File:The principles and practice of surgery (1916) (14741256176).jpg

Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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traction andthe accompanying endarteritis, the centre of the mass undergoes anaemicnecrosis and a yellow gummatous slough is formed; there may beone large slough occupying most of the organ or several smaller onesscattered through its substance. The underlying changes in these twoforms are similar, viz. formation of fibrous tissue, the differences are fromthe fate of the fibrous tissue. The sarcocoele is the condition more oftenfound in congenital syphilis. A gumma, as it breaks down, becomesadherent to the skin, which softens and gives way. allowing the extrusion SYPHILIS OF THE TESTIS 657 of the characteristic wash-leather slough, while the granulations mayprotrude through the aperture as fungus testis. Signs and Symptoms. The testis quietly and painlessly becomes enlargedand hard, testicular sensation being lost early. On examination the en-largement is found to involve the body of the organ, the epididymis beingstretched over the back of the ovoid mass, which is firm and smooth at
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Jfaa. 221. Tertiary syphilis of the testis (section). A large gumma involves theupper part of the body of the testis ; the epididymis is unaffected. first. Where breaking down of a gumma takes place, the latter will befelt as a lump whirh softens and later breaks through the skin showingtin- usual yellow slough. The absence of pain and loss of testicular sensa-tion are characteristic. The enlargement is seldom greater than a turkeysbill occasionally may assume the dimensions of a cocoanut, and whensuch a mase fungates throng)) tin- skin it closely resembles a malignantgrowth. Diagnosis. Prom tubercle it is fairly easily separated by the distribu-tion in the body of the organ the freedom of the cord, vas, epididymis,ii i- 658 A TEXTBOOK OF SURGERY and prostate, the absence of signs of tubercle elsewhere, and the presenceof syphilis as shown by the serum reaction, &c. From malignant growth, the smaller size, the freedom of the epididymiscord, and absence of enlarged lumbar glands, a

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