Hernia of Testicles in Neglected Case of Syphilis.

WE

BY PROF. ORVILLE HORWITZ, M. D.,

PHILADELPHIA,

Professor Genito-Urinary Diseases, Jefferson Medical College.

E BRING before you a patient who had an attack of gonorrhea six years ago. Four years ago there was a sore on the foreskin, which lasted two weeks. One year ago there was another sore, lasting six weeks. There was no eruption at this time. Six months ago the left testicle enlarged and began to give a great deal of pain. Two weeks ago this became ulcerated, and the patient now comes presenting a hernia of the testicle.

This condition may be caused by syphilis, which is the case here; by tuberculosis, by sarcoma or carcinoma, by extravasation of urine, or by gonorrheal abscess.

We have here a large, indurated testicle partly protruding through an opening in the scrotum. There is a tendency to strangulation, caused by a hard, indurated ring of tissue which surrounds the organ. This is typical of syphilitic condition.

In the operation for removing the testicle the cord is dissected a little bit inside the abdominal ring, is transfixed and a double ligature applied. In this case the mass must be dissected loose from the adhesions, and the bloodless operation of castration cannot be done.

A section of the testicle shows a true orchitis in the substance of the organ, and a gumma which caused the condition for which we have operated. In these cases a gumma forms in the central part of the testicle. After a time this perforates the tunica albuginea. Then it ruptures into the tunica vaginalis. Here the gumma sets up an inflammation, and adhesions form between it and the tunica. Following this the other tissues become involved and adherent. Finally the skin softens and breaks down, and the testicles protrude.

This was probably a case where the secondary symptoms were slight and not noticed, or the constitutional treatment was slighted. As a result we have these severe tertiary lesions.

Treatment in this condition has no result. It could have been cured early, but operation and removal is the only plan now.

But do not think that every gumma of the testicle demands removal of the organ. Some two weeks ago I had occasion to operate on a man for hydrocele. On the testicle was found a gumma as large as a walnut. I decided to leave the testicle in and try treatment, watching the case and doing castration, if necessary. Under this short treatment the gumma has diminished one-half in size, and will probably be entirely cured.

REPORTED SPECIALLY FOR THE MEDICAL FORTNIGHTLY,

LONDON LETTER.

[SPECIAL CORRESPONDENCE ]

THE JENNER (FORMERLY BRITISH) INSTITUTE OF PREVENTIVE MEDICINE. On July 1st, 1889, a meeting was convened at the Mansion House by the then Lord Mayor of London, Sir James Whitehead, in order to raise a sum of money to be presented to the illustrious Pasteur, and a further sum for sending poor people bitten by rabid animals to Paris for treatment. The committee elected for the above purpose a little later decided that it would be well to establish in England an institute for the special study of bacteriology and preventive medicine, similar, to some extent, to the institutes already existing in Paris, Berlin and St. Petersburg. A sufficient sum of money having been raised by public subscription and by bequests the Institute, while its permanent home was building, commenced its work in temporary premises in Great Russell St.

The objects for which the Institute was started were:

(a.) To study, investigate, discover and improve the means of preventing and curing infective diseases of man and animals; and to provide a place where research may be carried on for the purposes aforesaid.

(b.) To provide instruction and education in preventive Medicine to Medical Officers of Health, Medical Practitioners, Veterinary Surgeons, and advanced Students.

(c.) To prepare and to supply to those requiring them such special protective, curative and diagnostic materials as have been already found or shall in future be found of value in the prevention, treatment and diagnosis of infective diseases.

(d.) To investigate and report on material sent by Sanitary Authorities, Medical men and others for examination and diagnosis.

The institute is governed by a council, the Chairman of which is Lord Lister, R. R. S., composed of representatives appointed by the college of physicians and surgeons, the universities, and others. The Treasurer is Sir Henry Roscoe, and Secretary and Director Dr. Macfadyen.

The new building which has now become the permanent home of the British Institute of Preventive Medicine has been erected on a site on the Thames embankment, near Chelsea bridge, fron designs by Messrs Waterhouse and son. The present building, of which Fig. 1 gives a front view, is only about two thirds as large as contemplated in the original plans but everything has been so arranged that if additional space be needed and the requisite funds are forthcoming, its completion will be a simple matter. The Institute is completely detached and stands in its own grounds.

Administration.-The ground floor contains the board room and general offices, together with a waiting room. To the right of the main entrance is the director's private office, together with two laboratories for himself and his assistants. These laboratories will accommodate six workers, and are fitted up with the usual appliances for bacteriological investigation. A lift is provided for goods and passengers and there is lavatory accommodation on every floor.