Abbildungen der Seite

having withstood for a month the use of a soap of glycerine and carbonate of potash and lunar caustic, finally yielded completely through a month's continuous use of collodion.

Only five reports were given in upon epidemics prevailing in Austria, outside Vienna, during the course of the year, of which four were upon scarlatina and one typhus.

The first of the scarlatina epidemies appeared at Himburg, in the fall of 1855. There were 32 cases and 3 deaths of girls; no boys died. Two of the fatal cases terminated in the first stage from convulsions, and the other upon supervening anasarca. The source of the disease could not be established, since no scarlatina was present in all the neighborhood.

The second occurred in the four cantons of the Hangsdorfer d'strict in the last month of 1855, and lasted until the 20th of February, 1856. There were 277 cases and 43 deaths. Many milder cases, however, did not come under the notice of the physicians. The fatal cases were also most numerous among girls. Death was caused by inflammation of the internal organs, especially the membranes of the brain, then through inflammatory discharges from the ears, and finally through anasarca. It is worthy of mention that scarlatina patients lying in the same room with cholera patients, were nevor attacked by cholera. The march of the epidemic in the four cantons was plainly from East to West. Its origin was not known, and its spread was not always ascertained to have been through contagion. Belladonna was shown to be useless as a prophylactic, and the results from rubbing the body with fat bacon appeared problematical

The third epidemic of scarlet fever appeared at Mannersdorf, in the district of Bruck, on the Leitha, and lasted from April to July, 1856. Out of 69 cases 11 died, a part through angina crouposa, and a part from pneumonia and atrophy of the brain. The sick were most numerous at the beginning and end of the epidemic. There occurred also cases without the rash, followed by desquamation of the cuticle and anasarca. Among the sequelæ were observed ulcerations of the mouth, and discharges from the ears. Tepid baths were found beneficial in cases showing albuminuria.

The fourth epidemic appeared at Hainburg and Hundsheim, lasting in the first from the end of April to August, 1856, and furnishing 96 cases, of which 26 were fatal.-and in the second 24 cases, of which 5 were fatal. The mortality among girls was also in this epidemic greater than among boys. Suppurations of the glands of the neck, ulceration of the mouth and tongue, discharges from the ears, and ophthalmias accompanied and followed the disease. Belladonna was useless as a prophylactic in this epidemic.

The remaining report upon the fifth epidemic, that of typhus. at Zistersdorf. presents nothing specially worthy of mention.-[American Medical Monthly.

Lecture on Chronic Orchitis. By Professor NELATON. Translated from the Gazette des Hop.taux, (Paris.)

The patient who occupies bed No. 27 in the male ward, is affected with a long standing and chronic disease of the testicle. On account of the obscure phenomena attending this case, it presents many points which render the diagnosis somewhat obscure.

By reviewing the symptoms which characterize the different diseases of the testis, this case will appear to be curious in itself, as illustrating one of the rarest and least known of these affections, viz: chronic engorgement of the testis.

The patient is aged twenty-six years; he appears to be powerfully made: in fact, his profession, that of a mountebank, requires considerable strength; for his principal feat consists in ascending an incline plane on a large ball weighing twenty-five or thirty pounds.

About four years ago he contracted a gonorrheal affection, and we here mention it in order that it may be taken into account with the other attending circumstances. The gonorrhea lasted about four weeks, and was followed by inflammation of the epididymis. Since this time the testicle has remained much larger than before, and the patient, though not again affected with gonorrhea has, nevertheless, constantly felt some pain in urinating: afterwards, this pain was greatly increased, and several times the act of micturition was followed by a few drops of blood. About a month ago, an external injury was superadded to the previously existing disease. It appears that in the establishment to which he belongs, some animals are also exhibited. While attending on an Ostrich, he received a severe kick from this bird in the hypograstric region. Now a kick from such an animal would certainly give rise to severe accidents, and the patient attributes to this cause an exacerbation of his disease. He adds that about a year ago, he fell and injured his scrotum. All of this must be taken into consideration when considering the nature of such an obscure organic affection; that it is obscure will appear from a description of the diseased part.

The right testis, which is the only one affected, has increased in size, but not very materially, being about the size of a hen egg. On first examination it appears smooth, but when carefully felt, it can be readily found to be somewhat irregular in shape. Nor is its consistency perfectly uniform, being hard in some points, and soft in others, but the limit between these two conditions is not distinctly marked, and the most careful investigation does not reveal any specific point of engorgement. Both in the epididy mis aud in the testicle itself, these indurated places can be felt. In frout, the body of the organ presents a well marked fluctuating point, which appears to be owing to a fissure in the tunica vagin alis. The spermatic cord retains its natural consistency, and is not

at all infiltrated or enlarged. The sensibility of the testis is greatly increased, and the slightest compression produces great pain.

Now, what can be the nature of an engorgement which has lasted three years and a half? This is certainly not the ordinary course of gonorrheal orchitis. There is no doubt that this species of orchitis existed at the beginning, but it cannot be maintained that it could have persisted all this time.

Perhaps this might be a case of hypertrophy of the testis: for the symptoms of the latter have some analogy to those which are presented by this case. But we must remember that hypertrophy of the testis generally affects both sides at once, and moreover, the organ is uniformly increased in size! Besides, hypertrophy of the testis is exceedingly rare in this country. By my researches on the subject, I have ascertained that this affection is seldom, if ever seen in France, whereas it is very common in the other hemisphere, and especially in South America. By looking over the published records on this subject, we find fifteen cases in that part of the world to one in Europe! Alone, this reason would not be sufficient, but combined with the physical appearances, we must unhesitatingly reject the supposition of hypertrophy of the testis. We must remember again, that the latter disease generally manifests itself in the period of growth, in the transition from youth to manhood.

Could this be a tubercular affection of the testis? Nothing in the examination of this young man, either in his general condition or in the particular diseased part would lead us to adopt this supposition; his robust frame, his herculean strength at once refute the hypothesis, his general health is excellent, he presents no symptoms whatever of the tuberculous diathesis, neither the cough nor the expectoration, no sign whatever. Look at the life which he leads, marked by excesses of every kind, yet he bears it all very well. If it were not for the pain and difficulty in urinating, his disease would not affect him in the least. The local appearance of the organ is also very different from that presented by the tuberculous testis. The latter disease affects two forms which are entirely distinct: The tuberculous deposits are either, 1st. Accumulated in isolated masses of a certain size, and situated in differen parts of the organ; or, 2d. Of miliary granulations in the substance of the organ: these granulations of about the size of a pin. head, accumulate in enormous quantities, and by their increase may gradually give to the organ an exaggerated volume. Could we have here either of these varieties? We can at once reject the latter form: for this kind of tuberculous testis generally develops itself with extreme rapidity, like galloping consumption, which is also characterized by the appearance of innumerable quantities of tubercles in the miliary state.

This rapid and abundant growth of tubercles is very rare, but when it does happen, it is very apt to mislead the observer. It

will generally be taken for a case of acute orchitis, and some days may elapse before it assumes its distinguishing characteristics. But in this case the engorgement has lasted three years and a halfso that this form of tuberculous degeneration is entirely out of question. Could it be the first variety? Certainly not! For when we meet those large turburcular masses in the testis the health of the patient is generally far from good; and it is very rare to see persons subject to this disease having such a good constitution, or retain the physical appearance of this man. Moreover, these turberculous masses would not remain three years and a half without softening, suppuration and ulceration. For these reasons we cannot hesitate to reject the idea of a tuberculous affection, in the same way that we eliminated the blennorrhagic cause and hypertrophy of the testis.

We have still three alternatives left.

It could be either a syphilitic affection, or an encephaloid tumor or chronic orchitis. Let us now examine these different morbid species.

In the first place would it be possible for this to be a syphilitic manifestation? It does not present the symptoms of the syphilitic testis.

In those tertiary forms of venereal disease which affect the testis there is generally some effusion in the tunica vaginalis; in fact, the universality of the presence of liquor is such as to amount to a law! Moreover, when the testis is examined, either with the liquid when the effusion is not too great, or after puncturing, if the quantity of liquid require this step; then it will be ascertained that the surface of the testis is rough and uneven on account of numerous small elevations about the size of a grain of wheat, which are deposited all over the surface of the tunica albuginea. And then the testis presents that shape which is characteristic of the venereal affection; the testis being completely surrounded and overlapped by the epididymis, something like an egg-cup, or an acorn in its cupula! But in this case we have none of these symptoms, neither hydrocele, nor uneven surface, nor enlargement of the epididymis. And, moreover, it is extremely rare to see a syphilitic affection remain confined to one testis during this space of time; for gener. ally after four, six or eight months, at the fathest, the other testicle will become affected in the same way. There is another sign which is very important. You will observe that in the testiary form of syphilitic testis, this gland loses its peculiar sensibili ty; and the patient can bear an amount of compression which in the healthy state would be utterly impossible. In fact, you would be astonished at the degree of compression which can be exercised on the gland without giving the patient any uneasiness. But here we have seen the sensibility of the diseased organ is greatly exag gerated. The man himself says he has never had any venereal symptoms, either primary or secondary, and this is certainly

not a tertiary manifestation. Not that we should put any great faith in these assertions on the part of patients as a general thing, but when they confirm the results of analytical investigation, it is well to give them some little weight in the pathological scale. We can therefore affirm that this is not a venereal affection.

Is it a cancerous degeneration? This is certain possible at first sight. But this disease generally progresses with exceeding rapidity. An encephaloid tumor, will, in three or four months, attain four times the size which this case has reached. This fact alone, should make us reject the supposition of an encephaloid affection! Moreover, these tumors are more uneven and nodulated than the present case, and are often accompanied by thickening of the cord with engorgement of the neighboring lymphatics. We now come to the last supposition.

Is this a case of chronic orchitis? And first, what is chronic orchitis? This is one of the most obscure questions in pathology, and on which the latest writers still leave many doubts and discrepancies. Look at Curling's treatise on the Testis, and you will find that what he describes as chronic orchitis, is nothing more than a turberculous disease of that organ. The principal anatomical character of this form of inflammation, says he, is the deposi tion of a peculiar yellowish product, homogeneous in appearance and devoid of any organic element. He describes two forms which this abnormal product affects, and these are nothing more than the two varieties which we described above as appertaining to the tuberculous affection. He discusses the primitive seat of this disease, and concludes that it originates in the tubuli seminiferi. He adds that in one case where he excised the diseased organ, the epididymis was also considerably affected, that the globus major was filled with a soft though concrete mass, filling an irregular sinus into which opened a fistulous communication. The globus minor contained a similar deposit, but without external opening. He has, moreover, illustrated his description, by a good engraving. The author himself, foresees the objections which might be raised, and says that this is not tuberculous matter, but something entire ly different! He admits that the term of yellow tuberculous deposite has been applied to this disease, but he condemns the term because it is apt to mislead one as to the true nature of this affection. But with all this, his description of the case is a faithful picture of the tuberculous affection of the testis; for he speaks of the diseased organ of the softening of the tuberculous matters retaining, though he reprobates the expression; he describes the fistulous communications which are so characteristic of this disease, and also the adhesions which take place between the testis and the


Unfortunately Curling has not confined his description to the tuberculous affection of the testis; he has mixed up with it the symptoms of the testiary venereal affection, viz: the syphilitic

« ZurückWeiter »