receptacle* into which the excretory vessels may instantly empty themselves at all times when such sudden or immediate relief is required; so that notwithstanding the absorbent vessels may be provided with powers to meet such emergencies, yet the effusion being in many instances sudden and more rapid than the absorption, an undue proportion of fluid will, for a short period at least, occasionally remain in the sacculus without being noticed.

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"Without such means of self protection, it seems to me probable that an organ so delicately constructed as the testicle would, at an early period of life, be endangered by the influence of venereal passions, or destroyed by other causes of accidental excitement. And if these visions really exist, they will not only explain many phenomena which occur in the sudden variations of the quantity of fluid within the tunica vaginalis; but as they evince the extreme sensibilities of the testicle, will afford farther proof of its liability to become deranged by such a slight and subtle source of irritation, as I have before stated to be frequently concealed within the urethra.”

The first division of this second part of the volume, as we would call it, treats of

The acute Hydrocele.

This disease is described as consisting of a sudden effusion of watery fluid into the tunica vaginalis testis, attended with pain.

"For the most part it occurs in persons of nervous and irritable habits, generally when they are placed under circumstances of venereal excitement, and never but in such as have stricture, or whose urethra is in some degree in an unhealthy state."

It may seem fastidious to doubt what the author means by "venereal excitement;" but as it is essential to have the language of science unequivocal, and perfectly perspicuous, we make the remark. The adjective venereal, has an extensive application. Venereal excitement possibly conveys an idea of a different kind to what the author intended; even the word excitement is at times so used as not to give a distinct meaning. When the latent irritation is the result of preternatural action, or of excitement, (p. 41) has this defect.

It is more satisfactory to select what is practically useful. The description and treatment of the complaint comes under this denomination.

* Other organs, which are liable to be suddenly overcharged with blood, and distressed by distension under passion or great exertion of the body, probably possess a similar provision. I do not think it unreasonable to suppose, for instance, that the cavity of the pericardium and the ventricles of the brain, even in their healthy state, are occasionally receiving effusions for the temporary relief of their respective organs, when those organs are placed under circumstances above described.

"The

"The commencement of the acute Hydrocele is marked by severe suffering in one of the testicles (I have never seen both glands affected), darting with great violence along the spermatic chord, and extending to the back and loins. The scrotum, without becoming inflamed, is soon distended to a considerable size; the pulse is quickened, and sometimes irregular; but the tongue seldom becomes dry or furred: neither is the skin heated, as in common inflammatory attacks.

"In bulk and outward appearance, and so far as the part is painful on being handled, this complaint very much resembles hernia humoralis, from which, however, it is in fact very different, and on acconnt of requiring another mode of treatment, ought to be carefully distinguished.

"In the acute hydrocele the testicle is not enlarged or diseased, but being in a very irritable state, becomes extremely painful when any pressure is made upon the already distended tunica vaginalis. In the hernia humoralis the bulk of the tumor consists of an inflammatory en largement of the compages of the gland itself.

"Acute hydrocele,if the tumor be not too painful to bear such a test, will necessarily be characterized by elasticity and fluctuation, and generally by transparency. In hernia humoralis the tumor will be firm, possess a considerable degree of resistance, and always be impervious to light.

"I have in some instances made the experiment of pouring cold water upon the acute hydrocele, but as cold constringes the scrotum, and thereby produces upon the testicle an effect similar to pressure, such a proceeding has greatly aggravated every symptom.

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Bleeding from the arm, which might be suggested as a proper and useful measure in hernia humoralis, is in acute hydrocele unnecessary, and in the habits in which the latter most commonly occurs does mischief.

"The principle of practice should comprehend those means which are best calculated to allay general irritability, and particularly to pro. duce local relaxation, since the pressure of the effused fluid against the irritable and tender testicle is the chief cause of the distressing pain, with which this complaint is always accompanied.

"The treatment I have found most beneficial is, to apply leeches (proportional in number to the violence of the symptoms) to the scrotum, and when they have fallen off, to direct the patient to sit in the warm hip bath for a proper time; a brisk purgative may then be given, and after its full operation, a free dose of laudanum combined with some sudorific medicine. In cases in which the pain is peculiarly distressing, I have found it necessary to give the anodyne, without waiting the effect of a cathartic, and in some few instances to direct the farther use of laudanum in an enema.

"On the patient's getting from the warm bath into his bed, the whole of the distended scrotum should be enveloped in a large warm bread and water poultice, and should be kept carefully suspended.

By such means I have never failed within twelve hours, and fre quently in less time, to remove all the painful symptoms; and when they subside the patient has only a common transparent hydrocele,

which is generally within a short though uncertain period spontaneously

absorbed.

"I have before remarked that this complaint is dependant on stricture, or on some more latent unhealthy state of urethra; it will therefore always be necessary when the excitement has subsided to direct the attention to the treatment of the urethra by the bougie, as the only means of securing the patient against a recurrence of similar distressing symptoms, whenever he may accidentally be again exposed to causes of

excitement.

"Acute hydrocele constitutes one of those cases dependant on an unhealthy state of the urethra, in which an early introduction of the bougie will be injudicious. A reasonable time (perhaps two or three weeks) should be allowed to afford an opportunity for the urethra to recover a more quiescent state, and for the fluid to be absorbed before the bougie be used but in case the hydrocele has not disappeared at the expiration of such period, it may be suspected that the existing mischief in the urethra has become permanently active, and continues to excite effusion, and the bougie should, then, be resorted to as the probable means of completing the cure of the hydrocele. In those cases in which the fluid is absorbed within the above period the application of the bougie will be adviseable as a proper precaution, and the only security against a relapse."

The next section is of great importance, and describes several complex forms of disease in the testicle and tunica vaginalis, under the general term,

Spurious Hydrocele.

"Morbid enlargements of the testicle are frequently accompanied with collections of watery fluid within the tunica vaginalis, and thus constitute a very extensive class of diseases. These mixed cases have been mnch too generally considered under the term hydrosarcocele, a name which solely belongs to an incurable affection of the gland; and by the indiscriminate use of which a testicle has doubtless been subjected to extirpation, when under another denomination it would have been deliberated upon, and perhaps eventually recovered. The morbid enlargement of a testicle, accompanied with watery fluid within its tunica vaginalis, may be sclerocele, varicocele, sarcocele, scirrhus, venereal, as it has been called, or scrofulous; and though some of these states may by an intelligent surgeon be recognized through the body of the fluid, or immediately upon the tunica vaginalis having been drained of its water, yet the characters of the disease of the gland are sometimes too much confounded to make it prudent for the surgeon to attempt to designate such disease until it has been subjected to certain tests of surgical treatment."

The object of this section is to shew, and of great impor tance it is, that many cases of enlarged testicle complicated with fluid effusion into the tunica vaginalis are curable, notwithstanding the received opinion that the diseased gland (No. 146.)

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under these circumstances should be removed; but we must allow Mr. Ramsden to speak for himself.

"When a testicle, after the evacuation of the fluid from a supposed true hydrocele, is discovered to be in any way or to any extent enlarged and hardened, whether the spermatic chord does or does not partake of the induration, instead of proceeding to the excision of the part, as has been hitherto too frequently done, it would be proper to have recourse to the bougie for the purpose of ascertaining how far the affection of the gland may be dependant upon an unhealthy state of the urethra; and if any unhealthy state of the urethra be discovered, it is incumbent upon the surgeon to wait the result of the judicious treatment of that membrane before he pronounces the disease of the testicle to be incurable.

"The introduction of the bougie should be also resorted to in those cases of spurious hydrocele in which the enlargement of the testicle can be recognised by examination through the fluid in the tunica vaginalis, even before the evacuation of the fluid. From my own experience 1 can state, that when this practice has been adopted, the necessity of evacuating the water has in many instances been superseded, and under the simple treatment of the urethra by the bougie the testicle has not only been restored to its healthy state, but the undue accumulation of water has been removed by the natural powers from the tunica vaginalis.*

Six cases annexed to this section explain the author's opinions, and illustrate his practice.

The last divisson of this work treats of the

Chronic or true Hydrocele of the Tunica Vaginalis Testis.

In this section, which is more elaborate than either of the preceding, the author inquires into the causes of the true hydrocele, and examines the operations employed for its cure. The same idea that excited states of the urethra, are a frequent cause of discase in the testicle and its tunic, is extended to the chronic hydrocele.

"As I have in the preceding pages endeavoured to demonstrate that the acute and the spurious hydrocele are dependant on excitement within the urethra, I shall now offer a few observations in support of an opinion that the chronic or true hydrocele is produced by a similar cause under further modifications.

"We have already seen that the testicle will become hardened and enlarged, and that the sacculus of the tunica vaginalis will be distended with watery fluid in consequence of various degrees of excite ment within the urethra, from the irritable and acutely painful stricture, down to that concealed, subtle, and local derangement of the mem

*In some very few instances the fluid has remained after the reduction of the enlarged gland by the treatment of the urethra; but when this has been the case the simple tapping of the tunica vaginalis has, so far as my experience goes, always proved sufficient to the radical cure of such remaining hydrocele.

brane

brane which is totally free from pain, until it is pressed upon by the bougie, and which may exist for years without the patient being conscious of its presence.

"It cannot therefore be unreasonable to suppose, that an habitual susceptibility of the whole membrane of the urethra may, in some instances, be induced by general or local causes, and although it create no conscious sensation to the patient, may have the power of gently provoking the excretory vessels of the testicle somewhat beyond their natural action, and thus by destroying the balance of fluid, in course of time establish that undue accumulation which characterizes the chronic or true hydrocele.

"I am induced to offer this opinion from a variety of facts which have presented themselves to my observation, and which lead me to suspect that in almost every case of true hydrocele, the urethra will be found either to have been exposed at some previous time to excitement or inflammation, or to be in a present state of increased sensation, from constitutional irritability, from the membranous fence, or from some other of the several general or local causes to which I have in the preceding pages referred the derangement of this membrane.

"The prevalence of hydrocele in the East and West Indies, instead of being attributable to the relaxation of the climate, may more reasonably be referred to the constant excitement to which the urethra is exposed from the habits of the table; since it is well known that in those hot countries every individual indulges in high seasoned dishes, and in the most stimulating description of diet.

"The frequency of the hydrocele being present with varicocele may also be satisfactorily explained, by referring to that state of continual excitement which is kept up by the distension and weight of the loaded vessels. In the more advanced states of varicocele nothing is more common than an habitual gleet or weeping from the urethra, which is occasioned by the dragging of the varicose vessels; and it certainly appears not difficult to suppose that such excitement in the urethra, when once established, may in its turn re-act upon the testicle, and produce a case of hydro-varicocele."

Though Mr. Ramsden is strongly impressed with his favourite hypothesis, he candidly acknowledges, that "in cases which present themselves under all the appearances of true hydrocele, in which the urethra is less obviously deranged, that an attempt to cure the complaint by the use of the bougie, will lead to no other result than an unnecessary waste of time."

The radical cure of hydrocele has been attempted, and in ́deed,' often effected by various means; as by cautery, incision, excision, caustic, tent, cannula, seton. discutients, and injection. All these Mr. Ramsden rejects, except the last, upor which he says,

"I consider what is termed the radical cure by injection, the only method which ought to be practised in this disease: because it is not attended by those severities and risks which attach to all other modes, and is generally so satisfactory in its final result. Its superiority is in

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