SAFETY-PIN BY A CHILD TWO YEARS OF AGE SUBSEQUENT PASSAGE BY BOWELS WITHOUT SYMPTOMS.

BY WILLIS JONES, M.D., ATLANTA.

I wish to report this case to show how quickly foreign bodies pass from stomach into bowel, and to show how we may be misled notwithstanding most perfect skiagraphic charts and, further, the absence of pain during passage of foreign body.

W. H., age two and one-half years, while mother was applying a napkin grabbed safety-pin from mother's dress, the same having been placed there while napkin had been previously removed; placing same in mouth, quickly swallowed it. The mother made an attempt to get pin from mouth of child, but efforts were fruitless. The child cried and was strangled considerably as pin passed down the esophagus. The pin was ingested with circular spring part of pin passing down first. I saw the child. fifteen minutes after ingestion. The mother was positive that the child had swallowed pin, but to look at the child one would think that she was mistaken. There was no pain over stomach upon palpation. Water was taken and swallowed without difficulty. I advised a skiagraphic examination of stomach, esophagus and intestinal tract, which was made by Miss Dendy.

Child was put upon farinaceous foods with directions to watch him carefully for any symptoms of pain or other trouble.

The skiagraph showed nothing in the esophagus, stomach or intestinal tract. I was inclined to believe that the mother was mistaken. On second morning following ingestion I was phoned that child had passed the pin.

HYDROCELE AND SPERMATOCELE, WITH

REPORT OF CASES.

BY W. L. CHAMPION, M.D., ATLANTA.

Hydrocele, or an accumulation of fluid in the tunica vaginalis, being a condition we are so frequently called upon to relieve, so easily recognized, and as a rule so successfully cured by the injection of carbolic acid, I desire to report fifty-one cases taken from my record book; and also to include, on account of its rarity, three cases of spermatocele.

When there is an accumulation of clear serous fluid in the tunica vaginalis, it is termed hydrocele; when the fluid contains blood, hematocele; and when spermatozoa are present, spermatocele. There are several varieties of hydrocele acute, chronic, multilocular, congenital, infantile, inguinal, and hydrocele of the spermatic cord. In this short article the various kinds will not be described-only dividing hydrocele into two classes: symptomatic and idiopathic. Symptomatic hydrocele follows a diseased testicle; idiopathic hydrocele develops without any known cause, or, not knowing the cause, this name is applied to the condition.

In the report to follow, ten of the fifty-one cases did not have any disease of the testicle or epididymis, nor did they give a history of gonorrhea or syphilis. The fact that so few males escape venereal diseases, and the possibility of injury being the cause, all hydroceles might be classed as symptomatic. With the patient in a dark

room and a light behind the tumor, diagnosis is easily made if the fluid is clear; if not translucent and eliminating hernia, a hypodermic needle inserted will clear up the diagnosis; unless the hydrocele is very large, the testicle can be felt to determine whether it is sensitive, hard, enlarged, or nodular. As a rule, when a testicle is syphilitic there is fluid in the tunica vaginalis. In small hydroceles incision, aspiration or tapping will occasionally perfect a cure, but in large tumors, after tapping without injection, the fluid will gradually accumulate.

Casper in his text-book on genito-urinary diseases states that the procedure of tapping and injecting irritating substances, such as tincture of iodine and carbolic acid, is not absolutely certain nor without danger; therefore, he favors the more radical operation by means of open incision.

Green and Brooks in their recent work on diseases of the genito-urinary organs state: "It has been a common custom for a great many years to inject into the sac through the trocar, a few drops of a powerful destructive agent, with the object of setting up an adhesive inflammation between the walls of the tunica that will cause them to adhere and thus prevent the re-formation of fluid. This method is sometimes successful, but personally the writers prefer one of the radical operations" -that is, incision. I have never seen any bad results nor toxic effects from the use of carbolic acid, and have injected a dram of the acid in a hydrocele sac. Keyes in late edition on genito-urinary diseases says: "After using carbolic acid injections in many cases ranging in age from two months to eighty years, in no case has any complication of serious reaction occurred in my hands."

I do the operation in the office, first cocainizing the part to be punctured, which makes the operation pain

less, with the exception of the first effect of acid, which is a severe smarting pain lasting perhaps for a minute. Before introducing the trocar, the testicle should be located, so as to avoid injuring it. Some operators after emptying the sac through the canula, inject the acid with a hypodermic syringe, inserting the needle at a location distant from the opening made to withdraw the fluid. The needle is inserted before the fluid is drawn off; after the fluid escapes through the canula, the syringe containing the acid is attached to the needle and the acid injected.

I prefer to empty the sac and inject twenty to thirty minims of the pure acid through the canula in the position it is in when the fluid is drawn, connecting the syringe with the canula, or, preferably, using a needle a fraction longer than the canula, and passing it through the canula to the bottom of the sac, thus preventing the acid from coming in contact with the skin or escaping into the tissues. Before injecting the acid, care should be taken to remove all the fluid, as a small quantity left in the sac may cause the operation to result in failure. Immediately after injecting the acid, remove the canula and knead the scrotum so as to distribute the acid over the surface of the sac. Close the puncture with collodion, and request the patient to remain at home for twentyfour hours, as there will be some soreness and swelling due to reaction. A suspensory bandage should be worn until the scrotum resumes its natural size.

I believe the operation will always result in a cure without any complications if aseptically done, except in cases where the walls of the sac are very much thickened or the accumulated fluid results from syphilis or tuberculosis of the testicle.

Of the fifty-one cases here reported, twenty-eight had