usual place, and after the fluid has been thoroughly evacuated, the
instrument is again conveyed along the canula to the upper and fore
part of the scrotum, for the purpose of effecting a counter-opening,
which should be from an inch and a half to two inches from the first.
The trocar is now withdrawn, when an eyed-probe, armed with a skein of
silk or piece of tape, is passed along the tube, upon removing which
the operation is completed. The seton need seldom be retained longer
than four or five days; during which period, as well as for some time
subsequently, the recumbent posture should be enjoined, along with
suspension of the scrotum, and the usual antiphlogistic means. When
the inflammation, tenderness, and swelling have considerably abated,
the reduction of the tumour may be promoted by the daily inunction of
equal parts of iodine and camphorated mercurial ointment.—ED.
[56] In upwards of one hundred cases examined by Mons. Breschet of
Paris, only one occurred on the right side. With this result, the
experience of nearly every practitioner must coincide. Cirsocele may
take place at any period of life, in the young as well as in the
old; but it is most common, by far, within the first ten years after
puberty, or during the period of the greatest excitement of the genital
system. In twenty-seven cases observed by Mons. Landouzy, in which
this subject was particularly noticed, seven occurred between the ages
of nine and fifteen; seventeen between fifteen and twenty-five; three
between twenty-five and thirty-five.
Cirsocele appears to be occasionally hereditary. Professor Blandin of
Paris, in an able article on this disease, in the “_Dict. de Medicine
et Chirurgie Pratiques_,” refers to three brothers with whom he was
personally acquainted, who were all exempted from military duty on
account of the existence of this malady: the father was similarly
affected. An analogous case is mentioned in an inaugural dissertation
published a few years ago at Paris.
The causes of cirsocele are, venereal excesses, masturbation,
protracted exercise on foot or horseback, contusions of the scrotum,
inflammation of the testicle, and mechanical obstacles to the return
of the blood to the spermatic veins, whether produced by the presence
of a tumour, fatty accumulations of the omentum or mesentery, or the
wearing of tight and ill-constructed trusses. Of these the first two
are probably the most frequent and influential. Indeed, I am persuaded,
from considerable experience, that this is the case. How these causes
act in developing this affection admits of ready explanation. Their
tendency is not only to determine an abundant afflux of blood to, and
consequent congestion in, the genital organs, but to produce more
or less fatigue in the muscles of those parts, especially in the
cremaster and dartos, together with a loss of nervous innervation,
which diminish their power and contractile energy. The testicle being
thus insufficiently sustained sinks down, by its own weight, into the
scrotum, which, with the spermatic vessels, is thereby kept in a state
of constant relaxation. Heat acts in a similar manner, and produces
similar results. Hence cirsocele is more frequent in hot than in
temperate climates, and worse in summer than in winter.—ED.
[57] [Although the symptoms of this affection are usually well marked,
yet it is sometimes liable to be confounded with other lesions. The
malady for which it is most apt to be mistaken is inguinal hernia,
especially that variety of it in which the omentum is concerned. The
best way in such cases is to place the patient on his back, and hold up
the scrotum until the vessels are entirely emptied of their contents;
the finger is then applied against the external ring and the patient
requested to rise, when, if the disease be cirsocele, the spermatic
veins will immediately refill, while, if it be hernia, the bowel will
be unable to descend.
The progress of this disease is usually tardy, years elapsing before it
causes much suffering or inconvenience. In some instances, however, it
increases with great rapidity, and gives rise to severe local disorder,
with more or less constitutional derangement. One of the most serious
and unpleasant effects of this disease is atrophy of the testicle and
epididymis, produced by the pressure of the enlarged veins; it may
exist in various degrees, from the slightest softness and diminution of
volume to almost entire wasting of the organ, and occasionally, though
rarely, affects both sides simultaneously. A gloomy and melancholy
state of mind, sometimes bordering upon alienation, frequently attends
this condition of the testicle.—ED.]
[58] [The least objectionable operation, in my opinion, is that of
tying the affected veins, after having carefully separated them from
the spermatic artery, vas deferens, and nerves of the testicle. The
vessels may be ligatured at one or more points, according to the extent
of the enlargement; and, by carefully excluding the structures just
mentioned, there will be no danger of cutting off the nervous and
vascular supply, as must necessarily happen, in some degree, in the
proceeding recommended by Mr. Liston, and which must therefore lead to
further wasting of the testicle; a circumstance which should be most
sedulously avoided. The external incision need not exceed an inch and a
half in length.
I am induced to subjoin the following account of a novel but harsh
operation for the cure of cirsocele, lately devised by Mons. Breschet
of Paris, not from any belief or hope that it will be generally
adopted, but because it has made some noise in the surgical world.
It is founded upon the anatomical arrangement of the part, or the
facility with which the varicose vessels can be isolated from the
spermatic artery and vas deferens, and afterwards compressed so as
to obliterate their calibre. This is effected by means of a forceps
with flattened plates, which are worked by a screw. The pressure is
applied in a gradual manner, but with sufficient force to destroy the
vitality of the scrotum and of the affected vessels. The instrument is
usually removed in from six to eight days, during which the patient
is left on his back, cold lotions are applied to the scrotum, and the
case treated on general principles. When the sloughs are detached, the
edges of the sore are approximated by adhesive strips, and the person
is permitted to walk about. In this way Mons. Breschet is said to have
operated successfully in more than a hundred cases; the average period
required for a complete cure being twenty-three days. I have never
performed this operation, the severity of which is such as to induce
the belief that very few persons in this _republican_ country would
submit to it. An American surgeon, Dr. F. Hamilton, of New-York, has
recently recommended castration for the relief of this affection, and
has published several cases in which he performed the operation in
illustration of its efficacy. This is certainly a _radical_ mode of
doing business, but in my opinion a very objectionable one.—ED.]
[59] [Of 5376 calculous cases mentioned by Civiale,[60] 2416 were
children, 2167 adults, and 793 old persons. Of these 1946 occurred
before the age of ten, 943 from ten to twenty, 460 from twenty to
thirty, 330 from thirty to forty, 391 from forty to fifty, 513 from
fifty to sixty, 577 from sixty to seventy, 199 from seventy to eighty,
and 17 after eighty.
Children are more subject to this affection in certain districts than
in others; and the same is true in regard to adults. The greater
proportion of calculous cases in Wirtemberg, in the mountains of
Switzerland, the Neapolitan States, and some of the provinces of
England, occur in young persons, from causes which have not hitherto
been explained. In the United States a larger number of children are
afflicted with this disorder in Kentucky, Tennessee, and Alabama, than
perhaps in any other sections. In very warm or cold latitudes, on the
contrary, adults, and, above all, old people appear to be most liable
to it.
Whether this affection is actually hereditary or not is not yet fully
decided. Facts certainly warrant the inference that it is. Thus,
Civiale relates the case of a man on whom he practised lithotrity,
whose mother had had the stone, and one of whose children died of it.
He also performed the operation on two brothers, whose grandfather and
two uncles had laboured under the disorder. Prout speaks of a family of
which the grandfather and father were affected with uric acid calculi,
and who had a son, aged thirteen years, that was very much predisposed
to the same disease.—ED.]
[60] Treatise on Calculous Affections: MS. translation by Dr. Colescott.
[61] [In comminuted fractures of the lower jaw, it sometimes happens,
in spite of our best-directed efforts, that the ends of the fragments
cannot be maintained in contact. Under these circumstances it may
become necessary to tie the pieces together by means of a gold or
silver wire, or to make the patient wear a thin metallic plate, adapted
to the shape of the jaw, and interposed between the cheeks and dental
arches; to the latter of which it should be immoveably fixed.—ED.]
[62] [The bones, owing to falls, blows, or other external violence,
are occasionally _bent_, with or without partial fracture. Within the
last few years a considerable number of cases of this accident have
been reported by American and European practitioners. The first regular
account of it was published in 1810, by Professor Jurine of Geneva; and
in 1821 a very able article on the subject appeared in the American
Medical Recorder, from the pen of that distinguished surgeon, Dr. John
Rhea Barton, of Philadelphia.
Simple bending is most common in the radius and ulna, though it is
by no means confined to them. For obvious reasons it happens only in
children, before the completion of the ossific process, or in whom
there still exists a predominance of animal matter. In older persons
the bones more readily break than bend. The diagnostic signs of the
accident are, pain and deformity at the seat of the injury, loss of
power in the limb, want of displacement of fragments, and absence of
crepitation. The deformity consists in an unnatural curvature, which
can be made to disappear under pressure and extension, but recurs,
to a certain extent, when the limb is liberated. When attended with
partial fracture, the symptoms are the same, excepting that, instead
of a curvature, there is angular deformity opposite the seat of the
accident. When the injury occurs in the forearm, and only one bone is
implicated, extension generally produces no change in the appearance
of the limb. The treatment, in both cases, is to be conducted upon
the same principles as that of fractures. The attempts to remove
the curvature by extension should neither be too violent nor long
continued, otherwise they must prove injurious. Mr. Mantel of England,
distinguished alike as an able surgeon and an accomplished geologist,
thinks that the application of leeches and the usual antiphlogistic
means should alone be trusted to when there is much pain and swelling,
alleging that the action of the muscles will ultimately restore the
limb to its natural form.—ED.]
[63] [A comparison of the results of the different kinds of treatment
of disunited fracture, furnished by Dr. Norris of Philadelphia, in
an able and elaborate article in the American Journal of the Medical
Sciences, for January, 1842, leaves no doubt as to their relative
value. Of forty-six cases in which the _seton_ was employed, thirty-six
were cured, three partially relieved, five not benefited, and two
died. In twenty-one the seton was introduced with, and in twenty-four
without, previous incision: of the former seventeen were cured, two
improved, one failed, and one died; of the latter eighteen were cured,
one was benefited, five failed, and one died. In reference to the seat
of the fracture, the cases stand as follows:—
13 for the femur, of which 9 were cured.
10 ” leg, ” 10 ”
16 ” humerus, ” 10 ”
6 ” forearm, ” 6 ”
1 ” jaw, ” 1 ”
The average period of the existence of the fracture in the above
cases was nearly twelve months and a half, the longest ten years, the
shortest six weeks. The mean period of the retention of the seton
was seven weeks and three days. In one instance—that of a fractured
humerus—it was left in thirteen months, notwithstanding which it
finally failed. The average time required for the cure was nearly
three months, the longest eight months, the shortest three weeks.
Arterial hemorrhage occurred in two of the cases; in ten, severe fever,
erysipelas, or profuse suppuration.
Of thirty-eight cases in which _resection_ was performed, twenty-four
were cured, one improved, seven failed, and six died. The seat of the
injury was as follows:—
12 were in the femur, of which 7 were cured.
6 ” leg, ” 5 ”
12 ” humerus, ” 6 ”
7 ” forearm, ” 5 ” and 1 improved.
1 ” jaw, ” 1 ”
The longest period of the existence of the fracture in these cases
was five years, the shortest ten weeks, the average thirteen months
and nineteen days. The average time required for effecting a cure was
four months, the shortest one month, the longest thirteen months.
In seventeen of the cases other methods of treatment had been
ineffectually tried: in six the resection was followed by erysipelas,
in one by phlegmasia dolens, and in two by profuse suppuration and
abscesses.
Of thirty-six cases healed by _pressure and rest_, twenty-nine were
cured, one improved, and six failed. The seat of fracture was:—
In 13 cases in the femur, of which 9 were cured.
” 7 ” leg, ” 7 ”
” 12 ” humerus, ” 9 ”
” 4 ” forearm, ” 4 ”
The average duration of the fracture in the above cases was five months
and twelve days, the longest twenty-two months, the shortest four
weeks. The mean period required for a cure was nine weeks, the longest
nine months, the shortest eighteen days. In one of the cases the
treatment was productive of excoriations, in three of severe pain and
inflammation.
_Cauterization_ of the ends of the fragments, after free exposure of
them by the knife, was successfully employed in six cases; in two
others it completely failed. The article most frequently used was the
caustic potash. Frictions succeeded in eleven cases.
From a careful analysis of all the circumstances connected with
the preceding cases, one hundred and thirty-nine in number, and of
which the above is an abstract, Dr. Norris has deduced the following
conclusions:—1. That non-union after fracture is most common in the
thigh and arm. 2. That the mortality after operations for its cure
follows the same laws as after amputations and other great operations
on the extremities, the danger being in proportion to the size of the
limb and the proximity of the injury to the trunk. 3. That failures
after operations are more frequent in the humerus than in other bones,
and in middle-aged and elderly persons than in young ones. 4. That the
seton, variously modified, is safer, speedier, and more successful than
resection or caustic. 5. That incising the soft parts previously to
introducing the seton augments the danger, but renders the cure more
certain and expeditious. 6. That allowing the seton to remain in for a
long time exposes to accidents, and does not facilitate the cure. 7.
That the seton is least successful in the femur and humerus.—ED.]
INDEX.
Abdomen, affections of, 412
injuries, 438, 440
Abscess, 31
lumbar, 441
Adhesion, 25
Albugo, 264
Amaurosis, 275
Amputation, 612
arm, 624
fingers, 619
foot, 628
forearm, 622
hip-joint, 631
leg, 628
shoulder-joint, 625
thigh, 630
Anchylosis, 73
Aneurism, 118, 121
by anastomosis, 127
popliteal, 125, 541
axillary, 389
osseous, 158
Aneurismal varix, thigh, 542
Anthrax, 63
Antrum maxillare, inflammation of, 317
Anus, pruritus, 460 artificial, 434
Arterial system, diseases, 116, 121
Articular cartilages, atrophy and hypertrophy, 75
Artificial anus, 433, 434
Artificial pupil, 287
Ascites, 435
Axillary aneurism, 389
Bladder, inflammation of, 469
irritable, 470
Blennorrhœa, 247
Bone, diseases, 94
fractures, 552
Brasdor’s operation, 126
Bronchocele, 377
Bruise, 610
Bubo, 197
Bubonocele, 416
Bunnion, 544
Burns, 211
Bursæ, diseases of, 80
inflammation of, 543
Calculus, in the female, 530
salivary, 336
vesicæ, 508
Carbuncle, 63
Carcinomatous tumours, 142
Caries, 96
Castration, 507
Cataract, 277, 279, 280
Chancre, 201
Chemosis, 259
Chest affections, _see_ Thorax.
Chimney-sweeper’s Cancer, 495
Choroiditis, 274
Cirsocele, 417
Club-foot, 545
Compression, 226
Concretions, salivary ducts, 336
Concussion, 218
Congestion, 23
Corectomia, 287
Corneitis, 261
Corodialysia, 288
Corotomia, 287
Coxalgia, 81
Croup, 354
Cynanche trachealis, 354
Deafness, 375
Delitescence, 26
Dislocations, 588
ankle, 606
carpus, 599
clavicle, 592
elbow-joint, 596
fingers, 599
hip-joint, 600
congenital luxation, 604
lower jaw, 591
patella, 605
radius, 597
shoulder-joint, 592
tarsus, 606
wrist-joint, 598
Distortion of the feet, 545
varus, 547
valgus, 548
pes equinus, 548
calcaneal, 549
Ear, diseases of, 373
foreign bodies in, 375
Ear, polypus, 375
Eburnation, 75, 113
Ectropion, 254
Eczema rubrum, 211
Emprosthotonos, 183
Empyema, 410
Encanthis, 252
Encysted tumours, 151, 336, 406
of eyelids, 253
of the breast, 406
Enterocele, 415
Entero-epiplocele, 415
Entropion, 255
Epiphora, 247
Epiplocele, 415
Epispadias, 495
Erethismus, 211
Erysipelas, common, 55
hospital, 57
phlegmonous, 56
Erythema, 55
Excision, diseased bone, 632
of joints, 634
Exomphalos, 415
Exophthalmia, 266
Exostosis, 153
of distal phalanx, 551
Eye, diseases, 245
Fever, hectic, 42
inflammatory, 19
irritative, 43
Fistula lachrymalis, 248
in ano, 449, 450
in perineo, 472
Fractures, 552
clavicle, 564
cranium, 227, 558
compound, 553, 556
disunited, 586
face, 558
femur, 575
humerus, 569
metacarpal bones, 574
olecranon, 571
patella, 581
pelvis, 574
phalanges, 574
radius, 572
ribs, 566
scapula, 565
shoulder, 567
simple, 553
spinal column, 560
sternum, 567
tarsus, 584
Fractures of the tibia and fibula, 583
ulna, 710
Frænum linguæ, division of, 334
Fragilitas ossium, 110
Fungus hæmatodes, 147
Furunculus, 62
Ganglia, 401
Gangrene, 43
Genital organs, affections of, 461
Glaucoma, 277
Gonorrhœa, common, 462
in females, 531
præputialis vel spuria, 490
Gonorrhœal lichen, 532
Gums, inflammation, 337
tumours, 337
Gunshot wounds, 180
Hare-lip, 323
Hæmatocele, 503
Hemorrhage, 129, 166
Hemorrhoids, 445
distinct varieties, 445
Hectic fever, 42
Hernia, 412
of the iris, 264
cerebri, 233
congenital exomphalos, 415
scrotal, 413
crural, or femoral, 416
infantilis, 414
inguinal, direct, 415
oblique, 416
scrotal, 416
umbilical, 430
humoralis, 467
Hospital gangrene, 191
Humeral artery, 394
Hydatic tumours, 161
Hydrocele, 417
of the neck, 381
Hydrops articuli, 68
Hydrophthalmia, 266
Hydrothorax, 410
Hypopium, 273
Hypospadias, 495
Incontinence of urine, in females, 489
Inflammation, 13
Injuries of the head, 215
Iritis, 272
Irritation, 20
Irritative fever, 43
Joints, diseases of, 67
growths from synovial membranes, 79
hip-joint disease, 81, 91
loose cartilages, 80
neuralgic affections, 78
scrofulous disease, 77
Keratonyxis, 284
Larynx, foreign bodies in, 363
ulceration, 361
Laryngitis, 354
Leucoma, 264
Leucorrhœa, 531
Ligature of arteries, 123
axillary, 392
Ligature, brachial, 392
carotid, 385
femoral, 159, 541
humeral, 394
iliac, 539
Ligature of innominata, 387
subclavian, 387, 389
Lips, congenital deficiencies, 322
ulcers, 319
Lithotomy, 519
Lithotrity, 517
Lower jaw, osteosarcoma, 343
spina ventosa, 341
Lumbar abscess, 441
Lupus, 310
Luxations, _see_ Dislocations.
Malignant pustule, 193
polypi, 303
Mamma, diseases, 405
encysted tumours, 406
Melanosis, 142
Metastasis, 26
Mollities ossium, 110
Morbus coxarius, 81
Mortification, 43
Mucous membranes, inflammation, 65
Myocephalon, 264
Nasal polypi, 310
nævi, 128, 130
Nebula, 264
Necrosis, 103
Neuralgia of the rectum, 460
Neck, hydrocele, 381 distortion, 382
Noli me tangere, 310
Nose, diseases, 308
Œdema glottidis, 358
Œsophagus, foreign bodies, 371
stricture, 369
Œsophagotomy, 372
Onychia, 399
Opisthotonos, 183
Ophthalmia, 257
neonatorum, 261
purulent, 260
tarsi, 265
Osseous aneurism, 156
Osteosarcoma, 154
Otitis, 373
Ovarian dropsy, 436
Ozœna, 310
Palate, congenital deficiencies, 332
ulcers, 329
Paracentesis abdominis, 435
Paraphymosis, 491
Paronychia, 396
Periostitis, 94
Pes equinus, 548
Phagædena, sloughing, 191
Pharyngitis, 368
Phlebitis, 130
Phlegmonous erysipelas, 56
Phthisis laryngea, 360
Phymosis, 491
Piles, 445
Polypus, 150
nasal, 301
ear, 375
Prolapsus ani, 453
Pruritus of the anus, 460
Pterygium, 256
Puncture of the bladder, 488
Pus, 29
Pustule, malignant, 193
Rachitis, 110, 112
Ranula, 335
Rectum, affections, 445
inflammation, 447
schirro-contracted, 452
neuralgia, 460
Resolution, 25
Retention of urine, 478
in females, 533
Rhinoplastic operations, 312
Rickets, 110
Sarcocele, 505
Scalds, 211
Scrofula, 34
Serous membranes, inflammation, 66
Sinus, 40
Sphacelus, 44
Spina bifida, 444
Spina ventosa, 157
Sprain, 607
Strabismus, 292
Staphyloma, 261
Stillicidium lachrymarum, 247
Stricture of the œsophagus, 369
rectum, 450
urethra, 470
Struma, 34
Subclavian artery, 387, 389
Suppuration, 29
Sympathies, 19
Syphilis, 195 tertiary, 203, 209
Teeth, caries, 338 extraction, 340
Testis, inflammation of, 467
Tetanus, 183
Tertiary syphilis, 203, 209
Thecæ, collections of fluid in, 401
Thorax, affections of, 409
Thrombus, 405
Tongue, inflammation of, 332
ulcers, 331
Tonsils, abscess of, 327
enlargement, 328
Tonsils, inflammation of, 326
Trachea, foreign bodies in, 363
stricture, 369
Tracheotomy, 364
Trichiasis, 255
Trismus, 183
Tubercle, painful, 149
Tumours, 134
adipose, 137
of the antrum, 304
of bones, 153
carcinomatous, 142
encephaloid, 142
encysted, 151, 336, 406
fibrous, 138
melanoid, 142
aneurismal, 158
osseous, 158
hydatic, 161
in the neck, 379
in the orbit, 290
painful tubercle, 149
of the scalp, 243
Tympanum, puncture of, 377
Ulcers, 186
of the genital organs, 195
Ulcers, indolent, 188
irritable, 189
of lips, 319
Urethra, stricture of, 470
Urinary organs, affections of, 461
Urinary calculi, 508
Uterus, affections of, 537
Uvula, elongation of, 328
Vagina, affections of, 534
Valgus, 548
Varicose aneurism, 393
veins, 132
Varix, aneurismal, 393
of thigh, 542
Varus, 547
Vein, external jugular of, 384
Veins, inflammation of, 130
Venesection, bend of the arm, 403
jugular vein, 384
Vertebral column, diseases of, 442
Vesico-vaginal fistula, 534
Whitlow, 396
Wounds, 164
by stings of insects, 177, 178
of the brain, 232
bruised and lacerated, 175
of the face and neck, 347
gunshot, 180
of the palmar arches, 395
poisoned, 176
punctured, 176
of the scalp, 215
of the temporal artery, 216
of the intestine, 440
Wry-neck, 382
THE END.