which preceded. Dr. Thomson's lectures on anatomy and mineralogy, and Dr. Sibthorp's on botany, were delivering at the same period; and produced a taste for scientific researches which bordered on enthusiasm. (To be continued.) Practical Observations on the Sclerocele and other morbid Derangements of the TESTICLE; also on the Cause and Cure of the acute, the spurious, and the chronic HYDROCELE. The whole illustrated by Cases. To which are added, four Cases of Operation for ANEURISM, Subclavian, femoral, popliteal, and femoral-popliteal; with practical Remarks and Plates. By THOMAS RAMSDEN, Surgeon to the Royal Foundation of Christ's Hospital, to the Foundling, and Assistant-Surgeon to Bartholomew's Hospital. 8vo. Lond. 1810. pp. xxiv. 347. Plates 2. Ir the opinion that medical literature is occupied, principally, by men of little practical knowledge, is founded on fact, it is not a doubtful assertion, that even this circumstance is accompanied with peculiar advantages. Though discoveries may not be made by this class of writers, though they may not suggest new modes of treating diseases on the ground of experience, they develope, by their erudite labours, the pages of antiquity; they select, examine, and condense, the knowledge of past times; and they render accessible to those, whose days and nights are employed in hurried visits to the sick, facts and observations which men of extensive practice have not leisure to seek among the frightful multitude of learned, dull, ingenious, obscure, illiterate, or trifling books. In the instance before us we have the satisfaction to notice, however, a book written by a Gentleman of extensive prac tice, of undoubted chirurgical skill, and of deserved reputation for operative dexterity. As it is our intention to pass by, as much as we can, all hypotheses, and to dwell upon practical facts, and that intelligence which leads to new and improved methods of treating diseases, we shall touch but slightly on the Preface or introductory chapter of Mr. Ramsden's work, which contains what he denominates "a new theory with regard to schirrus and cancer of the Testicle." But it will be proper to observe, that we are instructed in this prefatory part, that accident directed its author to an inquiry which ended in a conclusion, that, most of the cases of enlarged and indurated Testicle are symptomatic. "While it is not my intention," he says, " to deny the existence of idiopathic diseases in the testicle, I am fully authorized in asserting,. that such a disease is extremely rare, and that very many cases of morbid induration, induration, hitherto supposed to be idiopathic, may be safely considered, and successfully treated, as arising from a principle of irritation con cealed within the urethra." In pursuing this investigation, the object is to shew that"Irritation frequently applied to a testicle, will produce appearances and consequences very similar to what are esteemed true characteristics of schirrus and carcinoma. And it is deduced from this fict, that the malignancy of the ulcerative stage of true schirrus in the testicle does not, as has been supposed, depend on the presence of any morbid poison, but differs from the malignancy of the ulcerative stage of common indurated testicle, merely with regard to the part of the gland in which irritation causing its derangement has been primarily established. "In illustrating this opinion, it is to be remarked that when a testicle is affected by true schirrus, as it is termed, its morbid alteration will be found to originate within its organic structure; but when the gland becomes indurated and enlarged in consequence of exterior.causes of excitement, the morbid symptoms are, in the first instance, entirely confined to the surrounding or intervening cellular substance." This is not to be considered as an hypothesis founded on conjecture, or arising out of analogical deductions, but as a plain demonstrable fact. "If a testicle, enlarged and indurated by idiopathic, schirrous derangement, be divided and examined, its organic structure, even before the gland has become painful or inflamed, will be found imperfect or obscured; the centre is more compact and has a more uniform texture than the rest of the tumour, and is nearly the consistence of cartilage. This middle part does not exceed the size of a silver penny, and from this in every direction, like rays, are seen ligamentous bands of a white colour and very narrow, looking in the section like so many irregular lines passing to the circumference of the tumour, which is blended with the substance of the surrounding gland. In the interstices between these bands the substance is different, and becomes less compact towards the edges." "If a testicle, indurated and enlarged from excitement exterior to itself, be examined before it becomes painful or inflamed, the morbid alteration will be found in the cellular substance only, and will appear more and more faint as it approaches near to the organic structure, which is yet entire.” Upon these premises, and admitting there are two very distinct classes of enlarged and indurated testes, symptomatic and idiopathic, Mr. Ramsden states, with a propriety of li mitation that becomes the investigator of the laws of nature, and the inquirer after truth, "That the disease which we are accustomed to call true schirrus in the testicle, consists solely in irritation primarily established within the organic structure, and that such idiopathic induration differs from symptomatic induration in the following particulars: the former always By organic structure those parts of a gland are meant which are necessary to its particular functions, and the office which it holds in the animal eeunomy, proceeding proceeding FROM organic structure towards the surrounding cellular substance; the latter as uniformly proceeding from the surrounding and intervening cellular substance TOWARDS organic structure." In conformity with this arrangement Mr. Ramsden proposes to distinguish these different forms of morbid alteration in the testicle, by the terms SCLEROCELE, for the symptomatic induration. HYDRO SCLEROCELE, when the symptomatic induration is accompanied with a scrous effusion into the tunica vaginalis testis*. CARCINOMA, if retained at all, may be used to describe the ulcerative stage of symptomatic induration; and IDIO-CARCINOMA, to express the ulcerative stage of idiqpathie ulceration, There is another form of disease in the Testicle, known by the term Sarcocele, upon which Mr. Ramsden treats, though he has not comprehended it in this arrangement, This mor bid enlargement of the testicle, which appears distinctly to differ from the preceding, he thus describes. "The Sarcocele, which has been unfortunately (I say unfortunately, because I believe it to be a circumstance which has perplexed and confounded our enquiries) considered by our best authors merely as a variety of Schirrus, in fact possesses very few morbid characters in common with it; it is true, indeed, that the Sarcocele commences within the organic structure of the gland,' and proceeds according to the laws of common irritation, but in outward character and on dissection it display's features which are peculiar to itself; since it is fleshy and elastic to the feel, and when divided is often found to contain within its substance partial collections of bloody sanies; it is also in a great measure freed from that ligamentous radiated appearance, which, in true schirrus, is uniformly observable.” Having premised this statement as explanatory of the fundamental principles in Mr. Ramsden's work, we shall proceed in our next Number to present our Readers with an analytical view of such diseases of the testicle as are detailed by the author, under the general head of affections of the testicle dependent on a principle of latent irritation within the urethra, particularly as arising from a membranous fence at the aperture of the urethra-of the sclerocele, or indurated testicle of the schirrous testicle, and its morbid distinctions -of the morbid state of the testicle which has been called venereal of the scrophulous testicle-of the sarcocele-of the acute, spurious, and chronic hydrocele. * Does the lymphatic if it does it will require, express it. (To be continued.) An Account of Diseases in an Eastern District of London, from Dec. 20, 1810, to Jan. 20, 1811. Dysenteria 2 Hypochondriasis Herpes 12 Rheumatismus Acutus 3 Rheumatismus Chronicus 17 CHRONIC DISEASES. Tussis Dyspnoea 12 Tussis cum Dyspnoea - 10 Catarrhus 3 Pleurodyne 4 Phthisis Pulmonalis 2 INFANTILE DISEASES. 5 3 2573 446 4 Convulsio In addition to this account it is sufficient to observe, that the state of disease during the last few weeks is very similar to that which was given in the last report. The different diseases of the lungs, which form a large portion of the list during the winter season, had then appeared, but in a more mild form. The extremely severe cold which has since prevailed, and which seems to have exceeded almost every thing which can be recollected for a considerable number of years, has produced a great aggravation of symptoms, amongst (hose who were before labouring under the complaint, and has given occasion to it amongst those in whose constitution there was a peculiar predisposition to it. REPORT OF DISEASES, Under the Gare of the late Senior Physician of the Finsbury Dispensary from the 20th of December, 1810, to the 20th of January, 1811. THE Reporter was a few days since consulted by letter from a remote part of the country, with regard to the expediency of a chirurgical operation in a very grievous instance of scrophulous disease. At a distance from the spot, and the case being of a nature partly surgical, it was of course only in a very qualified and conditional manner that he ventured to give his medical opinion. The circumstances and history of the com plaint, however, were represented to be such, as led him to discourage the the two hasty performance of the meditated operation. Scrophula being a disease of the constitution, is seldom to be remedied by the extraction or amputation of parts. The human frame rarely indeed suffers, unless when it is induced by external violence from any morbid affection that may strictly be regarded as local. The appearance of it may be superficial, or confined to a particular spot, but the real root is. for the most part fixed in the interior, and is secretly ramified throughout the whole substance of the frame. For want of a due regard to this circumstance, limbs may be lost without life being preserved, or health in any degree amended by the deprivation. A case of epilepsy, that has recently fallen under the Reporter's notice, was a considerable time before anticipated, in a certain degree, by : feelings which not unfrequently occur in a person who is destined, at some future period, to be the subject of this affection. Not merely an acquaintance with the actual symptoms of a disorder, bnt with the previous history also of the patient, are highly interesting and instructive: the latter knowledge is often as necessary to the. prevention, as the former is to the cure, of a disease. It is of im-; portance to know and to interpret rightly those signs which por tend the approach of any formidable malady, that our fears may be aroused in time, and that we may seasonably oppose to the morbid tendency all the means of precaution and counteraction in our power. In complaints which fall under the denomination of nervous, this is more particularly incumbent. Upon minute enquiry of the patieut alluded to, it appeared that several years before the complete formation of an epileptic paroxysm, she had been liable to a sleepiness, which was not removed by actual sleep, to a frequently recurring sense of intoxication,, without having taken any inebriating draught or drug, to an almost habitual unsteadiness upon the feet, and sometimes to an actual staggering. She had been also remarkable for some months before her late, which was her first attack, of this complaint, for an incessant restlessness, and propensity to locomotion, a continual disposition to change her posture or her place. This mobility extended likewise to the mind, so that a permanent direction of it to one subject was an effort beyond her power. The attention was always fluttering on the wing. Not long before her epilepsy, she mentions having frequently experienced a variety of uncomfortable feelings, such as flashes of light before her eyes, head-ach, violent rushings as it seemed of blood towards the head, dizziness, dimness and confusion of vision, and a frequent sense of faintness approaching to syncope. She also states the having been subject to transient absences of the intellectual faculty, which would seem to desert her for a few minutes, and then return in a manner that she could not account for. It is but seldom that we meet with a person whose previous life afforded so many admonitory hints of the specific danger which threatened her constitution; although perhaps it is for want of a scrutiny sufficiently strict that we do not ascertain, in every case of true epilepsy, the occurrence of most at least of these preliminray circumatances of awful presage. J. REID. |