VARICOCELE.
In all mild degrees of this condition, palliative measures should have a fair trial before operative procedures are thought of, unless where the subject of it is exposed to severe physical exertion, or where he wishes to cuter into some department of the public service. Indeed, many cases cease to give trouble after a few years even without treatment.
By relinquishing an occupation which entails long standing without exercise, and substituting for it one involving a fair amount of sitting, the diseased condition often disappears. In all cases the scrotum requires the support of a good suspensory bandage; constant bathing and sponging of the skin does good. The regular and persistent use of a cold douche night and morning, or oftener in hot weather, is of great service. can be very easily applied by means of a piece of India-rubber tubing, which can he attached to the cold-water tap in the bath, and in this way a stream of water can he directed on the scrotum. It should be kept running till the part becomes almost numb. The writer has satisfied himself that great benefit may be obtained by kneading the scrotum between the finger and thumb several times a day so as to excite con traction of the muscular elements. This is especially valuable in those cases where the scrotum is very lax and toneless.
Lotions are of little use, as they must be covered in with oiled silk, when they soon act as poultices. The following may he sponged over the scrotum every morning before the patient begins to dress: Hazelini Spiritus Vim' Rah". 5iiss. Aqua Destillata Misce.
Fiat lobo.
Sexual excitement and excesses should be guarded against, and con stipation must be carefully avoided. Electricity may have a trial; a weak continuous current passed through the moistened scrotal integu ment morning and night, combined with massage, greatly assists in improving the tone of the part.
Ergot, Ilamamelis and other drugs supposed to act upon the blood vessels when administered internally are useless,but there is no doubt that any good tonic which improves the general tone will assist the varicocele weakness. Quinine, Iron and Strychnine in combination as in Easton's Syrup may be tried.
Sometimes the mental condition will require attention from the phy sician, as individuals are apt to become hypochondriacal and dread the supervention of sterility or of impotence, becoming also morbid in their dread of having permanently damaged themselves by early abuse.
As a rule the calm and positive assurance that no such results need be feared is quite sufficient to remove any depression. The question of a secondary wasting of the testicle is a more difficult one, as this does sometimes happen and is often made the final reason by the surgeon for performing a radical operation on the dilated veins. In the writer's experience of varicocele, which has not been a limited one, owing to his having to examine candidates fur various services, he has seen wasting of the testicle follow operation in ninny cases where the gland showed no tendency to atrophy before.
When the individual is a candidate fur any of the public Jervit es or when the tumour is large and is causing severe dragging pain, especially if he contemplates emigrating to some region where surgical assistance is not easily procurable, operation should be decided upon.
The open method of operation is now always preferred to the sub cutaneous. The scrotum and surrounding skin must be thoroughly sterilised, and the various steps of the operation carried out under the most rigid asepsis. The incision should be made through the smooth skin in preference to that of the scrotum, and a wound in the line of the cord about i inch long over the external abdominal ring dividing the skin and subcutaneous tissue will expose the dilated vessels after incising the spermatic fascia. The veins, being carefully dissected from the cord and from their surrounding areolar tissue, are to be ligatured with strong catgut at the external abdominal ring and near the epididymis, and the intervening mass of veins excised between the ligatures. The bunch of veins beyond the ligature above and below the part removed are then sutured together. This prevents the slipping of one or other ligature, as sometimes happens when they are simply tied together. The cord is thus shortened, the dilated veins are removed and obliterated, and the drag, largely due to the weight of blood, disappears. The wound is closed in layers by interrupted sutures, no drainage being required. The patient should rest in hed for at least 14 days, and for a couple of months after beginning to move about he must wear a suspensory bandage.
When the scrotum is thin and pendulous, Brault advises the excision of an oval piece of its tissue.