If the antiphlogistic treatment, and other means mentioned under hernia humoralis fail in curing the carcinomatous, and the spermatic cord is free from pain, castration should be performed in the fol lowing manner:—An incision is made from the external aperture of the inguinal canal along the cord to the inferior point of the scrotum, through the skin and cellular substance; the cord is then insulated, and grasped by the fingers of an assistant, and divided between the fingers and the testis, the latter of which is to be dissected out, cutting first on the mesial aspect, to preserve the mediastinum scroti. The arteries of the scrotum are next to be instantly secured, and then those of the spermatic cord; the sides of the wound approximated with sutures and adhesive plaster, and a piece of charpie and two silk handkerchiefs, or a T bandage applied. If there is any diseased skin, two semi-elliptical incisions arc to be made on each side of it, that it may be removed along with the testis; and since hemorrhage from the arteries of the scrotum is ex ceedingly liable to follow, an assistant ought to be appointed to observe their situation during the operation.
If hemorrhage ensues and fills the scrotum, the affection is termed hxmatocele, and is to be treat ed by styptics; and if these fail, the wound must be exposed, and the arteries secured, but they are commonly so small as to be scarcely .visible, the wound therefore must be stuffed with dry lint or sponge, and afterwards stitched. The common vas cular or organized sarcoma, or sarcocele also re quires castration, and in this species the cord is commonly thicker, which however is no obstacle to the operation. In the advanced stage of sarcocele, cancer, and fungus hxmatodes, a fungus excrescence sometimes originates from the body of the gland; and a similar growth, in some instances, arises from the tunica albuginea, or even the body of the testis, in consequence of hernia humoralis, or an enlarge ment from a bruise. A small abscess occasionally appears, which bursts, and a fungus is protruded, that is named lipoma. In all of these the excres cence should be removed with the knife, and nitrate of copper or potassa afterwards applied. A chronic enlargement of the testis sometimes occurs in gonor rhtra, stricture, and syphilis, which is to be treated as recommended under hernia humoralis. At other times, this chronic enlargement is not dependent on these affections, but upon scrofula, and acquires, on some occasions, a prodigious magnitude, ulti mately involving the other testis and the scrotum, and cured by no other remedy but castration.
A peculiar irritable condition of the gland not unfrequently presents itself, resembling neuralgia; which is to be treated with rest, warm bath, and the mecurial pill, combined with hyosciamus; and if these fail, by castration. A neuralgic affection of the external spermatic nerve occasionally occurs, which is to be treated as recommended under that disease of the face. Sarcocele is frequently ac
companied with hydrocele, and then termed hydro sarcocele, in which case it will become a matter of consideration, whether the hydrocele ought not first to be cured, and then an attempt made to cure the af fection of the testis, by the means recommended for hernia humoralis. This will chiefly depend on the magnitude of the gland; and hence, in all compli cated cases, a trocar and canula should be plunged into the tumour, to ascertain whether fluid does not chiefly constitute the bulk of it.
Hydrocele is also occasionally complicated with hernia and circolele. In simple hydrocele, the serous fluid is effused between the tunica vaginalis, and tunica albuginea, and gradually as it collects, the testis ascends, and occupies the middle and back part of the tumour, while the fluid rises by the side of the gland and cord, upwards to the inguinal re gion, and hence is liable to be mistaken for hernia, diseased testis, circocele, and anasarca of this part. Hydrocele is distinguished from these affections by its pyramidal figure, elasticity, transparency when examined by a candle, by the deficiency of swollen cutaneous veins, and the history of the case. The fluid is generally serous, of a pale straw colour, but sometimes greenish, at other times dark, turbid and bloody, while occasionally it is of a violet co lour. When the disease has existed long, cartilagi nous bodies are found in it, and the tunica vaginalis becomes thickened. In some instances, adhesions exists either between the middle, the sides, or the bottom of the testis and the tunica vaginalis.
The treatment of hydrocele is palliative and radi cal; the former consists in simply drawing off the fluid with a trocar and canula of steel, as represent ed in Fig. 9 of Plate DXV, which are to be plunged into the tumour, a little below its middle, and where no veins are present, first at right angles until the operator feels he has entered the tunica vaginalis, and them sloped obliquely upwards nearly parallel with the integuments; the operator during this grasping gently the tumour and the testis with his left hand, in order to remove the latter from the trocar, which is then to he withdrawn; and after the removal of the fluid, the canula also. A piece of adhesive plaster, a compress of lint, and a T band age are to be applied. This palliative operation is performed to remove the fluid when the testis is dis eased, in order that all pressure may be removed; and afterwards, an alterative course of mercury with sarsaparilla, a succession of blisters or mus tard cataplasms, or friction with the ointment of iodine, and the insertion of the bungle if necessary. It is also performed to ascertain the condition of the gland.