The radical treatment consists in incision, excis ion, caustic, tent, seton, and injection, the last of which is now only employed. A kind of tent, however, made of a piece of elastic gum catheter is employed by Baron Larrey; the seton by Sir A. Cooper in children; and excision in a modified way by Mr. K. Wood. Injection is merely re-dis tending the vaginal sac, after the evacuation of the serous fluid, with cold water, port wine, a solution of the muriate of mercury in lime water, spirit of wine, a solution of the sulphate of zinc in water, in order to excite such a degree of inflammation, as to cause adhesion between the tunica vaginalis and albuginea, which is accomplished with the greatest safety and equal certainty by the cold water; for if injected at the temperature of of Fahren heit, it will produce, instead of the adhesive inflam mation, mortification; and if diffused in the contig uous cellular tissue at a more moderate tempera ture, it will prove less stimulating than any of the other fluids. In this operation, therefore, whenever the serous fluid has been evacuated, the canula is to be allowed to remain, and into it is to be inserted the pipe of a common brass stopcock having affix ed to it an ox's bladder, filled with cold spring water, see Fig. 23 of Plate 1)XV. The cold water ought to excite pain in the testis, spermatic cord, and loins, which it commonly does in ten or fifteen minutes; but if not, a fresh quantity should be in jected, or some at a lower degree of temperature. If the water by accident is diffused in the cellular tissue of the scrotum, it should be evacuated by punctures with the lancet.
If hemorrhage takes place in the tunica vaginalis producing hxmatocele, this tunic is to be laid open, according to circumstances, the blood removed, and its further effusion checked by the application of cold water, or some other styptic, or lint. After this operation, the patient is to be treated antiphlo gistically, or allowed to walk about, according to the inflammation induced; and when this action sub sides, the scrotum should be annointed or fumiga ted. If this operation fails, it ought to be repeated in the course of two or three months. Encysted dropsy of the spermatic cord occasionally occurs, particularly in children, and is to be treated like hyd rocele.
Circocele, or varicocele of the spermatic cord, is a varicose enlargement of the veins of the cord, oc casionally extending to those of the testis and scro tum, and sometimes present on both sides, which either presses on the gland, and removes it by ab sorption, or produces ulceration. It has a knotted or vermiform appearance, and is easily distin guished from the preceding diseases. The mode of treatment is confining the patient as much as possible to the horizontal position, suspension of the parts with a suspensory truss, the application of cold water, or oak bark decoction twice or thrice a day, and keeping the bowels gently open.
Chimney sweeper's cancer, or soot-wart, is a pe culiar cancerous ulceration of the scrotum, which spreads to the clefts between the latter and the thighs, and ultimately involves the testis, the lym phatic glands in the groins, the spermatic cords, and the viscera of the abdomen, and proves fatal.
The ulceration is divided into rugx, is of a red co lour, and the discharge extremely nauseous and fetid, even the perspiration of the whole body has a rank ammoniacal smell. This ulceration generally oc curs between twenty and forty years of age, although it has appeared so early in life as eight, and attacks chimney sweepers, shoemakers, and smelters of ores which contain arsenic, and all classes of work men who are uncleanly in their persons. The treat ment is the same as that recommended for ito/i me tangere, an cl the other herpetic ulcers; and if this fails, by the knife.
Some of the diseases of' the female organs have been already described in the present article, and others under :MEDICINE and Minwirzirv. One or both of the external labia are sometimes so injured in parturition by a blow, that ecchyinosis takes place to such an extent as to produce retention of urine by closing the meatus urinarius. This is to be treated by leeches, warm fomentations or poultices, and draw ing off the urine by the catheter. Sometimes they suppurate and even mortify, the treatment of which is described under acute abscess and mortification. Laceration of the labium or perineum is sometimes to such an extent, and produces so much hemor rhage as to require compression with lint, or dry sponge and a bandage. The labia, particularly in children, are often attacked with inflammation that runs on to phagedena gangrenosa; and in milder attacks, or even in excoriation, they sometimes ad here, and shut up the passage, which requires to be opened with the scalpel, that the urine may be voided.
Children from one year old to puberty are fre quently the subject of a purulent discharge from the pudendum, that originates chiefly beneath the prx putium clitoridis, the nymphx, the orifice of the vagina, and the meatus urinarius, all of which are inflamed: and this disease has been mistaken for the injury done to these parts in a rape, and men, says Sir A. Cooper, have been executed on the evi dence of an ignorant surgeon. The treatment is the same as that recommended for acute inflamma tion of a mucous membrane.
Imperforated congenital vagina is far from being uncommon, and there is generally a mark or raphe indicative of its situation; sometimes it is deficient, at others the whole of the middle portion of the canal is filled up with solid matter; and in other instances again a firm septum is stretched across behind or deeper than the hymen. An incision should be made from above downwards, carefully guarding against wounding the meatus urinarius, and preserving enough to correspond with the peri neum; and preventing a reunion by oiled lint. In some instances there is a small aperture superiorly into which a probe or bistoury can be inserted, and the part divided.