HRmatocele.—This is a collection of blood in the tunica vaginalis, which may either be due to traumatism, disease, or occur as a sequel to the tapping operation for hydrocele.
The scrotum assumes a globular shape, the largest circumference being below. The tumor does not fluctuate and does not transmit light. Being abnormally heavy, it is unusually low.
TREATMENT.—Rest in bed, elevation of the scrotum. and the application of lead-water and laudanum are first indi cated. After the acute symptoms have subsided, the scrotum should be strapped. When these measures fail, the tunica vaginalis should be opened, all clots turned out, and an iodoform-gauze pack ing introduced.
Epididymitis. — Inflammation of the epididymis may be inflammatory, syph ilitic, and tubercular. It commonly re sults from the extension of gonorrhoeal inflammations from the posterior urethra through the sac, but is sometimes due to syphilis and tuberculosis.
SYMPTOMS.—These are of the inflam matory type: tenderness along the cord, hard swollen vas, and pain in the back. The testicle rapidly swells, and becomes exceedingly tender, the patient walking with a stooping posture and the legs wide apart. On examination the tenderness and swelling will be found confined to the posterior part of the scrotum. An acute hydrocele by contiguity may result. Suppuration is rare, the general tendency being always toward resolution. Traces of the attack often remain for a long time after the inflammation has sub sided, the regular outline of the organ being interrupted by masses of lymph.
The syphilitic variety is usually noted as a complication of the secondary period, and consists of small, gummatous le sions.
The tubercular variety may be primary, but is often secondary to that of the tes ticle or prostate. The disease usually begins in the head of the organ as a series of nodules, of slow growth, which become adherent to the skin, soften, and leave a fistulous opening. This form is usually followed by sterility on the affected side.
TREATMENT.—In the simple inflam matory form rest in bed, elevation of scrotum, and lead-water and laudanum are indicated. When the pain is severe, the acute hydrocele may be punctured.
After the acute symptoms have subsided, the testicle should be strapped and small doses of iodide of potassium should be given internally to favor resolution.
Salicylate of soda used in the treat ment of gonorrhoeal rheumatism success. After a thorough purge with sulphate of magnesia, rest in bed with elevated testicles being enforced, the salicylate is given in four doses of 15 grains each, and repeated each day as long as required. In ordinary cases the swelling and pain rapidly disappear. Picot (Gaz. Heb. de Med. et de Chin, Apr. 16, '99).
In blennorrhagie epididymitis the scro tum should be cleansed with soap, and the following ointment applied with a layer of cotton supported by a suspen sory bandage:— I4 Guaiacol, 45 grains.
Vaselin, 450 grains.
Janowski (lndependance Med., May 3, '99).
A 10-per-cent. solution of guaiacol in vaselin recommended. This is smeared on the scrotum once a day, and covered with wool and a suspensory bandage. Internally, salol. grains (0.5 gramme), or salicylate of soda, 15 grains (1 gramme), are given four times a day. The pain is eased at once, and the resolvent effect is rapid, cure taking only about twelve days. Bocchi (Gaz. degli °sped., March 16, 1902).
The syphilitic form requires the mixed treatment internally, combined with in unctions of mercurial ointment. The tuberculous type is met by the measures indicated in tuberculosis of the testicle. Castration.—The operation for the re moval of the testicle is indicated when tumors, tuberculosis, gummata (occasion ally), or extensive suppuration are ent, or for the relief of enlarged prostate and certain cases of undescended testicle.
OPERATION.—The testicle being made prominent, an incision is made from the base of the scrotum to the external ring. When the skin is involved, two elliptical incisions should be made. The testicle, with its tunics, is now quickly freed and the cord exposed. While traction is be ing made, a double catgut ligature is passed through the cord with an aneu rism-needle, the loop cut, and the needle withdrawn. The cord is then ligated in each half and once around, and divided one-fourth of an inch below the ligature. The stump is cauterized with pure car bolic acid to prevent infection of the wound from the vas. All haemorrhage being controlled, the wound is closed by silk-worm-gut sutures, the operator be ing careful to evert the skin-edges.