. Diseases of children. symptoms, and is notpainful on pressure, is a hydrocele. Treatment.—The simplest, and often the only treatment, is topuncture the cyst and draw off the fluid, which is best accomplishedwith a small aspirating needle. If after three such withdrawals curehas not resulted, surgical measures should be resorted to. The besttreatment for the reducible form of hydrocele is to return the fluid bymeans of gentle taxis into the abdominal cavity, and then apply atruss with the hope that pressure may not only prevent the return ofthe fluid, but also gradually produce obliteration o
. Diseases of children. symptoms, and is notpainful on pressure, is a hydrocele. Treatment.—The simplest, and often the only treatment, is topuncture the cyst and draw off the fluid, which is best accomplishedwith a small aspirating needle. If after three such withdrawals curehas not resulted, surgical measures should be resorted to. The besttreatment for the reducible form of hydrocele is to return the fluid bymeans of gentle taxis into the abdominal cavity, and then apply atruss with the hope that pressure may not only prevent the return ofthe fluid, but also gradually produce obliteration of the canal. Injec-tions of iodine into the hydrocele sac are not to be recommended;the subsequent inflammation is often very severe, and in those patientsin whom the canal is still open, the procedure is attended by a certainamount of danger. Phimosis which causes tenesmus and consequentincrease of intra-abdominal pressure should be operated upon. Thesurgical operation, of choice, is extirpation of the hydrocele Fig. 16.—Hydrocele in an infant aged six months. OBLITERATION OF THE BILE DUCTS. The common hepatic or cystic duct may be obliterated as the resultof imperfect development. A narrowing of the lumen of one or moreof these ducts results in inflammation of their lining membrane whichfinally stops entirely the flow of bile. Either the common duct alonemay be affected, or the hepatic or cystic duct may be the one peritonitis is probably secondary to the atresia of thebile ducts. In about 10 per cent, of these cases there is a history ofsyphilis. The gall-bladder is small, often onl}^ rudimentary, althoughin atresia of the common duct it may be greatly distended. Theliver is usually much enlarged and shows the changes due to chronicinterstitial hepatitis. The spleen is enlarged, and the bile duct may bereduced to a fibrous cord. 100 CONGENITAL MALFORMATIONS Symptoms.—^All the tissues and organs of the body are deeplyjaundiced, and hemorrhag
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