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Case I. Wm. Johnson, aged twenty-three, negro, roustabout, was admitted to the hospital April 24, 1884, for chronic orchitis of the left testicle. He stated he had a fall in 1883, and injured the testicle, the gland becoming inflamed and enlarged. He was admitted to the U. S. Marine-Hospital, St. Louis, where he remained for treatment over a month; Surgeon C. S. D. Fessenden, the officer in charge, evacuating considerable pus by trocar and canula. The injured gland was but slightly larger than the other when discharged from the St. Louis hospital, but a gradual increase in size occurred up to the time of my examination. The gland was ten centimetres (four inches) long, by six centimetres (two and threeeighth inches) transversely; smooth as felt through the skin; indurated, the induration extending upward to the groin, and besides inconveniencing locomotion, gave the patient considerable pain at times. The skin and subcutaneous tissues were attached to the testicle where the trocar had been introduced. The patient had once had a venereal ulcer, but the evidences of constitutional infection were wanting. Nevertheless he had been treated with gradually increasing doses of iodide of potash, in order to eliminate the question of specific gland infection.

He was anesthetized April 25th, the scrotum, thighs and pubis were washed with a carbolized solution; a rubber ring encircled the scrotum, and an incision was made along the testicle to the fundus of the scrotum, including an ovoid piece of skin containing the cicatrix above referred to. The testicle. was torn loose from the fascia, the blood vessels separated from the cord and ligated, and the cord and its attachments severed from the gland. The hemorrhage was not very copious, and after thoroughly cleansing the wound with hot water, iodoform was dusted over the surface and the wound dressed.

Every second or third day the wound was washed with a warm carbolized solution. Suppuration was very free, and healing progressed by granulation. At no time did the temperature exceed 38 degrees centigrade (100.4 degrees F.) The patient was discharged recovered July 25, 1884.

The tubular structure of the gland was replaced by hypertrophy of the connective tissue; and three unconnected sacs

of pus, averaging two centimetres in diameter, occupied the substance of the gland.

Case II. Landy Moore, aged forty-one, white, laborer, admitted to the hospital January 14, 1885, for hydrocele of tunica vaginalis testis. In 1865 a ball from a revolver accidentally discharged in his pocket glanced along the scrotum, causing enlargement. Hydrocele of right tunica vaginalis tapped in 1870 and 1877, and again January 16, 1885; three hundred cubic centimetres (almost ten ounces) of fluid removed at the latter date. January 25th operated, as in the former case, for removal of enlarged testicle, and the patient was discharged recovered February 17th.

The testicle presented evidence of atrophy of tubular structure, connective tissue hypertrophy, and numerous pus foci. The sac of the hydrocele was covered with gelatinous exudate. This case has been reported, in extenso, in the Annual Report of the U. S. Marine-Hospital Service for 1885.

Case III. Joe Grant, aged thirty, negro, roustabout, was admitted to the hospital for chronic orchitis. In 1881 he had three venereal sores on penis, and a bubo in the right groin ; no good evidence of secondary manifestations. Has never had gonorrhoea, and does not remember any injury of the testicle. In December, 1885, the testicle attracted his attention on account of enlargement. It gave him but little pain, but was very tender to the touch, and inconvenienced his walking. When examined the testicle was nine centimetres (three and one-half inches) in length, and six centimetres (two and one-quarter inches) transversely; soft and fluctuating, and closely resembled a hydrocele of the tunica vaginalis. February 14, 1886, I introduced a trocar and canula, presuming that I had to deal with a case of the last mentioned disease; a small quantity of a purulent and gelatinous fluid escaped, but it was too viscid and lumpy to flow through the canula, and efforts at expression gave pain. It was now ascertained that the entire gland was diseased.

On March 3d the testicle was removed, the same method being employed as in the previous cases, except the use of a mercuric bi-chloride solution and suturing the operation wound.

VOL. VI-14

As a result of the operation a constant pyrexia, existing for some days past, ceased, and the temperature curve was normal. The operation wound healed well, but the disturbance of the connective tissue caused an inflammatory induration about the size of the left testicle, and there was a small quantity of purulent discharge. The patient was discharged recovered March 19th.

Almost the entire testicle was occupied by a pus cavity, and the glandular structure remaining was so degenerated that any proper performance of its functions, had the abscess cavity been treated by incision and drainage, would have been out of the question.

The results of the examinations of the testicles in these cases justified the operations.

It is a question of some importance to a patient, whether the diseased testicle can best be treated by incision and drainage or by extirpation. If the patient is a monorchis the utility of the gland may be judged by the presence or absence of spermatozoa in the semen, due care being employed to ascertain whether there is an undescended testicle.

In encephaloid disease, sarcoma and cystic testicle, there is no question of the advisability of castration. In tubercular, syphilitic and chronic inflammation of the testicle, after exhausting ordinary therapeutic measures, it would seem desirable to remove the gland, as the changes in its structure are of a character to unfit it to perform its special function.

The operation of ligating the spermatic artery, thus cutting off the blood supply and causing atrophy, does not commend itself, as the diseased gland remains to all intents and purposes as a foreign body.

The operation is not a particularly dangerous one, and an examination of the records of the United States Marine Hospital Service, (report of Surgeon-General 1879 to 1885) shows thirty-one castrations, all recovering. As a matter of interest regarding the relative frequency of the various affections, I would state that eight of the above cases were cystic disease; four, each, chronic orchitis, scirrhous cancer, and encephaloid cancer; three, each, tubercular orchitis and sarcoma; two were classed tumors of the testicle; and one, each, syphilitie orchitis, medullary cancer, and fungoid sarcocele.

MEMPHIS, March 18, 1886.

STRICTURE OF THE URETHRA.

A Lecture Delivered to the Graduating Class, Session 1885-86,

BY W. B. ROGERS, M.D.,

Prof. Clinical, and Genito-Urinary Surgery, Memphis Hospital Medical College.

GENTLEMEN-We will endeavor to entertain you to-day with the subject of urethral stricture. And it is a subject of no minor importance to each one of you, for whether you follow the role of a successful specialist in diseases pertaining to the genito-urinary organs or plod the weary way of the rural practitioner, I can with safety promise at least one case that will tax your skill to its utmost.

Preparatory then to the study of this affection, it devolves upon you to master thoroughly the anatomy of the male urethra. In a previous lecture we lent our best endeavors to point out the divisions of this canal, the structure of its wall, as well as its functions. But you must not content yourselves with the urethra on the blackboard, nor in your anatomies. You must familiarize yourselves with the canal itself by the use of the sound in the dead room, at the same time, with the fingers externally, trace the relations of the parts, locate the bulb, the triangular ligament, the arch and rami of the pubes, and above all do not fail to explore the rectum, for therethrough you will learn the prostate gland. 'Tis justly held that no hand is competent to use the sound unless its fellow is acquainted with the various structures that can be felt through the anterior wall of the rectum.

Stricture is the term applied to any abnormal narrowing of the urethra, at least such is the definition given by many authors, writing on this subject. Sir Charles Bell, however, remembering the urethra was a shut canal, its walls being normally in apposition, defined stricture as "a loss of the nat ural dilatability of any portion of the canal."

While most all authors speak of two varieties of stricture ―spasmodic and organic-they usually dismiss the first named with a few cursory remarks and confine themselves to the discussion of organic stricture. That the flow of urine is frequently impeded or even wholly retarded by spasmodic contraction of what is known as the cut off muscle, no one of

any experience will hasten to deny. But I must confess myself skeptical to the views held by some that the contraction of the muscular fibres encircling and going to make up the urethral wall retards the passage of urine; and surely not the introduction of the sound. As a complication, however, of organic stricture, the spasmodic element is often present. Spasmodic stricture is transient in character, usually readily overcome, and tho' frequently associated with, is not necessarily dependent on an organic lesion of the genito-urinary organs.

It is the other variety of stricture-organic stricture, also called permanent stricture, about which so much has been written that demands your study, and to which we will confine our remarks during the hour.

First, then, let us have a decided understanding as to what we mean to discuss. Let us accept for organic stricture the condition of the part defined by the gentleman named "a loss of the natural dilatability of the canal.”

Recalling the anatomy of the urethra we find the dilatability to be dependent on the elastic tissue found in its wall. What then destroys the elasticity of this tissue? Experiments teach that yellow elastic tissue is unaffected by acetic acid, but pathological researches show that the products of inflammation when they become organized may, and do, so mass and mat and bind together the component elements of a part, that they cannot be stretched. The wall of this canal being composed of muscular and fibrous tissue supplied by blood vessels, may become the site of an inflammatory process, and inflammation here gives a transudation into the meshes, which when it becomes organized, forms fibrous masses or bands, involving completely or in part the circumference of the canal. The essential anatomical element of organic stricture then is a product of inflammation, or rather the consequence, if you please, a sequela. We shall exclude in this term all causes of obstruction to the flow of urine or to the dilatability of the canal, when said causes lie, or are situated without the proper tissues of the urethra-such as spasm of the "cut off musele," cancerous, syphilitic or tubercular deposits-collections of fluid, such as abscesses, serous cysts and the like, situated in the body of the penis, or in the perineum and without the ure

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