TUBERCULAR ORCLIITIS. — Tubercular orchitis is usually secondary to a like affection of the epididymis; the organ isms, however, may reach the gland through the blood, and a primary focus develop. The disease is often bilateral, and is most commonly met with between the ages of twenty-five and thirty-five.
Symptoms.—The organ becomes hard, knotty, and irregular; there is a feeling of dragging weight and a sense of dis comfort referable to the back. Sooner or later inflamed tissues become adherent to the skin, soften, break down, and rupture spontaneously, leaving fistulous openings, which exhibit little or no tend ency to heal. There is little or no pain in the early stages of the disease. Not infrequently the disease has been pre ceded by tuberculosis of the lungs. Tu bercular testicle must be distinguished from syphilitic orchitis. The syphilitic is uniform, hard, painless, and seldom or never suppurates.
In not a few cases resolution takes place. The disease may become capsu lated and cause no further trouble. In bad cases it may involve the epididymis, vas, prostate, and bladder.
Treatment. — The routine treatment consists in the internal use of iodide of iron and codliver-oil, with good food, fresh air, and sunlight. Locally, the part should be kept at rest, and iodide-of-lead ointment applied. Should the disease progress, injections of chloride of zinc, from 3 to 5 drops of a 1-per-cent. solu tion, may be made around the periphery of the focus every third or fourth day. A 10-per-cent. emulsion of iodoform and glycerin may be used in the same man ner, from 20 to 30 drops being used at each injection. When the disease is
circumscribed, it may be curetted and touched with pure carbolic acid. Such a procedure will destroy the function of the organ. Castration is indicated when other measures have failed.
There is a growing tendency to aban don castration in favor of conservative operations in the treatment of testicular tuberculosis. The chief arguments urged against castration are three in number: First, that the removal of the whole tes ticle is unnecessary, because the disease nearly always commences in the epididy mis, and may therefore be got rid of by clearing out the individual foci of tu bercle, or by excising the epididymis. Second, that the removal of the whole testicle is not curative, because other parts of the urogenital apparatus are also diseased, the idea being that the tuberculous infection has descended from the kidney or prostate. Experience shows, however. that the disease is often primary in the testis and confined to it or, having commenced iu the testicle, it may spread upward along the cord, both of which facts are of great impor tance in relation to treatment by cas tration. Third, that the removal of both testicles should be abandoned, because of its injurious influence on the mind and on the organism as a whole, and also because where both testicles are affected, the urinary organs, prostate, and seminal vesicles are very frequently the seat of tuberculosis. Editorial (Edinburgh Med. Jour., Sept., 1901).