AN INVESTIGATION ON THE REGENERATION OF NERVES, WITH A VIEW TO THE SURGICAL TREATMENT OF CERTAIN PARALYSES

Abstract

Operation.-Afew days later an oblique incision was made over the 4external abdominal ring and the tunica vaginalis exposed.It was found to be large, and extended from.the external ring downwards.On opening it, about 2 drachms of clear yellowish fluid escaped.The 'testicle and cord hung free in this cavity from the external abdominal ring, and were covered by visceral tunica vaginalis.There was a broad ,arrangement of the cord, with separation of the vas deferens from the 'vessels, and the testicle itself hung almost horizontal.The parietal -tunica vaginalis was removed, and a strip of the visceral investment was separated with difficulty from the free aspect of the testicle.Catgut .sutureswere inserted, uniting the fresh surface of the testicle and the scrotal wall.The after-history was uneventful, and two years later the patient veported that he was in the best of health.CASE III. A. W., aged x6, was seen in the out-patient department of the Edin- "burgh Royal Infirmary in February, 1902.For three years he had been isuffering from sudden attacks of severe pain in the left testicle.Strain -apparently brought on the attack, which varied in severity and duration.The pain was always sudden in onset, and got very severe in character.-It was accompanied by vomiting, in a little time swelling appeared on the affected side, and at a variable time sudden relief would be obtained.As the attacks incapacitated him from work he applied for treatment.~On examination there did not appear to be anything abnormal about the 'testicle, nor could the characteristic pain be induced by endeavours to ,twist the cord.Operation was recommended, and Professor Annandale, -whose receiving day it was, operated later.Operation.-Thetesticle, considerably atrophied and soft, was found 'lying free and horizontal in a large tunica vaginalis, which contained two to three drachms of clear fluid, The cremaster muscle was hyper- trophied.The testicle and cord were covered by visceral tunica 'vaginalis, and the cord was broad, with separation of the vas deferens from the vessels.The tunica vaginalis was evaginated and stitched in 'this position, the testicle and cord lying in apposition to the fresh 'internal aspect of the scrotum, to which it was fixed by catgut sutures.As far as could be followed there was no recurrence of the previous symptoms. CASE IV.'W. G., aged 24, seenat the Royal Infirmary, Edinburgh, in September, "1902, when in charge of Mr. Catheart's wards.A year ago he had a 'bicycle accident and injured his left testicle, which remained painful for three weeks.Three weeks previous to admission there was a sudden onset of pain in the left testicle, sickening in character, and this remained for four to five hours, swelling gradually taking place and the pain subsiding.There was no vomiting.Altogether there had 'been three attacks of a similar nature.On examination there was a slight varicocele, the testicle lay somewhat horizontal and could not be "twisted so as to produce a recurrence of the symptoms.Operation was advised and carried out later.The testicle lay free and almost horizontal in a large tunica vaginalis, and with the epididymis and part of the cord was covered completely by visceral tunica vaginalis.There was free fluid present in the tunica, and the cord contained a slight varicocele and was broad in its arrangement.The varicocele was excised and the ,cut ends united, the tunica vaginalis clipped away, and the testiale anchored by catgut sutures to the rawed scrotal surface.Except for some slight superficial suppuration the case did well, but no after- history could be obtained.CASE V. R. C., aged 23, was seen in the out-patient department of the Edin- 'burgh Royal Infirmary in July, 1903.There was a history of recurring 'attacks of pain In the right testicle from the age of 3.These attacks usually began in the early morning, waking him from sleep.The pain was sudden in onset, sickening in character, and quickly followed by Vomiting.He could not bear any handling of the part, the pain was so severe.In two to three hours from the onset swelling began, and dis- appeared in twenty-four hours after relief had been obtained.The severity of the attacks varied in duration and degree but always passed off suddenly.He noticed that crossing the left leg over the right tended to' induce an attack.The right testicle was smaller than the left; it lay horizontal, and was markedly raised compared to the other.'The characteristic pain could be induced by rotation of the testicle out- wards.He had been treated with a truss for supposed hernia but no sign of one could be found.Operation was advised.Operation.-Mr.Cathcart, into whose wards he was admitted, operated, and found the testicle -considerably atrophied and soft.It was lying horizontal in a large tunica vaginalis, which contained clear fluid.The testicle and cord were covered completely by visceral tunica vaginalis, and the veins and vessels of the cord were enlarged.The cremaster muscle was hypertrophied.The tunica vaginalis was clipped away and the testicle sewn to the scrotum.Recotery was uneventful.