Two Clinical Lectures ON LESIONS OF THE TRIGEMINAL NERVE
fingers placed above Poupart's ligament came directly upon the tumour. There was very little pain. He had begun to have a little uneasiness down the course of the anterior crural nerve. He gradually became cachectic as the tumour increased and died about six months after I saw him. In this group the tumour is in the lower abdomen, usually on one side, and, as in Cases 1 and 2, it may have the outlines of an enlarged testis with the epididymis attached. It is interesting to note that in two of
... e cases there was ascites, a not uncommon event in connexion with the solid abdominal tumours, particularly of the ovary.2 The general contour of the abdomen in Case 1 suggested simple ascites and the tumour was only discovered on deep palpation. The cases are not very common. Chevassu in his recent study has collected 128 cases of tumour of the testicle from recent literature, and of these ten were inguinal and five abdominal. There is not much difficulty in the diagnosis, as very often the tumour has the shape of the testicle with its epididymis. In the cases of Abel 4 and of Marion 5 the tumour occurred in hermaphrodites with the external genitalia of women. The nature of the growth was of course not suspected until operation when the uterus and ovaries were absent and sarcomatous change was found in one of the abdominal testicles. The question of prompt surgical treatment is important, as involvement of the glands may occur very early as in this case. The abdominal tumour has been removed in many instances, but great difficulty has been met with in complete extirpation, as in Case 1. The retained testis lies so close to the posterior abdominal wall that the adjacent tissues are soon involved. Considering the liability to rapid involvement of the lymph glands of the affected testicle it would seem reasonable in all cases to remove them as well as the primary tumour. It adds greatly to the seriousness of the operation, but in young persons the risk is worth taking. It was done by Roberts 6 of Philadelphia, but his patient was old and fat and the operation was secondary to a recurrence.