and quickly breaking down and ulcerating, leaving a protruding fungous mass. As the disease progresses, the in guinal lymphatics become involved and also the lumbar. The general health rapidly fails, the face becomes cachectic, and the body emaciated.
In the last stages cancer might be mis taken for tubercle. However, the age, rapid growth, and ulceration would all point to malignant disease.
—Early and complete ex tirpation is alone indicated.
Case of a man, aged 60, whose right testicle had been removed for sarcoma, of which microscopical sections were ob tained. Three weeks later the stump fungated, and a large mass was removed, with as much of the cord as possible. In another three weeks there was infil tration in all the surrounding skin. Morris unhesitatingly pronounced it ma lignant, but suggested arsenic in rapidly increasing doses. In ten days, when the poisonous dose had been reached, the growth had entirely disappeared. That was three years ago, and there has not been any recurrence. Golding - Bird (Med. News, Jan. 9, '97).
In radical operation for malignant tes ticular disease the testicle and its cover ings, half of the scrotum with the sep tum scroti, the cord as high as the in ternal ring, and the inguinal glands and fat should be removed. Stimson (Med.
Rec., Oct. 30, '97).
Hydrocele.—This is a collection of fluid in the tunica vaginalis. It may be acute, as the result of extension of flammation from either the epididymis or testicle; congenital,—the result of anatomical deficiency in the vaginal and funicular processes; or it may be cysted. In many cases, however, the cause is not appreciable, although it is probable that traumatism and strains may favor its development.
In the acute variety of hydrocele, owing to the prominence of the symp toms of the primary condition, the char acteristic symptoms are not pronounced. Pain is agonizing and is due to pressure.
In the encysted form swelling, of slow formation, beginning at base of the scro tum and which is pyriform in shape, smooth, tense, fluctuating, and elastic on pressure, is noticeable; this does not, however, alter the size of the organ, which is dull on percussion, stands away from the body, and cannot be reduced. In the congenital variety the swelling is also of slow formation, dull on percus sion, filling from below; it disappears when the patient assumes the recumbent posture, but returns slowly when he is in the erect posture. Such hydroceles are frequently complicated by hernia.
Diagnosis.—Hydroccle must be dis tinguished from hernia, varicocele, and lunmatocele. This can usually be done by the "light test." The patient should be examined in a dark room; a candle or lamp is held close to the scrotum, by looking through the scrotum toward the light the swelling will appear translucent. This test may fail in thick-walled sacs.
A small incandescent electric lamp used to detect the fluid in obscure hydro celes. When a suspected hydroccle is presented, the mouth of the tube is pressed firmly against the tumor on the side opposite to the operator and the lamp turned on, when the entire tumor, if fluid, will be rendered luminous. The light is very powerful, and in most cases the testicle can be readily mapped out and definitely located. W. K. Otis (Jour. Cut. and Genito.-Urin. Dis., Dec., '93).