File:Modern surgery, general and operative (1919) (14597609760).jpg

Identifier: modernsurgerygen1919daco (find matches)
Title: Modern surgery, general and operative
Year: 1919 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery, Operative
Publisher: Philadelphia : Saunders
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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If but oneepididymis is involved the testicle may not be affected for weeks or months.Von Bruns says that in 18 per cent, of such cases the testicle is not involvedfor six months; in 40 per cent, for over two months (Archiv. f. klin. Chir.,Bd. 63, H. 4). It usually comes on gradually, but it may begin acutely, as Ihave seen in two instances during the progress of tuberculous peritonitis. Anacute onset or an acute exacerbation of a chronic case usually means mixedinfection. The disease may follow a slight injury orinflammation, and is mostcommon in young men, but may arise at any age. The causal influence of ante-cedent or existing gonorrhea is doubtful. Some maintain that sexual excesspredisposes. There is often a family history of tuberculosis. A chronic casebegins by swelling of the epididymis. Palpation detects one or two or severalrounded nodules, or a diffuse hardening. In the latter case the epididymis ismuch enlarged, and there is usually a slight hydrocele. Rectal examination
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Fig. 1021.—Obstructive hyperemia for the testicles. The ends of the elastic tube areheld by the patient, crossed. A piece of tape is placed beneath to be tied by an attendant(Meyer and Schmieden). commonly detects nodules in the prostate and vesicles. In a few cases thereare frequency of micturition, tenesmus, hematuria, and seropurulent fluid canbe massaged from the vesicles and prostate and milked from the urethra. Insome cases bacilli are found in the urine. In others the urine is hazy. Inabout 80 per cent, of cases the guinea-pig test will prove the presence of bacilli.In some cases the urine is normal. Sooner or later nodules appear in the testicle.The vas is always swollen and may or may not be palpable. In an acute caseone testicle is involved. The testicle is very painful and the epididymis is greatlyswollen and smooth. The testicle quickly swells, there is always a hydrocele,and the scrotal skin becomes reddened. In a few days the acuteness of thesymptoms subsides, but supp

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