No. 11 sketch exhibits a curved instrument, with the pointed lancet projecting as when applied. No. 12 exhibits ditto, but with a differently formed instrument, consisting of two portions separated, so as to allow a director, in the form of a thin silver wire with a silver knob, to pass for the purpose of exploring the passage which the instrument is to follow and enlarge. It is indispensable in strictures seated upon the soft and deep parts, lest a false passage should be made. No. 13 represents a straight instrument; No. 14 ditto, but with the lancet in reserve—the last a perforator.
The reader has now been made acquainted with the various resources the surgeon has at his command. A few words on their employment will complete the necessary amount of information to render the one as wise as the other. By way of recapitulation, the treatment of stricture is by dilatation, cauterization, and division. They are to be estimated in the order of their arrangement. By dilatation is meant the enlarging of the urethral passage through the frequent introduction of bougies of graduated sizes. It is an operation unattended with any considerable pain; its novelty sometimes renders a patient a little nervous, but a complaint is rarely made after a second or third introduction. Indeed, it is oftentimes courted more frequently than is desirable. The application also of caustic, or even the perforator, produces scarcely the least inconvenience. Hemorrhage, of most things to be dreaded, is less frequent, with cauterizing and cutting instruments (in skilful hands), than the incautious employment of blunt-pointed bougies.
———<>———
Diseases of the Testicles.—The testicles, from their office and connexion with other structures equally as important, are liable to many excitations. In gonorrhœa they are subject to sympathetic inflammation, as in hernia humoralis, which, if neglected or maltreated, gives rise to abscess or chronic hardness. Inflammation also occurs in them as in other structures. Accidents, such as blows or bruises, horse-riding, wearing very tight pantaloons, are all fertile sources of derangement. Scrofulous constitutions are predisposed to have their testicles, like the rest of the glands, diseased. The most frequent disturbance, however, of the testicles, is a dilatation of the veins, constituting what is called varicocele; and generally accompanied by a wasting away of the testicle itself. It is rare, indeed, to find perfectly healthy testicles in an individual who has been exposed to amatory pleasures and sensualities; and as, of course, even amative desire, as well as amative power, depends upon the absolute sound condition of the glands in question, the inference is, that in very numerous persons, the sexual instinct is considerably diminished, and not unfrequently wholly suppressed, before half the natural term of their existence has expired, at which time they ought in reality to be at the climax of their prime and capability.
It is not so much a painful complaint, as an unpleasant one. There are occasionally pains in the back and loins, and other feelings, creating a sensation of lassitude and weariness; and now and then some local uneasiness is felt.
Varicocele gives to the examiner a sensation as though he were grasping a bundle of soft cords. It sometimes exists to such a degree as to resemble a rupture. In advanced stages of the disease, or disorganization, the epididymis becomes detached from the body of the testicle, and is plainly distinguishable by the finger. The result of all is, that a considerable diminution of sexual power takes place; and if means are not adopted to arrest a further break-up of the structure, the venereal appetite will subside altogether. The annexed drawing exhibits a tolerably faithful portrait of the disease; it represents the varicocele to be on the left side—the side most usually affected.
View larger image
The folds formed by the veins lapping over each other are clearly distinguishable, and the dependent state of the scrotum on the affected side exhibits very well the occasion of it. The treatment consists in giving support by means of a suspensory bandage, which may be worn during the day, and the use of local refrigerants night and morning. The state of health is sometimes mixed up with it; and tonics and generous diet are useful. The cold shower bath helps to brace the system. It is a complaint in which, if it be not of very great severity, nor very long continuance, much good may be done. In some instances the veins may be allowed to empty themselves, which they will do when the body is in a recumbent position, and a coated ivory ring, or a silken band, may be so placed around them as shall prevent their refilling. It is, however, a case fitter for the surgeon’s management.
Abscess in the Testicle.—The testicle is subject to inflammation and suppuration like any other structure. A case about three years ago fell under my notice, where a quantity of dark fœtid fluid was released on puncturing a testicle in which the sense of fluctuation was very evident; and the patient stated that it had been five or six years in arriving at that condition. He was wasted considerably from nocturnal perspirations and acute pain, and his sexual desire was much diminished. The case did well, and the latter function was restored without much loss.