A system of practical surgery / by William Fergusson; with 246 illustrations by Bagg.

  • William Fergusson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson; with 246 illustrations by Bagg. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    where there may he reason to apprehend swelled testicle coming on,— as in puncturing the scrotum for hydrocele,—in the acute stages of gonorrhcea. Even in the after-treatment of lithotomy I have known suspension of the testicles of service, for in some individuals the in- flammation following the wound in the neck of the bladder (doubtless from its proximity to the seminal ducts and vasa deferentia) appears to induce a similar action within the gland. My own experience of the method of compression by means of straps of adhesive plaster, as recommended by Fricke, Ricord, and others, has not been such as to entitle me to give a very decided opinion upon the practice. The same reasons that would induce me to object to the application of pressure in erysipelatous and other swellings during the acute stages of inflammation, would actuate my course of treatment in hernia humoralis ; but towards the latter stages, when the swelling assumes a chronic condition, I should deem the method of great value, and here the plaster or the straps may be of the ordinary adhesive kind, or such as may produce a greater excite- ment on the surface,— as the camphorated mercurial plaster which, in other parts of the body is so beneficial in promoting absorption of in- dolent swellings. 1 have tried the method occasionally, and the reader will find in Mr. Acton’s work on Venereal Diseases a drawing illustra- tive of the mode in which the scrotum may be enveloped by such straps. It is seldom that the inflammation in these cases runs on to suppu- ration : occasionally, however, it does, or sometimes abscesses form in the substance of the testicle without the whole organ being affected with inflammatory action. These abscesses must be treated like simi- lar diseases in other parts of the body. It will often be found, how- ever, that they heal up slowly, and that sinuses are apt to be formed. These latter may, in some instances, be closed by the judicious use of injections, ointments, and pressure; but sometimes they resist such treatment, and then the knife may probably be required. I need scarcely caution the young surgeon against cutting freely in this organ ; but that is rarely, if ever, required; for in such instances the most that may be necessary will be a free external wound in the scrotum, to permit the proper dressings to be applied to the bottom of the sinus. In some instances hernia humoralis ends in chronic enlargement of the testicle, which may resist all the usual modes of inducing absorp- tion : sometimes it seems the commencement of new action in the organ, whereby it is converted into a mass, to which the term “ tu- mour” is more strictly applicable. At last it becomes evident that the natural structure cannot be saved or restored, and that the removal of the disease becomes advisable or absolutely necessary. The operation may be done thus :—The patient should be laid on his back, and the surgeon should grasp the organ in his left hand—supposing it to be about the size of a large pear or a pine-apple, and by means of the thumb and fin- gers should render the skin in front tense: with a bistoury he should then make a slight lunated incision from the upper end of the testicle to