AN ACCOUNT, &c.

AN Hydrocele is ſo irkſome a diſeaſe to the indigent and la⯑borious, furniſhes even the eaſy and opulent with ſuch diſagreeable ideas and apprehenſions, and is to all who are afflicted with it ſo troubleſome and in⯑convenient, that every rational attempt toward relieving mankind from ſuch an evil, will, I make no doubt, be favour⯑ably received.

It is now ſome years ſince I firſt began to make particular inquiry into the nature of this, and ſome other diſeaſes of the teſticle, and the uſual methods of treat⯑ing [2]them; an inquiry, which they ap⯑peared to me, for many reaſons, both to deſerve, and require. The reſult I com⯑municated to the public, under the title of, A "Treatiſe on the Hydrocele, or Watry Rupture, and other diſeaſes of the teſticle, its coats and veſſels;" in which I endeavoured to be as preciſe, and as explicit as I could.

One part of this tract contains an exa⯑mination of the various means, which have at different times, either accidentally produced a radical cure, or have been profeſſedly propoſed, and practiſed for ſuch purpoſe.

Among other means uſed to obtain this end, I mentioned the Seton; and ſpake of it as that, which for many reaſons, appeared to me to be prefera⯑ble to all others; as a method which I [3]had for ſome time practiſed with great ſucceſs, and as that, which if nothing ſhould occur to induce me to change my opinion, I ſhould continue to make uſe of.

Since that time I have had frequent opportunities of repeating the experi⯑ment, and it has ſo conſtantly, and uni⯑formly anſwered my expectation, that my opinion concerning it is determined, and I am convinced, that it is the moſt ſucceſsfully efficacious of any.

This might be urged, and would per⯑haps be admitted as a good reaſon for laying my thoughts on the ſubject again before the public; but I have others alſo to plead in vindication of the few following pages.

In the firſt place, I think that I have conſiderably and materially improved the operation and proceſs; and have render⯑ed it leſs painful, and more certain.

In the ſecond, I find, that what I ſaid of it in the general treatiſe, has not been ſo clearly and perfectly underſtood as I could have wiſhed; and in conſequence either of brevity and obſcurity on my part, or miſintelligence on the part of ſome of my readers, my true meaning has not been received, and I have been ſubjected to the frequent interruption of troubleſome correſpondences on the ſub⯑ject.

And, in the third place, I might add, that ſome few gentlemen of conſequence, who have by this means been cured, have requeſted this publication.

A minute account of the nature and circumſtances of the diſeaſe, would be a mere repetition of what I have already ſaid at large in the book referred to; would be therefore unneceſſary, and be⯑ſide my preſent purpoſe; a ſhort and curſory one may perhaps throw juſt as much light on the ſubject, as may ſerve to render the deſcription of the opera⯑tion, and the treatment after it, more eaſily intelligible.

The common bag in which both the teſticles are included, is called the Scro⯑tum, and conſiſts of epidermis, ſkin, and that looſe cellular membrane, which is here called the Dartos; to which might perhaps be added, the expanded fibres of the cremaſter muſcle on each ſide. The proper coats of the teſticle, are, the tunica albuginea, and the tunica va⯑ginalis. The former of theſe immedi⯑ately [6]inveſts the vaſcular compages of the teſtis, and is that coat with which it is covered while within the cavity of the abdomen, before birth. The latter is form⯑ed on the outſide of the ſaid cavity, is a proceſs of the peritoneum, and is placed ready for the reception of the teſticle when it ſhall be thruſt forth, thro' the groin, into the ſcrotum. Between the vaſcular ſtructure of the teſticle, and the tunica albuginea, there is no vacuity, but the external ſurface of the gland, is in every part firmly adherent to, and connected with the internal one of the inveſting coat; the tunica vaginalis forms a hollow cavity, or bag, which looſely, and unconnectedly envelopes the teſticle, covered by its albuginea.

When I ſay looſely and unconnected⯑ly, I would wiſh to be underſtood aright. I do not mean that the teſticle hangs [7]in the middle of the tunica vaginalis, (like a clapper within a bell) and has no connection with it; I mean, that all the ſuperior, anterior, and lateral parts of the tunica vaginalis are looſe from, and un⯑connected with the teſticle, which is at the ſame time firmly united to its poſte⯑rior part, in ſuch manner, that if the cavity of the tunica vaginalis was to be diſtended with wind, ſuch wind would occupy, or fill all the looſe, and uncon⯑nected part, and produce a tumefaction not unlike to a hydrocele, while the te⯑ſticle would be found firmly and im⯑moveably attached to the hinder part of the ſaid cavity ſo diſtended.

To prevent the accretion of theſe coats in thoſe parts where they ought to be unconnected, and perhaps for ſome other purpoſes, the cavity of the tunica vagi⯑nalis is furniſhed with a fine lymph [8]conſtantly exſuding into it; which lymph is as conſtantly abſorbed by proper veſſels; ſo that, in a healthy and natural ſtate, there never is any more of this fluid, within the bag, at a time, than may juſt ſerve (beſide what other purpoſe it may be intended for) to keep the two mem⯑branes from coming into immediate dry contact, and coheſion with each other. This ſmall quantity is ſufficient to pre⯑ſerve the proper and natural cavity of the tunic, but never occaſions any de⯑gree of intumeſcence, or any unnatural or diſeaſed appearance of the part.

This being the caſe, that is, the in⯑tumeſcence of the ſcrotal bag, being cauſed by the gradual accumulation of a fluid, which ought to have been abſorbed, it is almoſt always produced gradually; and therefore has, in moſt inſtances, made ſome progreſs before it is taken notice of; eſpecially by careleſs and in⯑attentive people. For the ſame reaſon [10]it will be found, that as it depends upon the circumſtances of ſecretion and ab⯑ſorption, it will in different people, make quicker or ſlower progreſs, according as the depoſition ſhall happen to be quicker or ſlower, and the abſorbent faculty, only more or leſs impaired, or totally obſtructed. As this diſeaſe is confined to the cavity of the tunica vaginalis teſtis, and as this bag has no commu⯑nication with the cavity of the belly, the tumefaction can never be leſſened by any attempt toward reducing or re⯑turning it into the abdomen. For the ſame reaſon, it never is, nor can be liable to any alteration of ſize, or temporary diſtention from the efforts, or actions of coughing, ſneezing, expulſion of foeces, &c. For the ſame reaſon, (I mean the confinement of the fluid within the ca⯑vity of the tunica vaginalis) the intu⯑meſcence, when early attended to, will [11]always be found in the lower part, and does not riſe above the upper-part of the teſticle, until the diſeaſe has made ſome progreſs, and the quantity is be⯑come conſiderable; therefore the ſper⯑matic proceſs, will always, in the early ſtage of this diſtemper, be capable of be⯑ing felt perfectly and diſtinctly; altho' when the tumour has arrived to any con⯑ſiderable degree of ſize, the fluid does ſo conceal the teſticle, as to render it not a very eaſy matter to find it. The three laſt circumſtances, well attended to, will always ſerve to diſtinguiſh the hydro⯑cele from the inteſtinal hernia or com⯑mon rupture, at leaſt in the beginning. To theſe might be added, ſeveral other characteriſtical marks of this diſtemper; ſuch as, that being neither accompanied by, nor occaſioning any inflammation, or irritation, it never gives pain, unleſs it be very rudely handled, or be permit⯑ted [12]to attain ſuch ſize as to be trouble⯑ſome from its weight, or to be ſubject to excoriation from its magnitude; which may ſerve to diſtinguiſh it from the her⯑nia humoralis, an inflammatory, and often a very painful diſorder. That if the fluid be thin and limpid, and the vaginal coat and membranes of the ſcro⯑tum not thick, the tumour is often in ſome degree tranſparent; that is, the light of a candle or lamp may be ſeen through it. That conſtipation of belly does not render it at all more tenſe, or produce any uneaſineſs in it while it laſts; neither does the removal of ſuch obſtruction or conſtipation at all leſſen its volume, or make any alteration in it either to the eye, or to the finger. To all which ought always to be added, the fluctuation of the fluid.

The ſize and figure of the tumour cauſed by this diſeaſe are liable to con⯑ſiderable variety, dependant upon the quantity and conſiſtence of the fluid accumulated, the time ſuch accumula⯑tion may have taken up, the thickneſs, or thinneſs of the vaginal bag, and mem⯑branes of the ſcrotum, and the equal or unequal manner in which theſe parts may have given way to the diſtention. Hence the tumour will be larger or ſmaller, round, flattiſh, pyriform, or globular; will be firm, tenſe, and reſi⯑ſtent, or lax, ſoft and eaſily compreſſible; ſmooth and regular in its ſurface, mak⯑ing one uniform figure, or divided by a kind of depreſſion or ſtricture, which will make it appear as if the water was in two diſtinct ſacculi or bags; it will alſo be more or leſs tenſe, as well as regular in its ſurface, as the contractile power [14]of the ſcrotum, by means of the cre⯑maſter muſcles, ſhall be more or leſs.

The qualities of conſiſtence and co⯑lour in the contained fluid is alſo various: it is thin, aqueous, roapy, viſcid, lim⯑pid, citrine, greeniſh, brown, bloody, clear, or turbid; from each of which ſome ſmall differences in the aſpect, feel, weight, tranſparency or obſcurity of the tumour will ariſe; but are of no con⯑ſequence with regard to any method of treatment, palliative, or radical.

The methods of cure of a hydrocele are ſaid to be two, one called the Pal⯑liative, the other the Radical; the lat⯑ter of which alone deſerves the name of cure.

The former conſiſts merely in letting out the water occaſionally, and is ſo ſimple and ſo trifling an operation, that I ſhall ſay nothing more of it, than that I think a ſmall trochar a much preferable inſtrument for this purpoſe on all accounts to the lancet, or any other.

The radical cures, as they are called, may be collected from the writings of ſeveral of our predeceſſors. The general means they made uſe of were cautery, cauſtic, ligature, and tent. For the particulars relative to each of theſe, I muſt beg leave to refer my reader to the writers themſelves, a minute detail of them not being conſiſtent with the plan of theſe few ſheets. But without entering into ſuch diſquiſition, I believe I may venture to ſay, that whoever will give himſelf this trouble, will find, that [16]all the means which were either pro⯑feſſedly uſed to obtain a radical cure, or which ultimately and accidentally pro⯑duced ſuch event, were put in practice for three general reaſons, or under the influence of three general opinions; the firſt of which was, that the fluid found in the ſac of a hydrocele was always originally formed in the cavity of the belly, and deſcended from thence into the ſcrotum; the ſecond, that it was a diſeaſe of the habit, as well as of the particular part; that is, that it was gene⯑ral, as well as local; the third, that the collection of liquor found in it, was either the neceſſary cauſe, or the con⯑ſequence, of a diſeaſed ſtate of the teſtis.

From theſe flow the applications of cautery, and cauſtics to the groin, and of ligatures on the ſpermatic proceſs. [17]From theſe are derived all the cautions to undertake the cure guardedly, to conduct it ſlowly, and to attend rigidly to the pa⯑tient's general ſtate by cathartics, altera⯑tives, ſpecifics, iſſues, &c. &c. &c. and to theſe we owe the experiments made to induce ſuppuration from the parts affected.

Not being acquainted with the anato⯑mical ſtructure and diſpoſition of the parts concerned in the diſeaſe, they had very terrible as well as very erroneous no⯑tions concerning it. They ſuppoſed that the fluid contained in the cyſt was thrown off from the habit as a kind of criſis; that the general conſtitution of the patient was by ſuch depoſition much relieved; that it prevented many other, and thoſe worſe diſorders; and, either that a morbid ſtate of the teſticle and epidydimis concurred in producing the fluid, or that the ſame parts neceſſarily became diſeaſed from ly⯑ing in it. They therefore concluded, [18]that although a radical or perfect cure might be obtained by certain means, or that certain means having been found now and then to have produced ſuch event, they might with probability be expected to anſwer ſuch purpoſe, yet the attempt ought never to be made without a ſtrict attention to the general evils which might enſue, as well as to the particular ones proceeding from the ſuppoſed morbid ſtate of the parts.

Inquiry and experiment have taught us better, have given us truer notions of the nature of the complaint, have induced us totally to lay aſide many of the means uſed by our fore-fathers, and although we do ſtill in ſome ſort continue ſome of them, yet it is upon different principles, and with very different views.

The noxious quality of the fluid, the diſeaſed ſtate of the parts whence it pro⯑ceeds, or wherein it is depoſited, the cri⯑tical, or depuratory nature of the depoſi⯑tion, the neceſſity of drawing off the wa⯑ter partially and at ſhort intervals, and the fear of curing it locally leſt the general habit ſhould ſuffer, are all now known to be groundleſs apprehenſions; and it being alſo known that the collection of fluid is originally made in the tunica vaginalis only, and that it does not deſcend from the belly, all attempts toward preventing ſuch deſcent are become equally abſurd.

The teſticle, although frequently ſome⯑what inlarged in its dimenſions and re⯑laxed in its texture, is known to be ſound, to be otherwiſe unaffected, and unaltered, and to be fit for, and capable of perform⯑ing the functions it was deſigned to exe⯑cute; the fluid is acknowledged to be in⯑noxious [20]in its nature, neither proceeding from parts in a diſeaſed ſtate, nor cauſing any diſeaſe in the parts in which it is de⯑poſited, and with which it is in contact; but being accumulated in conſequence of conſtant ſecretion, and deficient, or non⯑executed abſorption, the intention of every rational practitioner, when he aims at a radical cure, is, to aboliſh the cavity of the tunica vaginalis, and thereby to pre⯑vent any future collection.

Whatever means can accompliſh this end with the leaſt fatigue, pain, or hazard, are certainly the beſt.

Of the inciſion I ſhall in this place ſay nothing, except that it lies under ſo many reſtraints from a variety of circumſtances, is ſo improper for the majority of per⯑ſons afflicted with the diſeaſe, and requires ſuch nice attention and ſuch judicious ma⯑nagement, that it never can be recom⯑mended as fit for general practice.

The cauſtic, upon the rational principle of which I am now ſpeaking, viz. that of aboliſhing the cavity of the tunica va⯑ginalis, has been practiſed by many, and that with ſuch ſucceſs as to induce ſome to think it the beſt and moſt eligible me⯑thod: Among theſe is Mr. Elſe, who has lately publiſhed his opinion on the ſubject.

The introduction of ſuppurative medi⯑cines by means of a tent, was practiſed by ſome of even our remote predeceſſors, and as they tell us with ſucceſs, even in complicated caſes; that is, in caſes where a diſeaſed ſtate of the teſticle has been ad⯑ded to the hydrocele: But whoever will attentively conſider their accounts of this matter will ſee, that this method, what⯑ever might be its accidental conſequence, was not intended for the purpoſe which I am now ſpeaking of.

Perhaps there is no part of ſurgery which was leſs underſtood by our anceſ⯑tors, or concerning which they expreſſed themſelves with ſo little preciſion as the ſubject of diſeaſes of the teſticle: they have multiplied and confounded them in ſuch manner, and ſpeak of them in ſuch a jargon of unintelligible terms, that it is next to impoſſible to underſtand often what they really mean.

For a particular elucidation of this ſubject the chirurgic world are much ob⯑liged to the late Profeſſor Monro of Edin⯑burgh, and Mr. Samuel Sharp, late of Guy's Hoſpital, now of Bath.

The accounts which many of the beſt among the writers in ſurgery, even quite into our own time, have given of the diſ⯑eaſes of theſe parts under the terms ſarco⯑cele, fungus attached to the ſpermatic veſſels, fungus ariſing from the teſtis, hy⯑drocele [23]and hydro-ſarcocele, are error itſelf; and the operations which they deſcribe and recommend are many of them coarſe, and either impracticable, or very unfit for practice. But however from theſe ac⯑counts, ſtrange and irrational as they are, we may collect that they conceived the diſ⯑eaſes which they call the hydro-ſarcocele, and the caro adnata ad vaſa ſpermatica, to be (in contradiſtinction from the ſarco⯑cele and the fungus ſpringing from the teſticle,) curable diſeaſes, the one by extir⯑pation of the fungus, the other by ſup⯑puration.

No preciſe definition of what they have thought proper to call the hydro-ſarcocele has been given by them, and therefore we have no better method of forming a judg⯑ment concerning it, than by conſidering the event and ſucceſs of their method of treating what they have ſo called, with what we know concerning the ſtructure [24]of the teſticle, its diſorders, the means which we now find to be ſucceſsful in them, and the diſappointments, and diſ⯑agreeable circumſtances which ſometimes occur in them.

Frabritius ab Aquapendente has been particular on what he calls the hydro⯑ſarcocele, and has given an account of his method of curing it; but whoever is ac⯑quainted with diſeaſes of the teſticle, and will compare with ſuch knowledge what Fabritius has ſaid concerning his method and its ſucceſs^*, will, I am inclined to be⯑lieve, think on this ſubject as I do, which is, that the diſeaſe which he gives this hard complex name to, is nothing more than a [25]true, ſimple hydrocele, in which the teſtis is ſomewhat inlarged beyond its natural ſize, and perhaps ſomewhat relaxed in its texture, in conſequence of ſuch enlarge⯑ment; but ſtill ſound, and free from diſ⯑eaſe, ſtill fit for, and capable of executing its office.

That by his method he obtained a radi⯑cal cure I make no doubt; his 'turunda digeſtivo, et pus movente medicamento imbuta,' would moſt probably occaſion a ſloughing of the tunica vaginalis, and con⯑ſequently an abolition of the bag or ca⯑vity; but whoever knows any thing of theſe matters muſt know, that a teſticle really and truly diſeaſed, would not bear ſuch treatment; and therefore that his ſucceſs was owing to the ſtate of the teſti⯑cle not being what he ſuppoſed it to be, and what the term he makes uſe of im⯑plies.

The method of Fabritius was within a few years paſt adopted and practiſed by Ruyſch.^*

The means and conduct were nearly the ſame, and I have no doubt that the ſucceſs was equal. But the ſame objection ſtill remained; which was, that not only a ſuppuration was brought on, but the whole tunica vaginalis was ſo irritated and inflamed, that it neceſſarily became ſloughy, and was entirely deſtroyed. An objection which had been made to the method by cauſtic, and which I muſt ac⯑knowledge, [27]is, in my opinion, an objec⯑tion to it ſtill.

The late profeſſor Monro, whoſe ob⯑ſervations on the diſeaſes of the teſticle are very pertinent and very ingenious, ſeemed to think that it was by no means impracticable, by means of a ſlight degree of irritation, to excite ſuch an inflam⯑mation both in the tunica vaginalis and al⯑buginea, as might occaſion a coaleſcence of them with each other, and thereby anſwer the end of aboliſhing the cavity without deſtroying any part of either tunic.

I made the experiment propoſed by him, and found it ſometimes ſucceſsful, ne⯑ver hazardous, or prejudicial, but by no means certainly efficacious, or to be de⯑pended upon. The cannula by its hard⯑neſs and reſiſtance was a very unpleaſant gueſt within the vaginal coat, and from [28]its inflexibility, upon any unguarded mo⯑tion of the patient, injured the teſticle and gave very acute pain; and the tent and bougie, which I occaſionally ſubſtituted in its place, although they did not give ſo much pain, were liable to a conſiderable degree of uncertainty.

Uncertainty and hazard are certainly very different things, and the latter much preferable to the former: not to have injured a man by an experiment, affords ſome degree of conſolation under a diſap⯑pointment, but yet when it is conſidered, that an operation and proceſs of this kind is ſubmitted to from choice and not from neceſſity, if it fails of ſucceſs, although no real harm be done either to the part, or to the conſtitution of the patient, both the loſs of time and the confinement will become doubly irkſome, as they will be found not only not to have anſwered the end propoſed, but not to have brought [29]the patient at all nearer to a cure than he was before the attempts. The reflexion is unpleaſant to both parties.

Being, from the effects both of the ca⯑nula and tent, ſatisfied that there was no kind of hazard in the introduction of a fo⯑reign body into the cavity of the tunica vaginalis, nor from its remaining there; and having many opportunities of meeting with this diſeaſe in St. Bartholomew's, I de⯑termined to try what a ſeton would do to⯑ward raiſing ſuch a degree of inflamma⯑tion as might occaſion a coalition of the two membranes, and effect the purpoſe propoſed by Profeſſor Monro^*. The ſuc⯑ceſs fully anſwered my expectation.

In my general treatiſe on the diſeaſes of the teſticle, I mentioned and recom⯑mended it, but as I could not be certain what a greater length of time might produce to make me change my opinion, I mentioned it with ſome degree of cau⯑tion.

Since that time I have embraced every opportunity, both in the hoſpital and out, of practiſing it, and that under [31]ſome improvements; and as I can now ſpeak poſitively to its ſucceſs, I thought it right to give it to the publick, who are always intituled to every benefit ari⯑ſing from the labours of every man whom they have honoured with any degree of confidence, and this as well on a principle of humanity as of gratitude.

What I have ſaid of it in the general treatiſe is in the following words, p. 176.

This method was, as I ſaid in, general very ſucceſsful; but repeated trials fur⯑niſhed me with objections to ſome parts of it, and induced me to think that ſuch parts might be amended.

I found that cutting upon the end of the probe was troubleſome, both from its ſmalneſs and from its flexibility, and alſo that it was ſometimes difficult to keep it ſteady, for the ſame reaſons, and that it always required the aſſiſtance of ano⯑ther perſon's hand beſides that of the operator: a circumſtance one would al⯑ways wiſh to avoid when poſſible. I found alſo ſometimes that the ſeton of candle-wick cotton did not paſs ſo eaſily as I could wiſh, and by rubbing the tunica albuginea too rudely gave more pain than I liked. The ſeton as made of cotton [36]adhered in ſome inſtances too long and too firmly. From the intimate connec⯑tion of the parts of the wet cotton with each other, it could never be brought away but entire, which in ſome caſes oc⯑caſioned an unneceſſary waſte of time. And, what was ſtill worſe, in two in⯑ſtances it adhered ſo firmly, that I was obliged to make a ſmall inciſion to get it away at all.

All theſe inconveniences and objections I have now obviated and removed.

The inſtruments I now make uſe of are in the annexed plate, and are,

With the trochar the inferior and an⯑terior part of the tumor is to be pierced, as in common palliative tapping: as ſoon as the water is diſcharged, and the perfo⯑rator withdrawn, the ſeton-cannula is to be paſſed through that of the tro⯑char, until it reaches the upper part of the tunica vaginalis, and is to be felt in the very upper part of the ſcrotum. This done, the probe armed with its ſeton is to be conveyed through the latter can⯑nula, the vaginal coat and integuments [38]to be pierced by its point, and the ſeton to be drawn through the cannula, until a ſufficient quantity is brought out by the upper orifice. The two cannulae are then to be withdrawn, and the operation is finiſhed. It is executed in two or three ſeconds of time, and with little more pain than is felt in common tap⯑ping.

By this method, every advantage which attended the former operation is obtained, and every inconvenience which it was lia⯑ble to, is obviated and provided againſt.

The ſeton-cannula by its firmneſs bears tight againſt the place where the ſeton ſhould be brought out, the trochar-point of the probe is kept from deviating by its confinement, and its point pierces through the ſkin immediately, and ex⯑actly in the place intended, while the ſe⯑ton by paſſing through the cannula is [39]prevented from rubbing rudely over the teſticle.

As ſoon as the operation is finiſhed I put the patient into bed, and immedi⯑ately give him twenty or twenty-five drops of tinctura thebaica, which I re⯑peat or not, pro ne nata.

About the third day the teſticle and ſcrotum begin to inflame and ſwell, and to put on the appearance of a hernia hu⯑moralis, or the ſwelled teſticle which now and then attends a clap; and re⯑quires the ſame and no other kind of treatment; that is, fomentation, poultice, a ſuſpenſory bag, a cool temperate regi⯑men, and an open belly.

By theſe means the inflammation is ſoon and eaſily appeaſed. As ſoon as this end is accompliſhed, I permit the patient to get out of bed and lie on a couch, or [40]ſit in a great chair with his legs up, and I generally give the cortex in ſome form or other twice or thrice a day.

The ſoreneſs and tumefaction now di⯑miniſh apace, and as ſoon as the parts are quite eaſy, which is generally about the tenth or twelfth day, I begin to withdraw the ſeton, taking out, four, five, ſix, or ſeven threads of it at each dreſſing, which dreſſing conſiſts of nothing more than a ſuperficial pledget upon each of the ori⯑fices while they continue open, and a diſcutient cerate (ſuch as the ceratum ſaturnin.) to cover the ſcrotum.

The diſcharge of matter from the ori⯑fices, is ſmall and trifling, no more than might be expected; the tunica vaginalis does not become ſloughy, but is preſerv⯑ed intire, and the cure is accompliſhed, merely by the coaleſcence or coheſion of the tunica vaginalis, with the tunica al⯑buginea. [41]An event, which from what has fallen within my obſervation, I am inclined to believe, is moſt frequently the conſequence of a ſevere hernia humoralis.

In this circumſtance, viz. the accom⯑pliſhment of the cure, by adheſion of the two coats together, without any de⯑ſtruction of parts, conſiſts the material difference between the method of cure by ſeton, and that by cauſtic.

All the practitioners who make uſe of the latter, allow that it produces a ſlough of the whole tunica vaginalis, that it de⯑ſtroys the whole bag or cyſt, and that it is uſed with intention ſo to do.

In the cure by ſeton no ſlough is pro⯑duced, (at leaſt I have never ſeen one) nor is the vaginal coat deſtroyed in any part of it, a firm coheſion is made be⯑tween the two membranes occaſioned by [42]the inflammation, and the cure is effected ſolely thereby.

I ſhall always moſt gladly embrace any opportunity to improve ſo noble and ſo really uſeful an art as ſurgery, but at the ſame time, ſhould be very ſorry to have it ſuppoſed that any partiality to my own opinion would make me miſrepre⯑ſent, or deviate from truth.

I have practiſed this method of obtain⯑ing a radical cure on a very large number of ſubjects, of all ages, from ſix years old, to ſixty and upwards, in ſome ſub⯑jects on both ſides, and I have never ſeen any bad ſymptoms or any degree of hazard from it, nor have I once, ſince the pre⯑ſent improvement, ſeen it fail of perfect SUCCESS.