370 



Case I. — Charle9 Teak, a seaman. aged thirty-four years, born 

 in England, was admitted into the New York Hospital, February 

 29th, 1848, with a circumscribed, hard, prominent swelling, of the 

 size of a Madeira nut, in the anterior part of the scrotum, covering 

 and closely embracing the urethra, and also extending on either side 

 around the root of the penis, in the form of an indurated ilattencd 

 band. 



It w;is very tender to the touch, and contained matter, as was 

 evident from deep fluctuation. The superjacent cellular tissue and 

 •turn retained their natural Buppleness and mobility, and dill not 

 participate at all in the deep inflammation. A stricture of the ure- 

 thra, admitting only the smallest sized bougie, was found within the 

 swelling, and had existed for more than a year. 



About three weeks before admission, the swelling in the scrotum 

 first appeared of the size of the end of the finger, after the intro- 

 duction of a wire sound by the patient himself. 



A deep free incision into the tumour evacuated a quantity of fetid 

 urine mixed with pus; and for some time subsequent, urine continued 

 to escape through the wound, in small quantities. 



In this instance, the rupture of the urethra had taken place 

 within the sheath of the corpus cavcrnosum at the stricture, and the 

 inflammatory swelling consequent on the extravasation of urine was 

 thus confined to the narrow limits described; the communication 

 between the urethra and loose superjacent cellular tissue being shut 

 off. 



Left to itself, the swelling sometimes gradually approaches the 

 surface, by appropriating to itself, by the adhesive inflammation, the 

 successive layers of cellular tissue covering it. and at length evacu- 

 ating its contents externally, through an ulcerated opening. This, 

 however, is not uniformly the case. It often happens that the ulcer- 

 ative process within the abscess goes on in advance of the adhesive 

 and conservative process on the outside, and opens a communication 

 into the loose cellular tissue covering it, the consequence of which 

 is rapid extravasation in every direction, filling up the scrotum, 

 Spreading up over the pubes, and sometimes extending along the 

 crest of the ilium as high as the false ribs. It is probably ran' that 



this extensive secondary form of extravasation is not preceded by 

 the circumscribed or primary form, hence the importance of the 

 established rule of practice; to make a free opening into these hard 

 swellings alons the urethra, as soon as their existence is ascertained. 



