ENZYME.—See FERMENTS.
EPIDIDYMIS.—See INTRODUCTORY CHAPTERS, S. V. ORGANS OP GENERATION (p. i66).
EPIDIDYMITIS.—Inflammation of the epididymis ; an affection most frequently arising as a complication of acute GONORRIKEA (which see), although it may complicate also a chronic gonorrhoea. It may occur at any time after the onset of the gonorrhoea (usually after the second week), and is due to an extension of the infection, exercise and sexual excitement being factors in aiding this extension. Epididymitis comes on very acutely, as a rule. There is considerable swelling of the testicle, with intense pain and heat. Not every inflammation of the epididymis, however, must be ascribed to gonorrhoea ; there is also a tuberculous affection of the organ, and the inflammation may sometimes be caused also by a blow or a fall. Finally, an epididymitis due to gonorrhoea may be followed by a tuberculosis of the organ, particularly if a tuberculous predisposition be present.
The significance of gonorrhoeal epididymitis lies in its very protracted course (the mildest cases usually persisting two weeks), and the scars that remain. A permanent functional disturbance may follow ; and if both
epididymal bodies become involved in the course of one or several attacks of gonorrhoea, sterility is not an infrequent result.
Tuberculous epididymitis usually terminates in suppuration with the formation of a fistula. The only possibility of effecting a cure in such cases lies in the removal of the testicle and epididymis, provided the body is otherwise healthy.
To limit the chances for the occurrence of gonorrhoeal epididymitis it is advisable to wear a suspensory bandage, to rest as much as possible, and to avoid instrumentation and too strong injections into the urethra. If in the course of a gonorrhoea there occurs a sudden (mostly one-sided) pain in the testicles, the patient should at once go to bed and apply cooling compresses (cold water is sufficient) until the physician arrives ; but the compresses must be changed often to be efficacious. It is beneficial also to place the affected parts in a raised position, to suspend all local treatment of the urethra, and to keep the bowels open by means of cathartics.