These opinions are illustrated by the subsequent cases: "sclerocele of the testicle from latent irritation within the urethra; sclerocele of the testicle from latent irritation within the urethra, mistaken for omental hernia; sclerocele of the testicle in the groin; sclerocele of the testicle commencing within the body of the gland; sclerocele of both testicles, one of which suppurated, arising from latent irritation within the urethra; fungous sclerocele from latent irritation within the urethra, in which the induration commenced within the body of the gland. The next section treats of

SCIRRHUS in the Testicle, and its morbid Distinctions.

The difficulty of discriminating between sclerocele and scirrhus, is often a source of great embarassment to the surgeon, and of hazard to the patient. This is fully felt by our author, and he gives the following pathognomonic symptoms with doubt and hesitation.

"Whenever a testicle increases in size, is craggy on its surface, and of a stony hardness, whether with or without watery fluid within the tunica vaginalis, at whatever part of the gland the induration may have begun, the first enquiry ought to be whether such a diseased alteration be dependent upon an unhealthy or too susceptible a state of urethra. If in spite of a proper attention to the urethra, and of a general or local trial of mercury seasonably and judiciously used, such induration and cragginess continue to extend, and especially if severe darting pains* in the direction of the loins come on before the skin appears reddened and inflamed, the disease must be viewed as scirrhus."

A case of sclerocele is annexed, which had the characteristics of true scirrhus.

The testicle is occasionally met with in a state of considerable enlargement and induration, free from pain for the most part, without fluid in the tunica vaginalis, unattended with thickening of the spermatic chord; and though hard and resistent, yet retaining an uniform smoothness and equality of surface. This has generally been considered as having a syphilitic origin, and is here noticed in a section treating of that

Morbid State of the Testicle which has been called Venere.

"This state of gland is unconnected with any derangement of the urethra; and being frequently observed to take place during the pro

Even this character should be received with caution and reserve. The common sclerocele, in an irritable habit, will be painful at an early period of the induration; and if accompanied with fluid constricted within an unyieldng tunica vaginalis, will (in consequence of the pressure of such fluid against he gland) be attended with darting pains toward the loins. ' (No. 145.) Nn

gress

in 1

flori.

gress of syphilis, and to yield to mercury, has been supposed to consti tute one of the symptoms of that disease.

"in its general features it bears some resemblance to the sclerocele, the scirrhus, and the sarcocele; but in its particular characters it is essentially different from them all. It resembles the sclerocele and scirrhus in hardness and resistence, but differs from them in its uniform smoothness and equality of surface; it resembles the sarcocele in smoothness and equality of surface, but is distinguishable from it by hardness and resistance."

Mr. Ramsden doubts if this morbid state of the testicle ever has a venereal origin, but observes,

suppo shew. It ta constitut

impaired

"Whether these opinions on the nature of that affection of the testicle which has been called venereal are well founded or erroneous, is perhaps of no great practical importance, since experience has taught us that whenever the gland presents the characters of that morbid enlargement, which I have defined, it will be proper to subject the patient to a judicious and well regulated course of mercurial frictions, which, for the most part, has the effect of restoring the gland to its na tural state.

"This affection of testicle, however, is sometimes blended with the sclerocele; and whenever therefore a derangement of the urethra shall be ascertained to be present with it (I have already said that in every instance of morbid enlargement of the testicle the urethra should be examined), it will be right to resort to the occasional use of the bougie during the mercurial course.

"I have to remark also, that in a majority of instances where the case is of this mixed kind, the back part of the testicle will be found, on a careful examination, to be more rugged and unequal, than the general bulk of the tumor."

The next morbid alteration of the testicle, noticed by Mr. Ramsden, is,

The Scrofulous Testicle.

"When a testicle increases in fullness of size, retaining in a great measure the outward features of the gland, is at the same time free from pain, or any affection of the spermatic chord, and is characterized by a soft, pulpy, relaxed feel without elasticity; such a state of the gland, called a scrofulous testicle.

"Children and adults are equally liable to this affection. It occurs those children who have light or red hair, a delicate skin, with a Aord complexion, and such other general external appearances as are supposed to mark a disposition to scrofula, and especially in those who Shew any tendency to mesenteric obstruction.

It takes place in those adults who are naturally of a weakly, delicate constitution, or whose system has been weakened, and general health impaired by a long residence in hot climates, or by an irregular course of life.

In children it is no unusual occurrence to find, even before the tes "In chticle has acquired any considerable degree of fulness of size, the skin of

of life.

the

ticle has

acq

the scrotum to give way, the testicle repeatedly to slough, and the arts afterwards to cicatrize without much difficulty.

"But in adults the skin of the scrotum seldom gives way, so as to expose the body of the testicle until a very considerable increase of bulk has taken place; yet such enlargement is not attended with pain or affection of the spermatic chord, neither is there any derangement of the health, farther than seems to arise from general debility.

"In such an enlarged state of gland the skin of the scrotum will redden and break sometimes in several places, and will expose different parts of the substance of the testicle in a state of slough. The progress of the sloughing, however, is commonly very slow, and only takes place at intervals; so that a patient will carry a diseased testicle of this description, from time to time throwing off sloughs and for many years, without the mischief extending up the chord, without much injury to the general health, and without being incapacitated for the common avocations of life.

"If the sloughing ceases before the gland be quite destroyed, the surface of the remaining portion frequently becomes elevated above the level of the skin of the retracted scrotum, and projects luxuriant granulations, which, from the difficulty of being restrained within proper bounds, very much impede cicatrization."

It is not contended that this morbid state of the testicle arises from irritation in the urethra ; but that such irritation will induce upon a testicle previously disposed to, or suffering under scrofulous affection, such a change in its appearances as will materially alter its pathognomonic symptoms.

In the former part of this analysis, we observed that our author did not include sarcocele in his arrangement of morbid alterations in the testicle. He, however, described this disease in the prefatory part of his work, as differing specifically from scirrhus; that on dissection it displayed features peculiar to itself; that it was fleshy and elastic to the feel; was often found to contain within its substance partial collections of bloody sanies; and that it did not present the ligamentous radiated appearance, which in true scirrhus is uniformly observable. He also gives it a place in the body of the work; and we consider it to be an affection of such importance both to the patient and to the surgeon, inasmuch as it is intractable to medicine, and demands a prompt decision on the part of the practitioner, that we shall insert the whole of the section which treats on it.

* It is to be remarked, that when the scrofulous testicle is about to enter into its second stage, which is generally a short time before the skin begins to appear discoloured, it gradually loses its grand characteristik feature, viz. its soft, pulpy feel, and acquires a degree of general hardness very ruca resambling what is attendant on the first stage of that state of the testicle which has been called venereal.

"When the body of a testicle increases in bulk, feels fleshy and elastic, is perfectly smooth and uniform on its surface, without thickening of the spermatic chord, and occasions no pain or inconvenience but from its weight, or on being handled, I should suspect such affection of the gland to be sarcocele.*

"This disease is idiopathic, and has hitherto been incurable; although it may occasionally exist for years without making much progress, it is always liable to sudden and dangerous changes, which may place it even beyond the reach of an operation.

"As the disease proceeds, it induces derangement of the system, and the countenance of the patient assumes a peculiar sallowness of appearance.

"In the more advanced stage of sarcocele, even without the presence of pain, there will occur partial collections of fluid, commonly of bloody sanies, within the body of the gland, which present themselves by mamillary elevations of the tunica albuginea. The fluctuation in these elevations will be so distinctly felt as occasionally to mislead the surgeon, and induce him to puncture them, under a supposition that the bulk of the tumor wholly consists of a collection of fluid.†

"Such a mistake may lead to the most serious results, since it seldom happens that the gland will again subside into a quiet state.

"When the disease in its regular progress, or by the excitement of any accidental circumstances, reaches its painful or suppurative stage, it will lose its elasticity, assume the common characters of irritation, and projecting a painful gleeting fungus from the ruptured part, extend with a rapidity which not only sets all means of relief from surgical treatment at defiance, but sometimes renders castration itself ineffectual.

"It will appear from the preceding observations that the fleshy elas

*"If the body of the testicle, though enlarged and indurated' to some degre, be perfectly equal in its surface, void of pain, has no appearance of fluid in its tunica vaginalis, and produces very little uneasiness except what is occasioned by its mere weight, it is usually called a simple sarcocele, or indolent scirrhus." POTT.

+ In some few cases of sarcocele a small quantity of fluid, but of a limpid kind, will also be found within the tunica vaginalis, and will be bound down so tightly on the diseased gland as to render it painful and progressive at an early period, I have a patient at this time under my observation with true sarcocele, and I have twice within the last eighteen months stopped the progress of the disease by cautiously evacuating a small quantity of fluid from the tunica vaginalis. I do not, however, venture to recommend the practice; and would gladly prevail upon my patient to part with his testiole, but he has hitherto resisted my advice, and will probably repent it, as the gland is daily liable to be placed beyond the reach of an operation.

"Gleeting." This sort of discharge, or a discharge of "bloody sanies," is not a pathognomonic character, though it has hitherto been considered as such. When a fungus of any description is projected through the tunica vaginalis, the natural but excited secretion of that sacculus mixes with the purulent discharge of the fungus, and gives the gleeting appearance." When this secretion of the sacculus happens also to be tinged with blood in passing over the irritable surface of the fungus, it constitutes "the bloody sanies," on which so much stress has been laid as a supposed character of cancer in the testicle.

ticity,

ticity, with the total absence of induration* and cragginess, are the chief characters which distinguish sarcocele from other morbid enlargements of the testicle; on this account a collection of blood or watery fluid within a diseased or thickened tunica vaginalis may easily be mis taken for sarcocele.

"The fleshy elasticity of a testicle in the first stage of sarcocele is so similar to the feel of fluid through the medium of thickened membrane, that the most experienced surgeons have been deceived by it. This de ception indeed is acknowledged to be so imposing, that it has now be come an established point in practical surgery, invariably to puncture a supposed sarcocele, previous to the intended operation of castration.

Since sarcocele is idiopathic, in all its stages incurable, and even in an apparent quiet state liable to sudden and dangerous changes, it will be the duty of the surgeon, as soon as he has distinctly ascertained its character, even before the gland has acquired a painful state, to explain to the patient the danger of his retaining a testicle under circumstances of such extreme hazard, and to submit to him the propriety of its removal."

The remainder of the volume appropriated to the diseases of this part of the frame, consisting of one hundred and forty pages, is occupied by observations on "Watery Effusions into the Tunica Vaginalis.' (To be continued.)

MEDICAL AND PHILOSOPHICAL INTELLIGENCE.

ROYAL SOCIETY.-The Society, on meeting after the holidays, concluded the reading of Dr. Parry's paper on the means of curing certain nervous affections merely by pressure on the carotid artery; a method which he proposed several years ago, and has found effectual in almost every case.

The same evening a mathematical paper on the hyperbola was laid before the society by the Rev. Mr. Helens; but it was of a nature not to be read.

A curious account of a child born in Wales without eyes, or rather without eye-balls, was communicated by Mr. Jones: a small round white ball is found in the place of the eye, and the tunica conjunctiva was perfect. The mother attributes this organic defect to a fright which she received when seven months gone with child.

A letter from Dr. Wollaston to Dr. Marcet was read, in which Dr. W. related his experiments formerly made with a view to ascertain the existence of sugar in the serum of the blood of diabetic patients. The result of a considerable number of experiments, as

* "Every species of sarcocele consists primarily in an enlargement, induration,' and obstruction of the vascular part of the testicle." Vide POTT. well