680 INFLAMMATION OF THE SPERMATIC CORD. 



treated as an open wound. Daily exercise favours drainage. Re- 

 covery generally occurs in fourteen days to a month, without 

 complications. 



If the new growth has spread outwards beyond the tunica vaginalis, 

 the subcutaneous connective tissue, which is infiltrated with small 

 abscesses, must, as far as possible, be removed. Any remaining 

 abscesses or sinuses should be scraped out with the curette, or dressed 

 with concentrated solution of chloride of zinc. 



Malkmus has recently proposed a modification of this procedure. 

 Starting from a spot, if possible behind the growth, he breaks 

 through the tissues in the direction of the inguinal canal with the 

 fingers, in order, from that point, to destroy the adhesions of the 

 growth to surrounding parts. The most resistant portions of 

 connective tissue are divided by the knife or scissors, blood-vessels 

 being, if necessary, ligatured. For dividing the spermatic cord he 

 uses a special ecraseur with a very strong chain. 



New growths of the spermatic cord outside the vaginal tunic 

 can sometimes be removed by ligature and caustics. It is often 

 possible to cut through the growth with a ligature or to scrape it 

 away with the finger, though this is not satisfactory unless the cause 

 i.e., the strangulation of the cord by the scrotum or tunica vaginalis, 

 be at the same time remedied. Fig. 442 shows a growth which was 

 removed by ligature three months after castration. As a rule, 

 however, it is best to remove the lower end of the spermatic cord 

 in the manner above described, otherwise the scirrhous growth 

 almost always extends. Degive passes a metal rod through the 

 swelling after the ecraseur has almost cut through the spermatic 

 cord, turns that portion of the cord lying within the ecraseur chain 

 once or twice around its axis, and then completes the operation. 



When the morbid growth extends as far as the inguinal ring or 

 into the abdomen, the inguinal canal may be dilated and the chain 

 of the ecraseur passed even into the abdominal cavity. Dollar has 

 successfully operated on several cases of scirrhous cord extending 

 as far as the inguinal ring, using the ecraseur. He has never had 

 bad results or troublesome bleeding, the secret of success being to 

 observe all possible antiseptic precautions and to divide the cord 

 very slowly. Cases are on record of growths weighing as much as 

 120 lbs. Necessarily they could not be removed. 



Soon after potassium iodide had been proved efficacious in 

 actinomycosis it was tested in the treatment of scirrhous cord. The 

 recorded results have been conflicting, probably because the organisms 

 producing the changes may not be the same in every case, and also 



