732 
SURGERY. 
ally protrudes. In some instances, the disease appears to 
have been accompanied with great irritablity of the urethra, 
or strictures. 
If, when the inflammatory affection of the testicle has sub¬ 
sided, the substance of this body should not be much indu¬ 
rated or enlarged, it is a very rational practice, to endea¬ 
vour to extirpate the fungus, and diseased portion of the 
testis, without removing the whole of this body, and the 
object may sometimes be fulfilled by destroying the fungus 
with the lapis infernalis. 
The sarcocele is very liable to be confounded with hydro¬ 
cele when the tunica vaginalis is much thickened. Hence 
some surgeons have advised that an opening should be 
made into the scrotum previous to commencing extirpation. 
Another disease, liable to be confounded with sarcocele, is 
a great and sometimes an enormous thickening of the scro¬ 
tum itself. This case is more frequently met within warm, 
than cold, or temperate countries; but it has been seen both 
in this country and in France. Though the scrotum may 
attain a magnitude which is truly surprising, the testes, con¬ 
cealed in the mass of new-formed matter, remain perfectly 
sound; and the principal grievances depend upon the man¬ 
ner in which the patient’s fitness for every active employ, and 
even his capability of walking, riding, and taking exercise, 
are destroyed by an enormous swelling, which sometimes 
weighs nearly a hundred pouuds. The only mode of relief 
consists in cutting the diseased scrotum away, in doing which, 
the operator is to avoid injuring the spermatic cord and 
testicles. 
The preceding diseases frequently render necessary the 
operation of castration, which should be thus performed. 
The parts being previously shaved, the patient is to be 
laid upon a firm table covered with a blanket or mattress. 
His legs should hang over the table, and be supported by 
assistants. An incision is to be made through the integu¬ 
ments with a common scalpel, extending from a little above 
the external abdominal ring to the bottom of the scrotum. 
The cellular membrane around the spermatic cord is to be 
dissected back, and the cord laid fairly bare; and this 
part of the operation is much more easily accomplished 
when the incision through the skin is very free. The cord 
is to be divided as high as the disease renders necessary and 
handed to an assistant who is to compress it. The whole 
of the testicle and its vaginal coat may then be readily dis¬ 
sected away, taking care not to cut into the vaginal cavity of 
the opposite side of the scrotum. After the testicle is re¬ 
moved, the cord should be loosened, and the spermatic ar¬ 
tery and veins included in separate ligatures. Much care 
should also be taken to secure any arteries of the integuments 
of the scrotum which are seen bleeding. 
The wound is to be dressed, so as to be healed if possible 
by adhesion ; and this may generally be accomplished, ex¬ 
cept at the upper part where the ligatures come through. 
With this view the wound and scrotum are to be carefully 
washed, and two or three stitches, as may be thought most 
expedient, are to be put through the edges of the wound ; 
for in a part like the scrotum, where the skin is loose and 
puckered, it is hardly possible to apply adhesive straps with 
sufficient accuracy, so as to serve the purpose. Small pieces 
of adhesive plaister, however, should be neatly placed be¬ 
tween each of the stitches along the whole extent of the wound 
and a pledget of simple ointment and compress afterwards 
to be laid over; the whole being secured with a T bandage. 
After the operation, the patient is to be put to bed, being 
directed to lie on his back with a pillow between the thighs, 
so as to support the scrotum. Opiates should be given to 
allay pain, and if any inflammatory symptoms supervene, 
bleeding at the arm had recourse to. Hemorrhage from im¬ 
perceptible vessels of the scrotum may generally be stopped 
by cold lotions. 
The scrotum is often exceedingly enlarged by collections 
of fluid. Of these, hydrocele , or watery swelling, is the 
most frequent. 
“Of this disease there are three principal kinds; one, in 
which the fluid is lodged in the cellular texture of the scro¬ 
tum ; another, in which it is contained in the tunica vagi¬ 
nalis testis; and a third, in which the fluid collects in the 
spermatic cord.” 
The first sort, sometimes named hydrocele cedematodes, 
is strictly only an anasarcous tumour of the scrotum, and 
generally a symptom of a dropsical affection of the whole 
constitution. And the most frequent causes of this species 
of hydrocele do not differ from those which are concerned in 
the production of ascites and oedema in general. The pres¬ 
sure also of certain tumours upon the large veins and lym¬ 
phatics within the abdomen; the accidental rupture of a 
hydrocele of the tunica vaginalis, or the water of this last 
disease not having a ready outlet through the puncture in 
in the skin, in consequence of the aperture having changed 
its situation with respect to the opening in the tunica vagina¬ 
lis, after the lancet is withdrawn; violent contusions of the 
scrotum ; the pressure of a very tight ill-made truss; are all 
circumstances which may give rise to an oedematous hydro¬ 
cele, has generally the appearance of a smooth, oblong, or 
pyriform swelling of one side of the scrotum. It is not 
attended with any discolouration of the skin, and, if carefully 
watched from the beginning, it is observed at first only at 
the lower part of the scrotum, whence it gradually spreads 
upward, until it reaches the higher part of the spermatic 
cord, on the outside of the ring. The ordinary shape of the 
tumour somewhat resembles a swan’s-egg pear, with its 
broader part downwards. In an early stage, it presents a 
softish feel, attended with fluctuation; but, on the fingers 
being being removed, it immediately rises to its former level. 
It cannot be diminished either by pressure, or by making 
the patient lie down upon his back; it cannot be pushed 
into the cavity of the abdomen by any artifice of the surgeon; 
nor can any impulse be distinguished in it, when the patient 
coughs; circumstances particularly marking its difference 
from hernia. When the disease is more advanced, and has 
attained a larger size, the tumour becomes ablong, and its 
weight and firmness increase, though they are still much less 
than in cases of common sarsocele. At” the same time, the 
fluctuation grows less distinct. If the fluid in the tunica 
vaginalis be clear, this membrane and the cremaster not 
much thickened, and a candle be placed behind the tumour, 
the scretum will be found to have a semitransparent appear¬ 
ance. Whenever the quantity of fluid is at all considerable, 
the testicle cannot be plainly felt, being distinguishable 
only at the upper and back part of the tumour, by a certain 
hard feel. The spermatic cord, however, is still obvious to 
the touch. Even when the swelling has acquired its greatest 
size, and the scrotum is considerably distended, the corruga¬ 
tions are seldom so completely obliterated as they are in the 
cedematous hydrocele. The penis appears small, and, as it 
were, buried in the tumour. In cases of long standing, the 
integuments of the scrotum are sometimes much thickened ; 
the veins are large; and, upon handling the swelling, a sense 
of elasticity, rather than of fluctuation, is communicated. 
When the hydrocele is of very great size, the spermatic cord 
itself may be concealed by it nearly or quite up to the ring. 
In children, the water commonly extends higher up the 
cord, than in adults. 
The quantity of fluid varies in different cases; a hydrocele 
of ordinary size contains about six, eight, or ten ounces; but 
instances are recorded, in which four, and even six pints of 
water have been drawn off. 
Scarpa, who has carefully examined hydroceles in the 
dead subject, assures us, that, whenever the tumour is large, 
the spermatic vessels are found so displaced and separated, 
that the artery and vas deferens usually lie on one side of 
the swelling, and the veins on the other; and that sometimes 
all these different vessels extend from the sides towards the 
front of the tumour, chiefly at its lower part. 
“ In a hydrocele, as well as a rupture, the cremaster (says 
Mr. Hunter) “ becomes stronger than usual, and its fibres 
can be traced spreading on the tunica vaginalis, and seem 
at last to be lost upon it near to the lower end of the body 
of the testicles.” 
Fungus haematodes testis is more liable to be confounded 
with 
