Surgery : its theory and practice / by William Johnson Walsham.
- William Walsham
- Date:
- 1897
Licence: Public Domain Mark
Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
780/898 page 764
![uncommon. Thoy occur as elongated, soft, semi-fluctuant, smooth, or occasionally finely lobulatod swellings. They spring from the subperitoneal fat, and during their descent along tie inguinal (-una] may draw down a process of peritoneum, into which a hernia may descend. They are more often met with on the left side, occur in lean as well as in fat people, and increase slowly and steadily in size. They may be distinguished from an inguinal hernia, with which they are often associated, by being irreducible, by having as a rule no impulse on cough, by their elastic feel and by descending lower when traction is made on the testicle. Treatment— Open incision and dissecting out the growth. Toksion of the spermatic cord, i.e., a twisting of the cord so that the epididymis is felt in front instead of behind the body of the testis, is occasionally met with either in a testis to all external appearance previously normal, or in a testis retained in the inguinal canal. The twisting has been attributed to spasm of the cremaster. If unrelieved the testicle will atrophy or necrose. Symptoms.—The torsion is attended by a tender and painful swell- ing in the groin or scrotum, dull to percussion, irreducible, and without impulse on cough, the symptoms generally coming on suddenly after great strain or exertion. Vomiting is nearly always present, and there may be constipation. Thus when the testis is retained a strangulated hernia is very closely simulated. Treatment.—When seen early the cord may be readily untwisted if the testis is in the scrotum, the symptoms at once disappearing as in Nash's case. If the testis is in the groin or inguinal canal, it should be removed and the canal and ring closed by sutures. Hematocele or common hematocele is an effusion of blood into the cavity of the tunica vaginalis. Blood may also be effused into an encysted hydrocele of the testis, epididymis or cord, into the substance of the testicle itself, or into the tissue of the scrotum; and to such the terms hsematocele of the testis, hsematocele of the cord &c., have been applied. All of these conditions, however, are too rare to admit of any description here. Causes.—An ordinary hematocele may be due to a blow on the testicle, or a strain in lifting heavy weights, or a like injury to a hydrocele ; to puncture of the testicle or a blood-vessel in tapping a hydrocele; or to the giving way of a weakened or varicose vessi I in consequence of the alteration in tension on removal of the hydrocele-fluid by tapping. At times, however, it may occur spontaneously, and is then probably due to some atheromatous or other change in the vessels, or chronic inflammation of the tunica vaginaHs. Pathology.—-The effused blood may be absorbed, or it may clot and be deposited on the walls of the sac, giving the hrematocele on section the appearance of an aneurysm (Fig. 387); or the central](https://iiif.wellcomecollection.org/image/b21514392_0780.jp2/full/800%2C/0/default.jpg)
