Note 57 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 9)

[Although the symptoms of this affection are usually well marked, yet it is sometimes liable to be confounded with other lesions. The malady for which it is most apt to be mistaken is inguinal hernia, especially that variety of it in which the omentum is concerned. The best way in such cases is to place the patient on his back, and hold up the scrotum until the vessels are entirely emptied of their contents; the finger is then applied against the external ring and the patient requested to rise, when, if the disease be cirsocele, the spermatic veins will immediately refill, while, if it be hernia, the bowel will be unable to descend.

The progress of this disease is usually tardy, years elapsing before it causes much suffering or inconvenience. In some instances, however, it increases with great rapidity, and gives rise to severe local disorder, with more or less constitutional derangement. One of the most serious and unpleasant effects of this disease is atrophy of the testicle and epididymis, produced by the pressure of the enlarged veins; it may exist in various degrees, from the slightest softness and diminution of volume to almost entire wasting of the organ, and occasionally, though rarely, affects both sides simultaneously. A gloomy and melancholy state of mind, sometimes bordering upon alienation, frequently attends this condition of the testicle.—ED.]