Treatment.—In the acute form rest in bed, elevation of the scrotum, and ap plication of lead-water and laudanum are indicated. When the pain becomes very severe, the sac may be punctured. After the acute symptoms have subsided, a well-fitting suspensory should be worn.
In the encysted variety treatment may be either palliative or radical. The palliative consists in tapping with trocar and cannula, drawing off the fluid, re peating the operation as often as the sac refills. In tapping a hydrocele the swell ing is made tense, and the trocar is plunged in with a firm, quick, boring motion, being careful not to wound the testicle. A spot should always be se lected on the scrotum free from veins, so as to avoid the possibility of haemorrhage into the loose cellular tissue.
The radical treatment may be carrier] out either by injections of irritating fluids or cutting operations. In the in jection method, pure tincture of iodine is thrown into the sac after the withdrawal of the fluid. From a drachm to an ounce may be used, according to the capacity of the sac. This method is especially valuable in thin-walled hydroceles.
Carbolic-acid injections by Levis's method tested in over 30 cases of hydro cele, with known results in 27: cure in 21, relapse in 0, all of which latter were cured by a new injection except 1. In 1 case, of hmmorrhagic diathesis, there were serious symptoms from swelling grain of bichloride of mercury and 1 ounce of water are injected, this solu tion remaining in the sac of the hydro cele. In about forty-eight hours after injection fluid has reaccumulated, but on third day this accumulation begins to be absorbed and patient soon recovers. Miller (Lance:.:., Sept. 4, '97).
Treatment of simple hydrocele by runcture and injection of a solution of corrosive sublimate of strength of 1 to 1000 recommended. In a couple of weeks fluid entirely disappears. A puncture is made and corrosive-sublimate solution is injected twice, and lastly a solution of of the scrotum with blood, calling for the radical incision. Ilelferich (Then Monats., Mar., '89).
[I have also employed carbolic acid uniformly in all cases of uncomplicated hydrocele and in a few that were com plicated, since reading Levis's article, and have yet to note a single failure.
E. L. KEYES, Assoc. Ed., Annual, '50.] In treatment of hydrocele by injection of solution of mercuric chloride, fifteen cases were cured with one injection; in two cases a second injection was neces sary. Field of operation is made aseptic, the sac is tapped, the fluid is drawn off, 15 minims of a solution containing 1 boric acid is injected. Etienne (Gaz. des 115p., Jan. 8, '98).
In the treatment of hydrocele in in fants a lotion of ammonitun nmriate, 10 grains (0.65 gramme) to 1 ounce (30 grammes) of water, should be applied constantly to the scrotum on lint, and under its use the fluid may disappear in a week or two. If, however, it does not disappear, then the distended tunica vaginalis should be tapped with the trocar and cannula and the fluid re moved, the tapping being repeated if it becomes filled up again. This usually brings about a cure of the disease; but, if this should fail after tapping, a few drops of tincture of iodine, carbolic acid. or alcohol may be inject ed. Radical operations, such as dissecting out a por tion of the sac, are rarely required in the treatment of hydrocele in infants or children. II. It. Wharton (Amer. Jour. Med. Sciences, Jan., 1902).
Several cases of radical cure by the in jection of 2 minims (0.13 cubic centi metre) of carbolic acid. The failure of many to secure a radical cure with iodine is due to the fact that too dilute solutions were employed. The so-called 95-per-cent. carbolic acid, as found in the hops, is usually much below this strength, and is much too weak to give efficient results in the injection method in hydrocele. An important procedure in the technique of the operation is to completely empty the sac. For this pur pose a double cannula is employed, the inner one projecting slightly beyond the outer, which may be attached to an ordinary hypodermic syringe when the injection is to be made. The cannula is first introduced and the hydrocele fluid withdrawn, compressing and manipulat ing the sac so as to empty it completely. The hypodermic syringe is then screwed on to the cannula and from 2 to 3 drops of pure acid injected. \\. B. Coley and 1'. A. Satterwhite (New York Med. Jour., March 29, 1902).