Hydrocele.—Hydrocele is an accumulation of yellow serous fluid in the tunica vaginalis testis (refer to the engravings in next page), or peritoneal covering of the testicle. It is a disease incident to every period of life, but more commonly met with in grown persons. The ordinary formation of hydrocele is unattended with pain; and the patient accidentally discovers the existence of the swelling, but oftentimes not until it has attained a considerable magnitude. The tumor, when large, produces an unsightly appearance, and forms a hindrance to sexual intercourse, from the integuments of the penis being involved therein, and thereby preventing a perfect erection of that organ. The disease may appear to originate spontaneously; but it is usually traceable to some bruise, blow, or other external injury to the part.
The two following drawings exhibit the outward and inward appearance of the scrotum in hydrocele:—
The Scrotum largely distended.
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The Scrotum distended to its utmost extent, and the position of the fluid shown. The penis is almost always more or less drawn up, and in severe cases it appears drawn up so as scarcely to be perceptible.
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The notion that the cure of hydrocele depends on promoting adhesion to the sides of the tunica vaginalis with the testicle is somewhat upset by several preparations in the London hospitals, exhibiting the tunic taken from persons in whom a radical cure was effected by injection, and in whom no fluid was reproduced; nor were the sides of the said investment at all adherent with the testicle, but apart, as in the healthiest individual. Hitherto surgeons, acting on the aforesaid notion, with a view to obliterate the cavity, adopted various plans of treatment—such as, for instance, laying open the entire cavity, cutting away a portion of the tunica vaginalis, the application of caustic, and, lastly, the seton, as advised by Dr. Pott, which was suffered to liberate itself by ulceration. When, in any of these instances, suppuration was induced, the cavity became in time filled up by the granulating process. The plan of the present day is by perforating the sac with a trocar, suffering the effused fluid to escape, and injecting some stimulating liquid which is allowed to remain until a degree of inflammation is produced, that shall cause an obliteration of the cavity by adhesion, or, as it has also been proved, prevent a reproduction of the fluid, by closing the mouths or altering the diseased action of the exhalent arteries. Whichever be the effect produced thereby, the cure is almost certain, and the principles of the treatment consequently judicious. But, notwithstanding, the operation is not always immediately, nor ultimately successful; the degree of inflammation set up may be insufficient, and the effusion again take place, and the operation may require a second and third repetition; or an excessive degree of inflammation may ensue, that shall occasion serious constitutional disturbance, either by suffering the injected fluid to remain too long, or its being of too stimulative a character, or from its escaping into the cellular membrane of the scrotum, an accident not unfrequent, unless great care be used in the operation.
Radical Cure of Hydrocele.—The term radical is applied to the process narrated in the last case; but, as has been observed, the operation is occasionally required to be repeated several times. In the case I am adverting to, after tapping, several injections were thrown in between the tunics, and withdrawn; and on one occasion the morbid fluid was secreted to the greatest possible distension of the scrotum by the following morning. Its subsequent withdrawal, and the injection of a more active stimulant, effected, however, a permanent cure. In the country, surgeons frequently plunge a lancet in the scrotum, suffer the effused liquid to escape, and desire the patient merely to wrap the parts up in a handkerchief, to take no further heed, and to ride home: and these cases generally do well.