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Show or THE EXTIRPATION or THE 'IESTICLE. OF THE EXTIRPATION 01' THE TESTICLE. 159 red in the skin ; though more commonly it is the cord which propagates the disease. CHAPTER X. or THE EXTIRPATION or THE TESTICLE. THE schirrous enlargement of the testicle, which requires extirpation, makes its attack on the body of the testi~ cle, and spreads and involves the epididymis. It is peculiar in the hardness and irregularity of the body of the testicle. This, however, is an irregularity which sometimes is not felt . awn-" «an s» use ‘ unless we press with some force ; for at the same time that the testicle is diseased, there is a degree of hydrocele which fills up the inequalities of the testicle. The disease advancing, the peculiar darting lancing pain of cancer is superadded to that gravitating pain in the thigh and loins, which is the common effect of the enlargement of the testicle. The stoney hardness--the imperceptible growth at first, with the lancing pain, form the most distinguishing character of schirrus. When the scrotum has ulcerated, and a fungus has sprung up, the character of the cancer is announced. To this extent, the progress of the disease may have been very gradual, but now it rapidly advances by contaminating the cord, or fixing on the skin. ' We have, as a previous step to any operation, to examine the progress of the disease towards the spermatic cord and the skin. If the cord be irregularly hard, and painful to the touch, the symptom is unfavourable, unless we have room above the diseased part to cut and tie the cord. If it be enlarged, irregular, thick, and painful in its whole extent, the operation should not be performed. If the scrotum have entered into disease, it is nearly as un. favourable to the success of the operation as the disease of the cord; for sometimes after amputation, the disease has recur- The INSTRUMENTS necessary for this operation, are scalpels, forceps, tenaculum, a large soft ligature for the cord, lesser ligatures for the artery of the cord and of the scrotum, lint sponges, slips of adhesive plaster, compress, tow, suspensory bandage, or split T bandage. Having examined the state of the testicle, cord, and scrotum; having determined that you can cut above the disease of the cord; and examined what portion of the skin it will be necessary to cut away, if the skin be diseased at all, we proceed thus ;__,_ The patient is placed upon a table, with assistants holding aside the thighs. The surgeon sits before him. There are two ways of doing this most simple operation: and of the two ways of extirpating the testicle, I must pre. misc that the one I am going to describe, is objected to. First cut down upon the sound part of the cord, and examine it well; dissect and put aside the cellular membrane altogether, until the free and perfectly distinct tissue of ves- sels forming the cord, is seen. Above the place where you have laid bare the cord, and in the upper angle of your incision, apply with a needle a large soft ligature under the cord, including the cellular membrane around the cord. There let it remain, but do not tie it. But if the disease of the cord has reached high-if there seem any risk of a necessity for cutting the cord very close to the ring, then I would pierce, or rather divide the cord with a needle and double ligature, so that if necessary I might tie a ligature on either side of the cord. Further, we have to recollect that the size of the testicle, the activity of its vessels or its weight, merely may have enlarged the cord considerably ; and this enlargement we must learn to distinguish from the progressive attack of the disease, and the contamination of the cord from the disease of the testide, |
