1000000031

;;nG

!.ho\1~h

wc do not perhaps cviu..!ndy percei \'c

jt .

yet \\'e

rcny

perfu2.dcd

lh:::rc

is a fl uid of fome kind,

we are

once afiured that

lhe

rliltcdi.on

of the

/twica twginalis

m;.ke~

the

l URlCur;

which

¡Ji

be diflinguinlcd in lhe

fol·

low: ng

(lIanncr.

I r

the the ¡ntenine. or

omcn1um,

form lh e

fwc:lliog.

the:y

will

rof' u d pEa!>le, (uolers ir.D.,med;) uneven in ,beir

fnTface, p<lrticuh rly

lhe

omemum; and

both

lhcm

eXlend

themfelvu

up rrom

the

Cerotum qui!c iOlo

the 'fcry

abdomen:

whcrcas, in

lhe

hyJroccl: , the

tumOur

teore

and [Dlooth',

end ccares

bdore or

arriral

the

rings

l he

abdo

minal murcies ; becau rc the

u;,>pe:r

extrcmity of the

/ ¡mica

fJnginaliJ

terminates al fome

nance fram

the

fu rface of

Ihe I>dly.

,"' bco ,he teílicle is

incrc;l(ed

its

fi2e,

the

tumOl1r

rounder'; and if DOl altendt'd with- aD C'nlargemcot of the

fperm>lic vell'd" lhe cord may be eaGl ydiflinguifh ed between

the f'A,clling and abdomen ; bUl without this rule of difHoBion,

either the p;lin, or (he 'Jer.,. great hardeefs,

\ViII

dircover

to be a direafe of ,be ,ellicle.

'o the cure of ,his diflcmper bye"ternal applicatioDs,

or internal mean" Ijnle

to be expeéled ; on which 1ecount,

i. generally advifeable to wait witb patience untiJ the tu–

meQr becomel troubJefome, and tbeD to tap it with a lancet

or trocar.

opealng

with a

lancet,

may poH1sly happen,

Iha, ,he orifice of Ihe Ikin fh .U fl ip away (rom Ihat o( Ihe

tuoick . aod preveDt the e,reíi of [he water: ,to

obvi~te

which incoovenience. you rnay intrqduce

probe, and by

that

mea.DS

recure the exaét Gcuatioo of the woaod; but

the coats are very ·mnch thickened,

will

be advifeable to gre

the Irocar, ralher

lb..

!he Iaoce!.

is fpokeD o(

ao eary

IhiDg, to hold Ihe tdlicle with the Id!

h.od

, while we make

the punéture

,,,¡th

the rigbt; but when the

lun;ca

vagina/h

very teofe, it canDot well be dillinguilhed: howe'f'cr

there

IJO

daager. of wouoding it, if you make thc punéture

ihe

inferior part of the {crotum. D uring [he evacuadon, the

fcrotum mufl be regularly prell'ed ; and .rter the operation,

linle piece of drylio! aDd {\ic1dng plafler are rufficieDt.

This methocl o( Iapping i, c.lled ,he pallia,ive cure; DO!

bUI Ihal it doe, DO'" aDd Iheo prove aD abfolute one. T o

pre.eo!

Ihe rel.pre of Ihi, direafe, rurgeo., prercribe the

making a large wound, either by ¡ociClon

cauUíc, that up–

healin'g it afterwards, the firmoef, and contraélion of lhe

cicalri" may bind up ,he relaxcd lymphalic.vdTels, and ob·

firua the fgrther precero2tural effuGon of their contents:

but Ihis praltice

generally auC'nded wi th fo moch trou–

ble, Ihat, ootwi,bflandiDg ilS ruccefs in Ihe cod, mofl furge.

"DS prefer the paJliative .

O! CAST RÁTtON .

·TH

I S

one of tRe moa melancholy operations

the

pr.élice of rurgery, Goce i! (e1dom takeo place

b~t

iD diror.

ders into which tne patient is very 3pt to rcdapfe,

viz.

thofe

of ·a fchírrhus, or c¡ocer: fer uoder mon of [he

fymptol11S

defcribed as renderiog

necelTary, it is abfoJutely improper;

fuch as

bydroce:le, abrctfs of the leneS, an iocreafi ng mor–

tificuioD, or what is Cometimes underílood by

Carc,Ocele ;

of which' la(l it may OOt be amifs to ray a word . In the utmofl

Jati[ude of the meaning of this

rm, it is recdved as a fld hy

fwelling of the !eHicle itrelf, c..., d likewire

hernia carno!a;

or in fome enJugr:meolS, Cuch as in a c1ap, mor,e fre'l1t.!nt–

hernia hum<ralit;

but geoerally rpe. kiog, is c6nGdercd

a, a a, fh y excrcfceDce formed OD,he body of the teHis, which

VOL.

III

96.

~ec:omi ng cxcecd;n~l y

har d ;1nd t\lmdi\:d, fer the moll

pan

fllppofcd :o

d~nl~,~d

( xtirl':ttion, cíthcr

cu:ting or hu rn–

ing

aw;¡y

the inJur:Hion, or amputatl. g

the

t(!f1icl~.

But

thi5

nl'lxim

tOO precipita tely

rectived,

l¡as \'t:ry

much

lUIr.

uid..d

lhe

praélitlClncrs

furgcT}'.

It fomelimes happcos that the epidydy'!l;s is rumdit'd,

in~

dependent ef the telliclc: ; and fecEng Ilke

Lll

:~dv(;,iti

tiaus

excrefance, anf

"(ccs ver)'

\Ve!!

the idt·.. Ololi fur"eons

form

f .;rcocelt::

bUI

nOI

bei ot! aware

[he

ddfercnt

n~[Ure

and

texturc: of the

epidldymis,

they have frc(juendy confllunc!–

ed its dirorder,

~vith

,hore or ,he te(licle itrdf, and cqulily re–

commended extirpation in lhe índu rarion of one or the olher.

Rut . 11 iodara,ions o( ,he glandular pa" o( the ,ellide

00 '

teoding to inR::ammation and .lbfcefs, geoeralIy,

not

aJ \V"y~.

lead

to fcirrhu, and c?ncers ; whereas thofe of the epi–

didymis felciom

never do.

is true,

in (pite

of internal

or external

means,

thefe

la(~

oflen reu in lheir hardnef!,

and fom: times fllppUr¿te, buc howe.,er without much dan.

ger

in citber

caf~.

Before caHratíon, it i,laid down as a rule to inquire: whe ..

lhcr the patient has

aoy

paio

his back, and in (hat' cafe:

to rejeét the operation, upon (he reafonable prefumption of

,he

rperm~ti~

. cll'd ,

being likewire direared. bu, we are no'

to bc too ha!l:y in [his determinadoo ; ' for lhe mere weight

' of the tumour firetching the cord,

will

fom.:timcs create

this

complaitt. To Jearo.the caufe then o( th is pain in the back,

wheo the fpermatíc cord is nOI thickenc:d, Jet yoar patíent

be kept iD bed,

ao~

(urpend bis fcrotum iDa bag.trur" whieh

will relieTe bim, if difordered by ,he weigh, only ; bu, if

the' fpermatic cord

thickened or iodurated, whic)l J ife"fe,

when

a[tended with

a dilatatioDof lhe vdfds of of lhe fcro ..

tum, is kOOWD

the G ret k appellations

cir('oc('/~

and

Vd·

ricocele,

[he: cafe is defperate, and not tO be unJerraken.

BtH

fuppofing no obOacle in the wa,y

tl!e

operatien,

!he m<thod of doiag il n"y be ,his :

L ay

your pa,ieo, on a

fquare table of abeut three

.fe.el

four inches hiCh, Jeuing his

leg. hao, dOlVn, which, as well as ,he refl

0(.

his body, mult

be held firn. by the al1illants.

Theo with a knire bcgin

your wound above lhe rings of the abdominal mufcl es, that

J OIl

may have room afterwards to tie che vd rds, fioce for

WJ.ot

of this caution operators

wiIJ

neceff,¡rily be ef1..1bar

ralTéd in making the ligature: then carrying it through the

mUlIbrana

adiPl)fa,

mufl be continued downward, the

Jength o( i, being iD propon ion

, he

Gze

or the tcllide.

i, i, very rm, II, it may be

dill',éle~

away wi thou, ,aking

aoy part of the raotum. If the tellid e, for inlbru:e, weigh.

tweDty OUDces ; having made om inc¡fion abota five ioches

long,

linle circularly. begin

fl!cond

lhe fame po:nt

él

the

li ra,

bringing it wirh

oppofi te fweC'2

meet the

ther in the inferior part,

fueh a

manr.er

as to cut OUt the

fh.pe

of ao

0..

1 whore rru.llefl di.meter !hall be ,wo inches :

after this, ¿¡{feét away the body of the turuour, Wilh the

piece of

lk.in

¡t,

from the {crotum;

fi rll:

tak:!Ig up fome

of [he

blood~vc{fels,

if the hx morrh2ge is dangerous. T hen

pars a ligature round [he cord, preuy near lhe abdomen,

and if

10U

hove rpace be,

wc.eo

the lig"ure and ,elbcle, a

fecond abou, half an ioeh lowor, to m,ke ,he (lor page of

blood (lill more fceure. T hc lig"ur., may be ,i, d with

what is calJed the

ItJrg~l)n'J ~n11,

whe-re Ihe thread lS

p3(–

fed through the ring t\Vice. T his aone;cut off the tt'HicJe

" Hu le underDealh the fecond Jigature,

3Gd

p. fs ..

r.e~d;e

{rom the Ikin at the lowcr pan of lhe' \\ oU!ld through ,[hl!

fkin al the l!ppcr pan , in fuch _a

mlnn~r

as to envdope in

S C