When the patient is already well under the influence of mercury, the mercurial dressing may be omitted and plain soap plaster applied direct to the shaven scrotum. This is often the only treatment necessary in dealing with a chronic orchitis which is not syphilitic, such as where considerable induration or enlargement follows the subsidence of an acute attack of orchitis or epididymitis, or follows upon an injury. Where the induration is localised in a portion of the epididymis or body of the testicle, or in those cases where pressure cannot be tolerated, a little mercurial ointment may be rubbed in with the finger.
The mercurial preparation may be diluted with an equal amount of the Unguentum Conii, or io or per cent. of the Green Extract of Belladonna may he combined with it when pain or tenderness exists. The Oleate of Mercury with Conium may be employed with benefit, as in the following: Oleatis Hydrargyri 3iij.
Unguenti Conii 3iv.
Extracti Belladonna Vir. 3j. /If isce.
Fiat Unguentunt.
After a few weeks' treatment the organ generally diminishes in size and in consistency, and the true testicular sensation returns. Rarely will castration be called for, unless in neglected cases where the surgeon may find the testicle hopelessly destroyed by abscesses or softened gummata. During the treatment by mercurials and pressure the patient can generally be permitted to walk about or pursue his usual avocation, all sexual indulgence being prohibited.
Close attention to diet and to every means by which the general health can be improved must not be neglected. and at a later stage Cod-Liver Oil, tonics, Chloride of Gold, or Arsenic and Strychnine in combination with Iron and sea-bathing will be very valuable.
Tuberculous disease of the testicle affects the epididymis. and is usually secondary to kidney and bladder infection. Unless it is proved to be primary by examination of the urine and cystoscopy it should never be treated by castration. When this is done the disease invariably spreads rapidly to the testicle on the opposite side. When there is a prospect of removing a primary focus from a tuberculous epididymis then operation is not only allowable but imperative. Secondary infections should be treated by removal of the primary focus, usually the kidney, and symptomatic treatment for secondary lesions. Where breaking down occurs the pus must be evacuated and the cavity closed, otherwise rest, tuberculin and general antituberculous methods are to be resorted to.
Where a chest lesion also exists there need be no hesitation in removing the entire gland if deeply involved and the lung affection is not in an advanced stage, provided the urine is free of tubercle bacilli.