SURGERY.
New Method of Operating for Extirpation of the Testicle.—The
Gazette des Hopitaux mentions a new mode of incision in extirpation
of the testicle, introduced by M. Jobert, surgeon to the Hotel Dieu.
Instead of making simply a longitudinal or an elliptical incision on the
anterior part of the testicle, M. Jobert makes a shell-like or valvular
opening, by carrying his incision in a semi-circular form along the
lower convexity of the organ. The usual method has been found ob-
jectionable, because a deep cavity is left after the removal of the testicle,
in which fluids may accumulate, and this circumstance seldom allows
of union by first intention. Aumont had formerly proposed to attack
the tumor inferiorly and posteriorly, both to prevent accumulation and
avoid the anterior cicatrix, but M. Jobert prefers the above-mentioned
method, and proceeds thus : “ The bistoury, held like a pen, is plunged
into the inferior part of the inguinal canal, and carried, from above
downwards, along the external and anterior side of the tumor, as far as
its basis, where the instrument is made to sweep round towards the
internal side and ascend in the direction of the ring, without, however,
running so far as that point, but stopping by the side of the penis. The
lips of the wound separate of themselves, and the bistoury needs only
be made to pass under the anterior flap, and then under the posterior,
in order to isolate the whole tumor with an astonishing rapidity. The
vessels may be tied as they are being divided. By this process, the
two flaps will be brought in contact without the least effort, or leaving
any cavity; and the surgeon has no occasion to fear the infiltration of
any liquid. The favorable circumstances will be conducive to union
by first intention, the hope of which had almost been abandoned by
surgeons in cases of castration. The threads, instead of being placed
in the middle of the scrotum, as is the case in the ordinary method of
operating, are placed along a semi-circle, and act as conductors to the
serosity which commonly forms in this region after the operation. This
incision was applied in a case of encephaloid tumor of the testicle, on
the 23d of November last ; and the wound was secured by the twisted
suture. Compresses of cold water were applied ; on the 24th there was
no fever and very little swelling; on the 25th no fe^er, and on the 26th
half of the pins were removed. On the 15th of December, the wound
had been for some days completely cicatrized. This is not quite union
by first intention, but the ligatures of the cord may have prevented that
result.—Lond. Lancet.