[Reprinted from the Journal of Cutaneous and Genito Urinary Diseases for April, 1895 ] 
A NEW VARICOCELE NEEDLE, AND HOW TO USE IT. 
By Dr. W. W. BOWES, 
Atlanta, Ga. 
THE principle involved in the subcutaneous ligation of the 
spermatic veins for the cure of varicocele (Keyes's method) is a 
correct one, but the means at hand for its perfect accomplish- 
ment have been inadequate. 
There were two leading objections to the needles in vogue for the 
performance of this operation : First, the almost impossible feat of 
returning the needle posteriorly through the place of entrance, and, if 
not so done, the engagement of the dartos with the ligature, which had 
to be torn through, making it very painful to the patient and liable to 
break the ligature; second, the danger with a sharp-pointed needle 
either in pricking the veins in going around them or of wounding the 
dartos in escaping them. The use of twTo needles is very unhandy. 
The above needle, constructed for me by George Tiemann & Co., 
does away with both of these objections. It consists of a blunt-pointed 
needle, covered with a needle-pointed sheath running its whole length, 
the eye being opposite in needle and sheath, the sheath having a mark 
near its proximal end (see cut). 
How to use the Needle.-The patient standing, with a pair of scissors 
curved on the flat, clip the hair very close on the upper scrotum, at 
junction to perinseum (shaving is not necessary), and bathe the region 
well in bichloride. 
Now with left thumb and forefinger separate posteriorly the vas 
deferens from the cord, and, while holding the scrotal walls tightly, 
press the sheathed needle, threaded, through from before backward, 
putting a small velvet cork on the point of the needle. Now let the 
patient carefully lie down ; the cork will prevent the needle from 
pricking the thigh in doing so. Unthread the needle, and well ad- 
Copybight. 1895, by D. Appleton and Company. 2 
A New Varicocele' Needle, and how to use it. 
vance the sheath; the cork will now balance the sheath on the thigh 
and take care of itself. Now withdraw the needle till the eye is barely 
seen, go around the veins to the outside, hugging the dartos all the 
time, returning the needle posteriorly to the sheath, which latter may 
now be advanced till the mark-on the proximal end is seen, the needle 
entered the sheath, and both passed out posteriorly. Rethread the 
needle, giving it a roll to engage the thread, and withdraw anteriorly. 
The ligature is now around the veins, but, instead of tying imme- 
diately, leaving a quantity of Blood in the veins below the ligature to 
be removed by absorption, I raise the scrotum, let all the blood drain 
out. then complete the operation by tightly tying, cutting the ligature 
close, and dropping the knot in by raising the skin over the knot. A 
strong carbolized silk ligature is used. As I always do this operation 
without the services of an assistant the use for the cork is necessary. 
Thus a varicocele is cured without cutting or bleeding or the use 
of anaesthetics, local or general, and with little or no interruption ot 
the patient's business. The patients sometimes come quite a distance, 
are operated on, and return home on the next train ; they do not go to 
bed, though it is a good plan to caution them against undue exercise 
for a few days, and to continue the use of a suspensory bandage for a 
month.