When the pain and high tension fail to yield to cold and belladonna, Leeches may be applied, a large scrotal vein may be opened, or a number of small incisions may be made into the oedematous skin. A more reliable and speedy method of reducing tension is to make a number of punctures in the epididymis or testicle by a sharp Glover's needle or a fine tenotomy knife. If any quantity of fluid has accumulated in the tunica it should be evacuated with a fine trochar and canula when the tension keeps high, but as a rule the swelling will be found to rapidly subside without making any breach in the cutaneous covering.
The rule laid down for the treatment of gonorrhoeal epididymitis is rigidly to suspend all local treatment of the gonorrhoea as long as the testicular inflammation exists, though the writer has often seen good results follow the gentle washing out of the anterior urethra with tepid water injections stained with Condy's fluid, but posterior urethral instilla tion should be suspended.
Vaccine treatment in gonorrhoea is often unsatisfactory and disappoint ing, but it unquestionably is efficacious in the encapsuled lesions as epididymitis and arthritis, and may be resorted to in chronic or bilateral affections of the epididymis. Should pus form, which is rare, the abscess must be promptly evacuated by a free incision and the cavity flushed with normal saline solution.
Hagner in acute gonorrhoeal epididymitis makes a free incision into the tunica vaginalis, opposite to the junction of the testicle and epididymis, followed by multiple punctures in the tunica albuginea; should pus escape from any of the punctures, these are enlarged and the cavity injected with in i,000 Perchloride and the tunica sutured after flushing with the same solution.
After the subsidence of active inflammatory mischief, induration and thickening may be dissipated by the application of the Lin. Pot. Iod. c. Sapone or by inunctions of Ungt. Hyd. Oleat. combined with Iodides internally.
Pressure by means of strapping is a valuable means of effecting the absorption of effused products, and this agent has been employed in the treatment during the acute early stage when there is high tension. Though often relief follows this procedure, it causes at first severe pain and distress. Some surgeons apply pressure by means of a laced suspensory bandage which can be tightened over the swollen gland.
An ordinary suspensory bandage should be worn for several weeks after the patient is enabled to leave his bed.
Gouty orchitis, or epididymitis, yields to rest, warm fomentations or hot poultices, and the administration of full doses of Colchicum \Vine combined with Salicvlate of Soda and the occasional use of cathartic doses of Sulphate of Magnesia as in Scudamore's Mixture.
Chronic Orchitis.—When not of tuberculous origin this is nearly always syphilitic, and will require both constitutional and local treatment. The constitutional remedy is, of course, Salvarsan, Mercury or Iodides or a combination of these.
In weak cachectic subjects who have suffered from syphilis for many years previous to the appearance of the orchitis, and who have been previously brought well under the influence of mercury at least once before, it will be wise to begin with at least one dose of salvarsan or one of its substitutes, or if this be contra-indicated by zo to 3o grs. of the iodide of potassium three times a day. In all other cases, mercury may be given in amount and in the manner indicated by the symptoms and history of the case. Thus in comparatively recent cases the patient should he brought under the influence of the drug without unnecessary delay by inunction or by the administration of moderate doses of any mercurial preparation. It will never be necessary to cause salivation, but the drug should he pushed till the gums are slightly touched, after which the effect may be kept up for long periods, without injury to the patient, till the induration in the testicle melts away.
The iodide may he combined with mercury and prescribed in a mixture, each tablespoonful of which can be made to contain 20 grs. Sodium Iodide, and gr. Perchloride. Donovan's Solution in the maximum dose of zo mins. may be given thrice daily. The orchitis occurring in congenital syphilis is best treated by full doses of Grey Powder.
Local treatment will consist in the use of mercurial applications and pressure applied to the enlarged testicle. Where hydrocele complicates the case—a very common occurrence—time will be saved by first tapping the tunica vaginalis, and, after the evacuation of the fluid, applying lint smeared over with Ungt. Hydrarg. Co. and then applying firm pressure to the swollen gland by strips of stout adhesive plaster.