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.
789/898 page 773
![Diagnosis.—The rapid growth, large size, and more or less globular shape of the tumour; the lancinating pain; the impli- cation of the skin and lumbar glands; the enlargement of the scrotal veins; the protrusion of a bleeding fungus; and later, the constitutional cachexia, will indicate malignancy. In the early stages, however, a puncture or even an exploratory incision may be necessary to distinguish it from chronic orchitis, hoematocele, and syphilitic orchitis. Thus, in malignant disease, arterial blood will generally flow; in hsematocele, a chocolate-coloured fluid containing hrematin crystals and broken-down blood corpuscles will escape; and in chronic orchitis, whether simple, syphilitic, or tuberculous, nothing beyond perhaps a drop or two of blood will be withdrawn by the cannula. At times a piece of the growth may come away in the end of the cannula, and a microscopical examination of this will further aid in the diagnosis. Treatment.—Unless the glands are much affected, the cord is thickened, and great emaciation or cachexia is present, with signs of the disease in the internal organs, excision of the testicle should be per- formed. When this appears undesirable from the above-mentioned reasons, all that can be done is to give opium to relieve pain and tonics to keep up the general health, and to apply some dis- infecting lotion to remove the fcetor attending the fimgating mass. After removal of the testicle an early re- currence of the disease m the lymphatic glands or in the internal organ's is only too probable. Excision of the testicle.—The parts make an incision over the growth from the .'xtenmUbdominal'rmg to the bottom of the scrotum. Free the cord from its connections, and having clamped and divided it, enucleate the testicle with a few touches of the knife, taking care not to cut through the scrotal septum, and so remove the other testicle at the same time, a danger best avoided by giving the sound testicle into the charge of an assistant. Next tie the spermatic artery in the stump of the cord and the cremasteric and deferential arteries, if seen] and having secured the cord by a Spencer Wells' forceps in order to prevent it slipping into the inguinal canal, loosen the clamp, and tie any other vessel that may then bleed before finally releasing it Atrophy of the testicle may be simply the result of old age • or it may be due to-1, inflammation, especially that occuiTin- Fig. 391.—Soft carcinoma of the testicle. (St. Bartholomew's Hospital Museum.) having been shaved,](https://iiif.wellcomecollection.org/image/b21514392_0789.jp2/full/800%2C/0/default.jpg)
