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.
784/898 page 768
![seminales and prostate, and thence to the bladder, and even to the ureters and kidneys. In some cases the testicle appears to be the starting-point of a general tuberculosis; in others, merely to be involved in common with other organs in the genera] disease. In many instances, however, the disease may remain localized to the testicle, and no other manifestation of tubercle occur in the body. The inflammatory products infiltrating the epididymis and testicle have a great tendency to undergo caseation, forming the non- vascular yellow masses of cheesy-looking material so characteristic of the disease (Fig. 388). Signs.—The disease usually begins very insidiously and with little pain. The epididymis, especially the head, and later the body of the testicle, are found enlarged. The testicle is usually but slightly tender on handling, and the testicular sensation is not lost; a hydrocele may be present, or part of the tunica vaginalis may be obliterated. Subsequently the cord, especially the vas, becomes thickened and the skin adherent; whilst still later, the skin may give way and a fungus composed of the infiltrated tubules protrude, or a discharging sinus be produced. The vesiculse seminales or prostate may now be felt enlarged on examining by the rectum, and bladder or urinary troubles may set in; whilst symp- Fig.388.—Tubercle of the testicle, toms of tubercle in the lung, (St. Bartholomew's Hospital larynx or other organs may super- Museum.) vene and the patient succumb to tuberculous disease. At other times no constitutional signs manifest themselves, and the patient may completely recover. Diagnosis,—From syphilitic orchitis it may generally be distin- guished by the enlargement of the epididymis, the moniliform thickening of the cord, non-absence of testicular sensation, adhesion of the skin, tendency to softening and suppuration, enlargement of the vesiculse seminales, concomitant signs of tubercle elsewhere, non-effect of anti-syphilitic remedies and the discovery of tubercle bacilli, should there be an open wound, by cultivation experiment of the discharge. From malignant disease it may, as a rule, be readily diagnosed, in that the malignant affection is of rapid growth, very painful, and affects the whole organ without destruction of body or epididymis. Treatment.—-In the early stages, before the vas or vesiculse](https://iiif.wellcomecollection.org/image/b21514392_0784.jp2/full/800%2C/0/default.jpg)
