TORSION OF THE TESTICLE.—The cord of an undescended testicle may be twisted as the result of congenital malformations. The symptoms depend upon the amount of torsion. There is usually inflamma tion and possible gangrene. This con dition must be distinguished from stran gulated hernia and epididymitis. In torsion the cpididymis is anterior, while in epididymitis it is posterior. In a hernia there is no impulse on coughing and obstructive symptoms are absent. Simple orchitis is to be distinguished by the normal anatomical arrangements of the parts.
Treatment.—When seen early the tor sion is to be reduced by manipulation and lead-water and laudanum applied, with elevation and rest in bed. After adhesions have formed the testicle and cord must be exposed, the twist reduced, and the testicle secured in proper posi tion by a few sutures on one side. Gan grene requires castration.
Injuries of the Testicle.—When nor mally situated, the testicle is not often injured. Contusion from kicks, blows, and bruises upon the saddle are not un common. There is usually an acute sick ening pain, often faintness or syncope, followed by rapid swelling. An ha nato cele or inflammation may ensue, followed by hydrocele and fibroid changes in the organ.
Incised, punctured, and gunshot wounds are occasionally met with, and require the same treatment as similar wounds of other parts of the body. Such
wounds usually do well, and castration is seldom or never called for.
Orchitis. — An inflammation of the testicle is caused by gonorrhoea, mumps, tuberculosis, syphilis, and traumatism.
Symptoms.—The symptoms of the sim ple inflammatory variety are as follow: Dull, sickening pain, radiating toward the hips and back; the testicle rapidly swells, but retains its ovoid form. Oc casionally an acute hydrocele develops, and as a result there is an increase in swelling and pain. Occasionally sup puration takes place.
Diagnosis.—Orchitis must be distin guished from epididymitis, which can be readily done by noting the position of the tenderness, this being posterior when the epididymis is involved.
Treatment. — The patient should be confined to bed, the scrotum elevated, and applications of lead-water and lau danum made. The bowels must be kept open and the pain controlled by mor phine. In the presence of an acute hy drocele, puncture of the tunica vaginalis with a fine tenotome will often instantly relieve the pain. After the acute symp toms have subsided resolution may be hastened by strapping or the application of mercurial and belladonna ointments. Should an abscess form, it should be opened early, and treated on general principles.