I have employed this method eight times each time the varix been cured the symptoms complained of relieved, and no mischief to the testicle has followed. These eight cases have shown me that there are three things to the carefully avoided. The first is hurry in the section of the veins twice a few drops of blood have followed the escape of the wire but only so little as to require nothing more than lint or cotton wool to be placed over th wound; in neither instance was there any haematocele. The second is to operate well above the tunica vaginalis in one of my cases acute hydrocele was lighter up it quickly subsided under belladonna fomentations. The third is burning of the skin, leading to a small slough; although there is nothing of serious moment in this slough it is of course best to avoid it, if the skin is of course best to avoid it, and if the skin is incised and kept cold and the loop of wire not brought too small it can generally be saved.
I can recommend you to practise this operation, first, because of its entire painlessness after the few moments of its actual performance and secondly because it fulfils the physiological indications better than any other I know of. My cases at present are too few to prove by statistics that it is less dangerous to life than those operations I have mentioned, but they are sufficient to show that the operation is simple effectual and introduces no new danger, while it is obviously free from the sources of irritation common to other methods.
The section of the veins is completed at once there is no foreign body liable to set up inflammation left in contact with the healing veins, which are allowed to remain at perfect rest, while their seared ends are becoming permanently closed. As you are aware the closure of an open vessel by the hot wire or iron is usually considered a particularly safe plan. There is also on interference with the skin of the scrotum, as in Lee’s operation; no compression of the scrotal vessels no oedema.
The only other method that I should at all recommend to you is the use of the catgut ligature applied to the veins subcutaneously. I have had no experience in it but it has been done with success. I think the heated wire is preferable, because the catgut ligature is rather uncertain in its action; it may soften very rapidly and then fail to occlude the vessels or it may not soften at all and cut its way through the veins like an ordinary hempen or silken thread, or remain and subsequently light up inflammation. These accidents are only occasional but we should none the less be on our guard against them, and give the preference to a plan of treatment which is free from them. In none of my eight cases has any slough separated from the veins; the eschar formed has been absorbed by the living tissues. I show you to-day dour cases at varying periods after the operation illustrating their progress.
I.W.J.–, aged seventeen a large left varicocele which he had noticed smaller than right, complained of dragging pains in scrotum and up to left loin. Operation june 21st 1879; left hospital June 28 th a firm induration the size of a marble felt not tender veins below plugged.
2. F.L.–, aged twenty four single injured left testicle five years ago; first noticed varicocele three years ago, after an attack of clap since then the pain and swelling had steadily increases in spite of wearing a suspender. No constipation; external piles for two years. Operation May 28th; left hospital June 8th. The induration as very hard, the size of a horse bean; veins below are firm and shrinking.
3. W.C. –, aged thirty single, very large left varicocele noticed suddenly in June 1879 while bathing. Pain in scrotum and groin had increased of late; testicle smaller than right. Operation May 1st; left hospital May 7th; delayed on account of a slough of skin. Induration now small veins below be felt testicle has regained its former size and is a little larger than right has regained its former size and is a little larger than right.
4. W. S-, twenty-one, a small varicocele noticed some years; scrotum not lax; considerable pain; frequent seminal emissions and mental depression. Operation September 29th; left hospital October 9th. No trace of dilated veins or of the seat of the operation to b e felt. All symptoms relieved.
I should state that the italics in the foregoing quotation are mine. Mr Gould does not even maintain that his operation by the galvanic ecraseur is less dangerous to life than the other modes of operative treatment. Was any one of these four cases sufficiently severe and hopeless to warrant an operation? Mentioning that one testicle is larger than the other proves nothing, as that is the other proves nothing as that is the normal state of all. Note also case 3 – here the operation was performed on May 1, and patient was discharged on may 7, and shewn on July 3, so that he was under observation during the two months and such is the efficacy of an operation by the galvanic of ecraseur that we are informed that the testicle which was smaller than the testicle which was smaller than the right one, not only regained its supposed original size – all in the space of about two months – but actually it “is a little larger than right” what mental myopia.
New let us just reflect on this last word of orthodoxy in the treatment of varicocele. Mr. Gould says “no mischief to the testicle has followed’ How does he know? just look at the dates of his cases. In the one of longest date, just one years has elapsed since the operation. In this period we have not time to see whether there will result a withering or a pseudo- hypertrophy. In the third case, says Mr Gould the testicle has regained its former size and is a little larger than right.” That is to say hyperplasia of connective tissue has begun, and that testicle is probably doomed to get very large and useless for these enlarged testicles are mere masses of tissue, and no real testicles any longer. Let us further note the ages of these patients: 17, 24, 30, and all single.
Of course this able surgeon believes he did the right thing by these poor young men; no man can go beyond his light but we believe that he did them not only no real permanent service, but we maintain that to operate thus on young single men for an affection of this kind is unjustifiable. At least medicines should have been carefully and persistently tried first.
Be it remembered that patients at times die of operations for varicocele; and Mr Gould himself admits that he cannot yet prove from statistics that his special operation by the galvanic ecraseur is less dangerous to life than other operations that he himself condemns. We admit that Mr. Gould is a first class surgeon but, THE BETTER THE SURGEON THE WORSE THE PHYSICIAN.
This surgical treatment of varicocele may be very grand from a surgical standpoint, but it is a bitter commentary on the state of medicine at our public Hospitals and in the profession at large. So I proceed with my task.
CASE OF HAEMORRHOIDS CURED WITH Nux AND Sulphur.
Some six or seven years since, a lady about 40 years of age, came under my observation. She was suffering from external piles, but otherwise was in perfect health and of magnificent physique. She had taken advice on the subject of her complaint and an operation had been determined upon, for which purpose she intended to go to her native city Dublin; but a lady friend of hers, having been admitted to her confidence, told her that the homoeopaths were in the habit of treating this affection successfully with medicines. She did not expect to be cured, but thought there could be not harm in trying the homoeopathic method of treatment.
An eight-weeks course of Nux vomica 30, and sulphur resulted in a complete cure. Nothing remained of the tumour whatever. The diet was not altered and no local application of any kind was local application of any kind was used. The case recent and not severe but yet severe enough for her to have been advised an operation.
Thousands of cases of piles maybe cured with Nux and Sulphur alone; almost any dilutions will act, but the thirtieth is more enduring in its effects apparently than lower ones. Sulphur is a grand polychrest from the crude substance upwards, but sulphur 30 is a mighty prescription. We get used to its wondrous effects and cease to marvel thereat, just we cease to wonder at the electric telegraph or steam locomotion.
I have repeatedly seen Sulphur 30 PRODUCE piles I once saw Sulphur C. cause a rather severe attack of piles “I used to suffer from piles, but I have cured myself with Nux and Sulphur,” is an oftold tale.
The use of Sulphur in piles is not contained to homoeopathic practice by any means, but the use of crude Sulphur rarely finishes a case of because its action seems to become what, in my mind stands as circular: it does the good and then goes over to then opposite action and reverses the good.
Sulphur is the great portal system medicine with Rademacher in his organopathic division of abdominal complaints. His article on the subject of portal stasis is most excellent.
Burnett was one of the first to speak about vaccination triggering illness. This was discussed in his book, Vaccinosis, published in 1884. He introduced the remedy Bacillinum. He authored twenty books, including the much loved "Fifty Reason for Being a Homeopath." He was the editor of The Homoeopathic World.