Surgical lectures and essays / by A. Marmaduke Sheild.

  • Sheild, A. Marmaduke (Arthur Marmaduke)
Date:
[1904?]
Catalogue details

Licence: In copyright

Credit: Surgical lectures and essays / by A. Marmaduke Sheild. Source: Wellcome Collection.

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    adhesions, which displace the organ. Hence incision is safer than the trocar, for the latter may pierce the testis and lead yon to the erroneous conclusion that you have a solid tumour to deal with. Confusion between ordinary vaginal hydrocele and soft sarcoma of the testicle ought, in reality, never to occur. Soft sarcomatous growth of the testicle is, on the whole, rare. Hvdrocele is very common. Soft sarcomatous growth of the testis is non-translucent; it is heavy when lifted up on the hand. It feels solid in some parts, fluctuating in others. The scrotal veins are much enlarged, and the cord above is thickened. Of course an exploratory incision immediately clears the matter up, because instead of opening into a cavity containing fluid you come upon a vascular, brain- like tumour. Nevertheless confusion between these affections is possible. You may reflect that non-trans- lucent hydrocele will have existed for years; soft sar- comatous growth of the testis will probably have existed for months, and will have progressively increased. Explora- tory incision may be the only means b}r which the matter can be certainly cleared up. I warn you not to take into account the appearance of the patient. Large malignant growths of the testis may be found in persons who have the appearance of perfect health. Confusion between these two affections is very disastrous, both for the patient and your own reputation. I have said very little about the diagnosis of ordinary common hydrocele from hernia. Ability to feel the elements of the cord above the swelling; is the main differential symptom on which to rely. But I will mention, as I am dealing with the subject, that the shape of the neck of a hernia is different from that of hydrocele. In hydrocele the swelling is definitely cut off from the abdo- men at the external abdominal ring; in hernia there is a wide neck which passes up into the abdomen distending the inguinal canal, so you can see at a glance the distinc- tion between the two conditions. The treatment of hydrocele is very variable. In a large 15