themselves to the radical cure by excision emersion. It is in cases such as these that I have performed the operation which is the subject of our discussion. The operation itself is very simple, the only instruments required being a trocar and canula, a pair of scissors, a pair of dissecting forceps 12 to 14 inches of sterile catgut, and a probe like the one I now pass round, which has been filed down and has been provided with a fish tail at one end. The parts are prepared in the same way as they would be for the open operation. Immediately before the operation a sterilised towel is so arranged as to cover the parts, exposing only the site of the introduction of the trocar. The fluid is evacuated in the usual way and when the sac is empty, the catgut varying in length from 10 to 14 inches is taken up with the dissecting forceps and one end introduced into The rest of the catgut is pushed the canula. into the sac by fixing the catgut against the side of the canula with the V of the fish tail and so pushing it on. Finally, the trocar is pushed back into the canula, carefully tilting the canula up at the time to prevent any injury to either the testicle or cord. The trocar and canula are then both withdrawn and the wound dressed with Collodion. It is essential for the success of the operation I have it that the catgut should be sterile. sterilised immediately before the operation, using Jellett's Alcohol steriliser. I can only guess at what takes place within the sac. I have never had occasion to open one after the introduction of the catgut. I imagine that there is an exudation of lymph, an aseptic inflammatory exudation which eventually organises. What is evident clinically is that within the next 24 hours the sac filled up partially forming a painless doughy tumour in which the catgut may be felt if it is rolled between the fingers. This gradually hardens till within the next ten or twelve days we get a hard painless tumour ^ or j the size of the original hydrocele. This in the course of time gradually contracts till it is scarcely perceptible after G months. Two questions now arise :? (1) Are there any risks in the operation ? (2) Is it suited to all classes of hydrocele and is the result a radical cure ? (1) The only risks I can think of are injury to the testes and the risks of suppuration. Both these can be avoided with care. (2) Is it suited to all classes of hydroceles ? I am inclined to think from an experience of more than eighty operations I have performed within the last five years that it is not. This method is more successful in the recent small or medium-sized thin-walled hydrocele.

subject or

% JPlirror of Hospital prarffre. A RADICAL CURE OF HYDROCELE.* V/

By A.

GWYTHER,

f.r.c.s.

Edin.),

MAJOR,

Offg.

Civil Surgeon, Howrah.

I AM bringing before you to-day for discussion the radical cure of hydrocele by the introduction, after tapping, of sterilised catgut. In two of the districts of Beliar where I have lately been stationed there is a large number of patients suffering from hydrocele who are in the habit of going every three months to the nearest dispensary and having the hydroceles emptied. A very large proportion of these, either from fear of the knife or of chloroform, or both, will not * Paper read at the August Meeting of tlie Medical Section of the Asiatic Society of Bengal.

Oct.,

191 l.J

CASE OF GASTROENTEROSTOMY.

Tt is the old large-sized hydrocele with the sac that tends to recur. In these?and only a few have come under my observation?it appears to me that some part of the old sac has been obliterated, that the operation has been partially successful, that perhaps a second or third operation of the same kind might result in complete obliteration of the sac. I am sorry that I have not had any opportunities of verifying this. Finally, we come to the question as to whether this is the operation of selection?as to whether we would prefer this method to the open methods?either emersion or excision. Considering the simplicity of the operation, the rapidity with which it can be performed, its safety under strict antiseptic precautions?the absence of the necessity for chloroform or other anoosthetic, the shortness of the subsequent stay in hospital. I think we may claim that it is the operation of selection in the class of hydroceles T have above referred to, the recent small or medium thin-walled variety. For the older large varieties with thickened sac J would prefer the open method, but where the patient objects to this operation, either from fear of the knife or chloroform, T think we should be justified in tapping and inserting catgut, repeating the operation, if necessary, in those cases which

thickened

refill.

385