These measures may be put in practice while the animal is on his feet; but if they fail in their effect, the surgeon must at once proceed to cast his patient and ligate the artery—an operation of delicate execution, and not always easy to perform, by reason of the deep seated position of the vessel. The use of the actual cautery has also been recommended, but even when successful there are many objections to this, one of which is the complication such an operation may bring on by the introduction into the wound of a scab which must necessitate for its expulsion a serious amount of inflammatory action. As a rule, however, the operation of packing is all that is required, the oakum being left undisturbed for twenty-four or even thirty-six hours. Its removal must be undertaken with great caution.
SWELLING OF THE SCROTAL REGION.
This, as we have seen, is an almost necessary consequence of the operation, the swelling making its appearance a short time after the alteration is accomplished. It usually first affects the parts immediately around the edges of the wound, and spreads forwards and upwards in such a manner that the entire scrotum and sheath become the seat of it. It is somewhat warm, tense, and slightly painful. If there is no increase beyond these limits, there is no occasion for alarm, as by exercise, fomentations, and scarifications, with the administration of diuretics, it ordinarily subsides. But if it continues to increase, and extends upwards and backwards, involving the inside of the thighs and the perineum, loses its character of heat and soreness, to become cold and painless, crepitating under pressure, we must prepare to encounter the most severe of all complications, that of gangrene, requiring the most prompt and vigorous treatment, as we shall presently see. It may also happen that even while retaining the characteristics of healthy œdema, it may assume such dimensions that the penis becomes so involved that phymosis and paraphymosis may supervene, to add to the other complications. These, however, are not serious sequelæ, as by proper care, with fomentations or scarifications, and the use of a suspensory bandage, they may be readily overcome.
GANGRENE.
This accident may be looked for from the fourth to the eighth day, manifesting itself not only by the extent which the œdema of the scrotal region assumes, and by its characteristics of coldness, loss of sensibility, and crepitant feeling, but by the fœtid odor proceeding from the wound, and by a change in the character, or the disappearance of the suppuration, which is succeeded by a sanious, bloody and offensive discharge. To this series of symptoms are to be added a marked increase of the general disturbance, manifested by increased thirst, anorexia, fœtid mouth, change of color in the mucous membrane to a livid hue, increase of pulse, with weakening, increased respiration, temperature at first elevated and then diminished, and after five or six days a final termination in the death of the patient.
The progress of this complication is so rapid, and the chances of recovery are so few, that the necessity for prompt treatment becomes at once obvious. All the diseased and mortified parts must be removed at once, and means instantly employed to prevent the absorption of gangrenous matter. Friction with ammoniacal and turpentine liniments must be used over the swelling; the parts must be subjected to the actual cautery at white heat, and disinfecting agents of all kinds must be freely used, as chloride of lime, carbolic acid, and permanganate of potash, while internal treatment must immediately be instituted by the administration of stimulants and antiseptics in the form of ammonia and phenic acid, or its preparations.
ABSCESSES.
When these are likely to result from a too rapid closure of the edges of the scrotal envelope, the premature union may be readily prevented, as we have before stated, by the careful introduction of the finger into the wound while it is still suppurating. But notwithstanding this precaution they will sometimes occur as the result of the infiltration and accumulation of the suppurative matter. A free incision and proper attention to the cavity of the abscess, is all that this accident requires. A careful examination of the parts will, however, reveal another cause for the formation of these abscesses. It is then against these causes that the therapeutic treatment must be directed. We refer now to the complication known as the formation of a
CHAMPIGNON.
This name is applied to an indurated condition of the end of the cord, or in its thickness, of a tumefied character, varying in size and extent, and slow in its growth. It results from an excess of inflammatory action, attributable to the manipulations which become necessary during the performance of the operation. The name “champignon” (or mushroom) is applied to it by the French, on account of the pedunculated appearance which it sometimes assumes, and which causes it to greatly resemble that fungus in its outward figure. It is also known as schirrous or indurated cord. The tumor is sometimes situated on the outside of the envelopes, when it is known as extra-scrotal, but more commonly it is found covered by the skin, in which case it is better known as intra-scrotal. In this latter condition it may be merely a growth at the end of the cord, becoming, as determined by its location, of an extra-inguinal character, or if the diseased process extends as far as the upper inguinal opening, or beyond it, it becomes, and is so denominated, intra-abdominal. There is also an extra-intra-scrotal growth, when it is partly within and partly external to the scrotum. This tumor will vary greatly in size, being sometimes very small in dimensions, and at others having those of a man’s fist. We have ourselves observed it equalling a child’s head in size.