bed and allowed only a very spare diet. No medicine was the second day the bowels acted freely. He was Some tenderness was complained of bed as before. on the surface of the scrotum at its attachment on the right side, but no evidence of any deep-seated inflammation anywhere
given. On still kept in existed.
The following day I made out that the tumor was not uniform in its character. The testicle could be felt at the bottom of the scrotum. The epiplocele could be traced along the inguinal canal down two-thirds of the length of the scrotum, and had all the characteristics of the omental tumor; but below and behind it I could make out a swelling?hardly a distinct tumor?which seemed to yield an elastic resistance, but which was dull on percussion, and translucent to light. The candle used'in the ordinary way for diagnosis of hydrocele showed that the translucency was limited to a distinctly circumscribed portion of the swelling, and was situated above and somewhat behind the position of the testis, and seemingly connected with the globus major of the epidydimis, from which it reached upwards along the cord for about 1| inch. This translucent portion, I thought, fluctuated on pressure ; but this was not very distinct. It certainly was dull on percussion, and I therefore came to the conclusion that it was an encysted hydrocele, which I proceeded to tap. From it we drew off from two to three ounces of the ordinary serous fluid of a hydrocele. I did not examine it microscopically, and therefore do not know whether it contained spermatozoa or not. When this cyst had been emptied, there was no difficulty in making out that the remaining tumor was composed above of an epiplocele, which received a distinct impulse on coughing, concealed the cord, and was adherent to the hernial sac and therefore irreducible ; and below, of a varicocele which had been revealed by the emptying of an encysted hydrocele. Complicated as was the nature of this case, I think, when the history given by the patient is taken into consideration, it will be seen that it contains many points of surgical interest.
A MIRROR OF HOSPITAL PRACTICE. A COMPLICATED CASE OF SCROTAL HERNIA.
By
H. C.
Cutcliffe,
F.R.C.S.
I was last month asked by my friend, Dr. Shircore, to see a patient of his suffering from a hernia which could not be reduced. The patient was a middle-aged gentleman, who first noticed that he was ruptured about two months ago. The tumor, however, completely disappeared, and though he had applied at a shop for a truss, he had never worn one. The day before I first saw him, he strained much at stool, and thus suddenly caused to appear, in the right side of his scrotum, a tumor which he is quite certain was not there before he went He was firm and clear in his denial of the pre-existto stool. once of any swelling in or about the inguinal or scrotal region "prior to the sudden appearance of the tumor, excepting on the occasion before alluded to, when it immediately and entirely
disappeared. Attempts to
reduce the hernia had been made ineffectually, I and ice had been ordered to be applied before I saw him. found him somewhat anxious and restless, with some pain about the right inguinal canal. But there was no evidence of peritonitis, nor was the swelling very tender. I thought I had to do with a scrotal hernia in whose sac were both intestine and omentum, and that its condition invited a further attempt at reduction by the taxis. Under chloroform I succeeded in getting back, as I thought, so much of the contents of the sac The whole tumor was thus as were made up of intestine. reduced about three-fourths of its original size. The remaining fourth I could by no means reduce. It appeared to be an epiplocele adherent to its sac, and consequently irreducible. But taking into consideration the clear statement of the patient ?who was an educated and intelligent man?I was not free from doubt and anxiety respecting this irreducible portion. Ice was ordered to bo continued. The patient was kept strictly quiet iu
given. On still kept in existed.
The following day I made out that the tumor was not uniform in its character. The testicle could be felt at the bottom of the scrotum. The epiplocele could be traced along the inguinal canal down two-thirds of the length of the scrotum, and had all the characteristics of the omental tumor; but below and behind it I could make out a swelling?hardly a distinct tumor?which seemed to yield an elastic resistance, but which was dull on percussion, and translucent to light. The candle used'in the ordinary way for diagnosis of hydrocele showed that the translucency was limited to a distinctly circumscribed portion of the swelling, and was situated above and somewhat behind the position of the testis, and seemingly connected with the globus major of the epidydimis, from which it reached upwards along the cord for about 1| inch. This translucent portion, I thought, fluctuated on pressure ; but this was not very distinct. It certainly was dull on percussion, and I therefore came to the conclusion that it was an encysted hydrocele, which I proceeded to tap. From it we drew off from two to three ounces of the ordinary serous fluid of a hydrocele. I did not examine it microscopically, and therefore do not know whether it contained spermatozoa or not. When this cyst had been emptied, there was no difficulty in making out that the remaining tumor was composed above of an epiplocele, which received a distinct impulse on coughing, concealed the cord, and was adherent to the hernial sac and therefore irreducible ; and below, of a varicocele which had been revealed by the emptying of an encysted hydrocele. Complicated as was the nature of this case, I think, when the history given by the patient is taken into consideration, it will be seen that it contains many points of surgical interest.
A MIRROR OF HOSPITAL PRACTICE. A COMPLICATED CASE OF SCROTAL HERNIA.
By
H. C.
Cutcliffe,
F.R.C.S.
I was last month asked by my friend, Dr. Shircore, to see a patient of his suffering from a hernia which could not be reduced. The patient was a middle-aged gentleman, who first noticed that he was ruptured about two months ago. The tumor, however, completely disappeared, and though he had applied at a shop for a truss, he had never worn one. The day before I first saw him, he strained much at stool, and thus suddenly caused to appear, in the right side of his scrotum, a tumor which he is quite certain was not there before he went He was firm and clear in his denial of the pre-existto stool. once of any swelling in or about the inguinal or scrotal region "prior to the sudden appearance of the tumor, excepting on the occasion before alluded to, when it immediately and entirely
disappeared. Attempts to
reduce the hernia had been made ineffectually, I and ice had been ordered to be applied before I saw him. found him somewhat anxious and restless, with some pain about the right inguinal canal. But there was no evidence of peritonitis, nor was the swelling very tender. I thought I had to do with a scrotal hernia in whose sac were both intestine and omentum, and that its condition invited a further attempt at reduction by the taxis. Under chloroform I succeeded in getting back, as I thought, so much of the contents of the sac The whole tumor was thus as were made up of intestine. reduced about three-fourths of its original size. The remaining fourth I could by no means reduce. It appeared to be an epiplocele adherent to its sac, and consequently irreducible. But taking into consideration the clear statement of the patient ?who was an educated and intelligent man?I was not free from doubt and anxiety respecting this irreducible portion. Ice was ordered to bo continued. The patient was kept strictly quiet iu
