File:The principles and practice of surgery (1916) (14761895054).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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l the whole epididymis formsan enlarged, hard, craggy mass encircling the posterior part of the testis ;a small hydroccele is common. Next, the body of the testis enlarges andnodules are felt along the vas, so that it feels beaded ; still later nodulesmay be felt in the prostate and rectum (some maintain that there are TUBERCULOUS EPIDIDYMITIS 655 always signs in the prostate once the epididymis is affected). Except inthe acute cases, pain is slight and testicular sensation present. The conditionmay end in healing and fibrosis, or in suppuration and caseation, and withformation of sinuses and fungation. When the base of the bladder isaffected frequency of micturition and pus in the urine are marked symptoms.Diagnosis. From gonorrhceal epididymitis the acute variety may behard to diagnose at first, on local examination alone, but the onset in theglobus major, the rapid breaking down, the suppuration which is rare inthe gonorrhceal type, and the absence of urethritis should distinguish.
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Fig. 220. Tuberculosis of the testis (bisected). The epididymis is filled with massof tuberculous material caseating in many places. A few scattered foci are alsoseen in the body of the testis. Later bladder signs, nodes in the prostate, and bacilli in the urine,make the matter clear. From syphilitic gummata the early and chiefenlargement being of the epididymis, the changes in vas, prostate, andbladder, and absence of serum reaction readily separate. From the epi-didymitis of secondary syphilis the diagnosis is less easy at first, but thelatter is bilateral, and there are signs of generalized syphilis and positiveserum reaction, while the syphilitic affection does not break down. Newgrowths are distinguished by their affecting testis and epididymis alike,by enlarging Ear more rapidly, and by not breaking down into abscesses. Treatment. Genito-urinary tuberculosis is essentially chronic anddifficult to heal completely by hygienic measures, such as good feeding,mountain air, sunshine,

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