gonorrhea, or gave a history of the disease; ten gave no history of gonorrhea or syphilis; eight had syphilitic involvement of the testicle; four were tubercular; and one cancerous. Three of the cases had double hydrocele. All of the eight syphilitic cases also gave a history of gonorrhea. Of the fifty-one cases, all were injected with carbolic acid except three of the syphilitic, the tubercular and cancerous. Three of the cases were tapped and never reported again. In three of the syphilitic cases injected, the fluid returned and they were injected again after being on anti-syphilitic treatment for a few months. After tapping a hydrocele, if the testicle is found to be enlarged, hard and irregular in shape, indicating syphilitic or tubercular condition, it is useless to inject carbolic acid. The patient should be put on proper treatment for such condition, and if the testicle is syphilitic, the hydrocele as a rule will disappear as the testicle becomes normal. It is rare to find a cyst springing from the testicle or fluid in the tunica vaginalis containing spermatozoa. This condition is termed spermatocele, and is produced by inflammation of the seminiferous tubules, thus causing retention of the semen in the constricted tube forming a cyst. Should the cyst rupture into the tunica vaginalis, the condition resembles hydrocele. On account of its rarity, without giving a detailed report, I mention three cases that have come under my observation. Two of the cases consulted me on account of an enlargement of the testicle; the first case in 1904, and the other in 1907. Both cysts were small, containing five or six drams of fluid alive with spermatozoa, and were cured by incision. The third case was seen by request of Dr. A. L. Fowler at the Federal Prison. About two ounces of fluid of a milky appearance was drawn off, which under the microscope showed the field swarming with spermatozoa. REFERENCES. Surgical Diseases of the Genito-Urinary Organs, Dr. E. L. Keyes, 1903. A Text-book of Genito-Urinary Diseases, Dr. Leopold Casper, 1956. DISCUSSSION ON DR. CHAMPION'S PAPER. Dr. T. H. Hancock, Atlanta: I have never done very much work in this line, but have often injected more than the thirty drops of carbolic acid allowed by the text-books and was glad to hear Dr. Champion say that he often uses a dram or two drams. Dr. Floyd W. McRae, Atlanta: I do not think this is the best treatment for hydrocele. I tried it for a good many years, and I think a good many of the cases we suppose are cured go to some one else and get operated upon. That has been my experience, and I have operated on a great many cases that have been injected, and so I have quit injecting them, not because I do not believe it will cure a number of cases, but because I think it is more of an operation than the simple surgical treatment, and it is less of a cure. The bottling operation is the simplest surgical procedure that I know of. It can be done under cocaine and will cure every one of these cases without complication, and you can do it in a few minutes. The operation simply consists in opening the sac, under cocaine or a little chloroform, and simply pushing the sac back over the testicle. If you make the cut too large and it doesn't fit well around the cord you can take a stitch in it. You turn the sac wrong side out. I never had any serious consequences follow the injection of carbolic acid, but can understand how it might occur if you had a sinus communicating with the peritoneal cavity. I think the knife simpler, safer and more certain in this class of cases. Dr. W. B. Armstrong, Atlanta: I do not think the common practice of aspirating and injecting carbolic acid and other irritants is exactly a scientific operation for one reason in particular: that the testicle by the open operation can always be inspected and any serious trouble can be eliminated early, while with the injection of an irritant any serious disease would only be increased and the chances of cure lessened. Dr. C. T. Nolan, Marietta: I have done a few operations, probably twenty, for hydrocele, and I do not think there has been a single case of failure. I have had to operate on some second time, and have often used as much as a dram of carbolic acid. I am sure every one of the cases was cured because they are where I can watch them. Dr. McRae's operation may be better, but the other method is so simple and easy that I prefer it. Dr. W. W. Battey, Jr., Augusta: Dr. McRae's remarks are well taken, but we frequently see cases that won't submit to the knife, but will allow this treatment. In ten cases I operated on five were cured by the aspiration method and two by the bottling method, while the other three remained uncured. I think we should give them a chance to, try the carbolic acid treatment before resorting to the knife. Dr. W. L. Champion (closing): Most of the cases I have followed up, and they have been cured. The open operation is indicated where there is very much thickening of the sac in old hydrocele, but it has been my experience that the carbolic acid cures them. As Dr. Battey has just said, some patients will not submit to the knife, and in these carbolic acid will accomplish the purpose. EARLY OPERATION FOR ADENOIDS. BY ALEX. W. STIRLING, M.D., C.M. (EDIN.), D.P.H. It may possibly appear to some that one who in these days ventures to write even a short paper upon the subject of adenoids thereby makes himself a public nuisance, and should at least apologize for his temerity. It is to be hoped, therefore, that the subject-matter of this communication may prove its own sufficient excuse. For, in spite of all that has been said concerning nasal obstruction, I believe that, in relation to the matter upon which I propose to dwell for a few moments, even now its dire effects have not been thoroughly appreciated. I shall pass lightly over the digestive symptoms produced by the swallowing of post-nasal secretions; the fever, the disturbed sleep, due to insufficient aeration of the blood and the natural attempt to breathe with the mouth shut; the consequent listlessness and aprosexia; the enuresis, explicable on the theory that the nerve centers are dulled as by nitrous oxide, or, perhaps reflex, like the not uncommon hay fever, asthma, and stammering; the enlarged glands behind and perhaps in front of the sternomastoid muscle; the enhanced liability to and danger from such diseases as scarlet fever, diphtheria, bronchitis, etc.; the frequent deterioration of the general health, as shown by anemia, stunted growth, headaches, night sweats, and so on, brought about by a combination of the various ingredients in the pathology of the whole condition, a vicious circle having been set up; the nasal "catarrh," along with the Eustachian infection, middle ear inflammation, deafness, and perhaps mastoid involvement, which we know to be common incidents in the lives of adenoid subjects. This cycle of events is already fairly familiar to all practitioners of medicine, and even the laity is beginning to look upon "asteroids," "aneroids," or whatever may be the name by which they know the offending growth, as one of the numerous penalties which afflict such as uphold the nation by multiplying the family. But there is one feature of the mouth-breathing question which has not yet become nearly so indelibly impressed upon either the medical or the lay mind as it deserves. I refer to the permanent deformities which follow upon it, if it exist while the facial or thoracic bones are still in the plastic stage. These deformities have been, by certain French authorities, laid at the door of rickets, and even of syphilis. The latter is certainly a very rare cause, but it may be that there is some relationship between the osseous changes and rickets, while rachitic bones are doubtless especially liable to alteration in shape from external pressure. In discussing these changes, it may first be stated in general terms that the mouth is related to the digestive, the nose to the respiratory system, and it ought to be looked upon as nearly as outrageous to breathe through the mouth as it would be to drink through the nose! Circumstances make the former, however, an all too common proceeding, and with disastrous, if insidious, effects, except when used as an assistance to normal nasal breathing during extraordinary physical effort. As regards the facial deformity, the crux of the affair lies with the palate. The palate is moulded into shape main |