ORCHITIS AND EPIDIDYMITIS.
In dealing with acute inflammation of the testicle, it is worth while remembering that when the infective organisms are conveyed in the blood-stream the body of the testicle is found to be the seat of inflamma tion as in the orchitis of mumps, typhoid fever and gout, whilst the infec tion, extending from the urethral mucosa usually produces epididymitis as in gonorrhcea. In gonorrhcea the testis proper does not wholly escape, hence the term gonorrhoeal epididymo-orchitis. In chronic tuberculous affections of the testicle, on the other hand, the epididymis is most fre quently the first part affected, though the bacilli reach the gland by the blood-stream. These facts have an important bearing upon treatment. The treatment of acute orchitis and of epididymitis is in the main identical.
Rest in bed in the horizontal position, lying on the hack, is to be prescribed. A small board should be placed across the front of the thighs; upon this the scrotum can be supported as if resting upon a shelf. A board about as thick as the sides of a cigar-box, only longer, with the upper edge bevelled in the middle, where it may be hollowed out, so as to get well under the scrotum, answers the purpose. A piece of broad strapping may he used in the same way, but it soon becomes permeated with moisture, and pillows are open to the same objection.
In mild attacks where the patient must move about, a different method of obtaining rest for the inflamed gland should be sought. Any of the ordinary suspensory bandages may be tried. As a rule they are much inferior for this purpose to one which the patient can extemporise for himself. This he does by tying a handkerchief bandage or girdle round the waist, to which another handkerchief (three-cornered) is attached behind in the middle line, brought down between the thighs and fastened again in front to the waist girdle. In this way not only is sufficient support given to the testicle, but whatever local application is selected it can thus be easily kept in contact with the scrotum, and at a later stage moderate continuous pressure may be kept up. Patients are found to devise various methods by which the suspension can be carried out by attaching the bandages to the braces or shoulders.
As soon as the patient comes under notice a smart Saline purgative should be given. i oz. Rochelle Salt in a bottle of aerated lemonade is an efficient and palatable dose. In very plethoric subjects Sulphate of Magnesia may be given often, in teaspoonful doses, so as to keep up brisk purging for a time.
Where there is much constitutional disturbance a diaphoretic and antiphlogistic mixture like the following may be given It . Tincturce Aconiti lllxxxij.
Liquor. Ammon. Acet. 5ij.
Vini Antimonialis 3vj.
Caniphorce Sv. Misce.
Fiat mistura. Capiat cochlearium ununt magnum secunda quaque hOra.
Aspirin or Salicylate of Sodium in to-gr. doses every 3 hours alone or with 2 grs. Antipyrine is also a valuable method of treatment when the constitutional symptoms are marked.
The diet should consist of milk and kali water or whey, rennet and mucilaginous drinks, solids and animal food being forbidden. One large opiate at night with Bromide of Potassium is a valuable method of giving ease and relieving pain. Local treatment is of importance. Where the patient is seen early, an ice-bag or a cold evaporating lotion continually changed is the best application. A cambric handkerchief, dipped in iced water, with small pieces of ice laid in between its folds, is an efficient method of applying cold, or Leiter's tubes may be employed.
Seldom are poultices or warm fomentations indicated. The most popular and time-honoured local application is the Green Extract of Belladonna rubbed up with three times its weight of Glycerin. The standardised B.P. preparations of belladonna should never be employed owing to the likelihood of absorption occurring from the thin scrotal skin, and the liniment is especially dangerous and is certain to cause poisoning \\lien t livered with oiled silk. i in 8 of I chtliyol and Glycerin is also a very satisfactory application. An ointment of 5 per cent. Guaiacol in Vaseline has most marked analgesic action. The belladonna cream is the best local routine in the treatment of the orchitis of mumps, in the epididymitis due to gonorrhoea, and to the inflammatory condition following catheteri sation and stricture dilatation.