THE Hydrocele, called also Hernia Aquosa, Hydrops Scroti, and Hydrops Testis, is a watery Tumour of the Scrotum; which notwithstanding the Multiplicity of Distinctions used by Writers, is but of two Kinds: the one, when the Water is contained in the. Tunica Vaginalis; and the other, when in the Membrana Cellularis Scroti: this last, is almost always complicated with an Anasarca, which Species of Dropsy, is an Extravasation of Water lodged in the Cells of the Membrana Adiposa and when thus circumstanced, will not be difficult to be distinguished; besides that it is sufficiently characterised by the shining and softness of the Skin, which gives way to the least Impression, and remains pitted for some time. The Penis is likewise sometimes enormously enlarged, by the Insinuation of the Fluids into the Membrana Cellularis, all which Symptoms are absolutely wanting in the Dropsy of the Tunica Vaginalis.

In the Dropsy of the Membrana Cellularis Scroti, the Puncture with the Trocar is recommended by some, and little Orifices made here and there with the Point of a Lancet, by others; or a small Skane of Silk passed by a Needle through the Skin, and out again at the Distance of two or three Inches, to be kept in the manner of a Seton, till the Waters are quite drained: but the two first Methods avail very little, as they open but few Cells; and the last, cannot be so efficacious in that respect as Incisions, and will be much more apt to become troublesome, and even to gangrene. Indeed it is not often proper to perform any Operation at all upon this Part, since the Membrana Cellularis Scroti, being a Continuation of the Membrana Adiposa, Scarifications made through the Skin in the Small of the Legs, will effectually empty the Scrotum, as I have many Times experienced; and this place ought rather to be pitched upon than the other, as being more likely to answer the Purpose by reason of its Dependency: however, it sometimes happens, that the Waters fall in so great Quantities into the Scrotum, as by distending it, to occasion great Pain, and threaten a Mortification: the Prepuce of the Penis also becomes very often excessively dilated, and, so twisted, that the Patient cannot void his Urine. In these two Instances, I would propose an Incision of three Inches long to be made on each Side of the Scrotum, quite through the Skin into the Cells containing the Water, and two or three, of Half an Inch long, in any Part of the Penis, with a Lancet or Knife; all which may be done with great Safety, and sometimes with the Success of carrying off the Disease of the whole Body. This, I can positively say, that though I have done it upon Persons in a very languid Condition, yet, by making the Wound with a sharp Instrument, and treating it afterwards with Fomentations and soft Digestives, I have rarely seen any Instance of a Gangrene, which is generally so much apprehended in this Case.

The Dropsy of the Tunica Vaginalis, is owing to a preternatural Discharge of that Water which is continually separating in a small Quantity, on the internal Surface of the Tunick, for the moistening or lubricating, the Testicle, and which, collecting too fast, accumulates and forms in Time, a Swelling of great magnitude: this is what I take to be the other Species of Hydrocele, and the only one besides; though, from, the Time of Celsus, down to our own Days, the Writers on this Subject make two Kinds; one on the Inside of the Tunica Vaginalis, and another between the Scrotum and Outside of it; and among the Causes assigned for this Distemper, the principal one is the Derivation of Water from the Ascites, which Opinion, though universally received, is absurd in Anatomy: for besides that People afflicted with a Hydrocele, are very seldom otherwise dropsical; and on the contrary, those with an Ascites, have no Hydrocele; the Tunica Vaginalis is like a Purse totally shut up on the Outside of the Abdomen, so that no Water from any Part can insinuate into it; and with respect to the Notion of Water falling from the Abdomen into the Tunica Vaginalis and Scrotum, it is equally impossible; for though in the Hernia Intestinalis, the Gut falls into this Part, yet in that Case the Peritonæum (which would hinder the Egress of the Water) falls down too, which the Ancients did not know, and the Moderns have omitted to reflect on in relation to this Subject: it is true, that where the Ascites is complicated with a Hernia Intestinalis; or where there has been a previous Hernia of the Scrotum, and the Sac of the Peritonæum remains within the Scrotum, the Water of the Ascites, in that Case, may fall into the Sac of the Peritonæum, and in that manner form a Tumour of the Scrotum; but this is not properly a Dropsy of the Tunica Vaginalis. It must be here understood, that when I say there is no Communication between the Cavity of the Abdomen, and the Cavity of the Tunica Vaginalis, I speak of Adults; for in the Fætus, and even in an infant State, there is a Communication, and in those few Instances, where the Communication is preserved to adultness, the Water of an Ascites may fall into the Tunica Vaginalis: but this happens so rarely, that it should not be considered as an Impeachment of the preceding Doctrine.

The Hydrocele of the Tunica Vaginalis, is very easily to be distinguished from the Hydrocele of the Membrana Cellularis, by the preceding Description of that Species of Dropsy: I shall now explain how it differs from the other Tumours of the Scrotum, viz. the Bubonocele, Epiplocele, and enlarged Testicle: in the first Place, it is seldom or never attended with Pain in the Beginning, and is very rarely to be imputed to any Accident, as the Hernias of the Omentum and Intestine are: from the Time it first makes its Appearance, it very seldom is known to disappear or diminish, but generally continues to increase, though in some much faster than in others; in one Person growing to a very painful Distention in a few Months, whilst in another, it shall not be troublesome in many Years; nay, shall cease to swell at a certain Period, and ever after continue in that State without any notable Disadvantage; tho' this last Case very rarely happens: in Proportion as it enlarges it becomes more tense, and then is said to be transparent; indeed the Transparency is made the chief Criterion of the Distemper, it being constantly advised to hold a Candle on One Side of the Scrotum, which it is said will shine through to the other, if there be Water: but this Experiment does not always answer, because sometimes the Tunica Vaginalis is very much thickened, and sometimes the Water itself is not transparent: so that to judge positively if there be a Fluid, we must be guided by feeling a Fluctuation; and tho' we do not perhaps evidently perceive it, yet we may be persuaded there is a Fluid of some kind, if we are once assured, that the Distension of the Tunica Vaginalis makes the Tumour, which is to be distinguished in the following Manner.

If the Intestine, or Omentum, form the Swelling, they will be soft and pliable, (unless inflamed) uneven in their Surface, particularly the Omentum, and both of them extend themselves up from the Scrotum quite into the very Abdomen; whereas, in the Hydrocele, the Tumour is tense and smooth, and ceases before, or at its Arrival to the Rings of the abdominal Muscles; because the upper Extremity of the Tunica Vaginalis terminates at some Distance from the Surface of the Belly.

When the Testicle is increased in its Size, the Tumour is rounder, and, if not attended with an Enlargement of the spermatic Vessels, the Cord may be easily distinguished between the Swelling and Abdomen; but without this Rule of Distinction, either the Pain, or the very great Hardness, will discover it to be a Disease of the Testicle.

As to the Cure of this Distemper by external Applications, or internal Means: after having tried upon a great variety of Subjects, most of the Medicines invented to that end, I have found but very little Satisfaction in the Event; for if by chance, any one has mended under a physical Regimen, it must be confessed too, that there are some Instances of People recovering, who have so absolutely neglected themselves as not even to wear a Bag-truss; on which account, I should judge it adviseable to wait with Patience 'till the Tumour becomes troublesome, and then to tap it with a Lancet or Trocar, In opening with a Lancet, it may possibly happen, the Orifice of the Skin shall slip away from that of the Tunick, and prevent the Egress of the Water; to obviate which Inconvenience, you may introduce a Probe, and by that means secure the exact Situation of the Wound but if the Coats are very much thickened, it will be adviseable to use the Trocar, rather than the Lancet. It is spoken of as an easy thing, to hold the Testicle with the left Hand, while we make the Puncture with the Right, but when the Tunica Vaginalis is very tense, it cannot well be distinguished: however, I think there is no Danger of wounding it, if you make the Puncture in the inferior Part of the Scrotum. During the Evacuation, the Scrotum must be regularly pressed; and after the Operation, a little Piece of dry Lint and Sticking-plaister are sufficient.

This Method of Tapping is called The palliative Cure; not but that it does now and then prove an absolute one. To prevent the Relapse of this Disease, Surgeons prescribe the making a large Wound, either by Incision or Caustic, that upon healing it afterwards, the Firmness and Contraction of the Cicatrix may bind up the relaxed lymphatic Vessels, and obstruct the further preternatural Effusion of their Contents: But by what I have seen of this Practice, it is generally attended with so much Trouble, that notwithstanding its Success in the end, I believe whoever reads the following Cases will be apt to discard the Method, and abide rather by the Palliative Cure.


A. B. aged 44. a strong Man, never in his Life having been subject to any other Infirmity, put himself under my Care for the Relief of a Hydrocele on the left Side of the Scrotum.

December 3, 1733, I discharged the Water, by making an Incision thro' the Teguments about four Inches long. Towards Night he grew feverish, got no Rest, the Scrotum and Testicle on that Side, beginning to inflame, and the capillary Arteries (dilating) to bleed freely. He was seized too, with a violent Pain in his Back, which was in a great measure removed by suspending the Scrotum with a Bag-truss.

From the 3d to the 7th, continued in a most dangerous Condition, when the Fever tended to a Crisis, by the Suppuration of both Wound and Testicle.

From the 7th to the 24th, he daily acquired Strength; but the Discharge from the Testicle increasing, and the Sinus penetrating now very deep towards the Septum Scroti, I opened the Body of the Testicle, the whole length of the Abscess.

From the 24th, the Discharge lessened surprisingly; so that in six Days, the Surface of the greatest part of the Testicle united with the Scrotum, and there remained only a superficial Wound, which was entirely cicatrised on Jan. 10, 1733-4.

March 31, 1737, he continued in perfect Health.


In the Year 1733, I made an Incision thro' the Scrotum and Tunica Vaginalis of a Boy about eight Years of Age, who narrowly escaped with his Life: but the symptomatic Fever terminating at last in an Abscess of the Scrotum, it proved his Cure, tho' with some Trouble, in a few Weeks.


A. C. aged 37, of a very hale Habit of Body, had complained of a Tumour on one Side of the Scrotum, which continuing to enlarge for six Years, he applied to a Surgeon, who laid a small Caustic on the upper Part of it, and opening the Eschar, emptied near three Pints of Water; but he relapsing soon after, this, I undertook the absolute Cure.

December 15, 1736, I laid, on the anterior and upper Part of the Scrotum, a Caustic about six Inches long, and one broad.

December 16, by a small Puncture thro' the Eschar, I emptied above a Quart of Water.

From the 17th to the 24th, he continued in a great deal of Pain, not only in the Part, but in his Back and Loins, and had very little Rest; the Scrotum on that Side, became exceedingly inflamed and thickened, the symptomatic Fever running very high, without any Signs of the Digestion of the Wound,

On the 24th at Night he grew a little easier, and continued so 'till the 29th, when the Slough separated; but the Wound retained still a bad Aspect, no Granulations appearing on its Surface.

From Decemb. 29, to Jan. 5. he remained in the same State.

From the 5th to the 13th, the Swelling and Pain rather increased, and that Night be was seized with an Ague-fit, which returned every other Day twice more.

From the 17th to the 26th, the Ague being stopt, he began to alter much for the better, two Imposthumations on the Scrotum being in this interim opened.

By Feb. 2, the Pain was quite gone, the Tumour very much sunk, and the Induration softened.

In a very few Days after, the Wound cicatrised, and on Feb. 24, I left him in perfect Health, and free from any Complaint.

Having in the preceding Cases been seemingly threatened with the Death of the Patients, I tried the following Experiment, upon the Reputation of its having been done with Success by others.


A.D. aged Forty-two, had for near four Years been troubled with a Hydrocele on one Side, for which I had tapped him about twelve times, taking away near a Pint of clear Water each Operation.

Jan. 3, 1736-7, after having emptied the Tunica Vaginalis, I injected an Ounce of Spirit of Wine; in the Instant, he complained of great Pain, which continued to increase, and the next Day, the Teguments were very much augmented in their Bulk and Thickness.

Jan. 7, The Tension became violently painful, and perceiving a Fluctuation, I made a Puncture, by which he voided about half a Pint of Water, very deeply tinged with Blood, but without any Flavour of the Spirits to be distinguished by the Smell: This gave him some Ease, but the Inflammation and Thickness continued a whole Month, and then terminated in two Abscesses on the Fore-part of the Scrotum, which I opened the 7th of February following; and on their Discharge, the whole Tumour subsided, leaving a firm Cicatrix and absolute Cure of that Disorder.

Something similar to the Circumstance of A. D's bloody Water, is the Case of another Person who was under my Care: He had at considerable Intervals of time been often tapped, discharging that sort of serous Water the Tunica Vaginalis for the most part yields; at last, it became tinged with Blood, and every time grew more bloody than the other: The fourth Discharge of this kind was attended with a remarkable Hæmorrhage, and terminated in an absolute Cure; no Signs of a Relapse appearing some Months after, as I had an Opportunity to inform myself.

To the Cases above recited, I could add still more that have fallen within my Know]edge, since the time I made these Observations; particularly two, attended with Inflammation and Abscess, from the mere Puncture of the Lancet; both of which terminated in an absolute Cure. It may be remarked however of these two, that one was attended with a thickened Tunick, and the Water bloody; and in the other, the Coat was thickened, and the Epididymis enlarged and indurated from a former Gonorrhoea.

I would not however be understood from this Catalogue of Misfortunes, that the Operation is never performed without much Trouble; some Examples I have known in its favour, but by no means enough to warrant the Recommendation of it, unless to such Patients who are inconsolable under the Distemper, and are willing to sustain any thing for a Cure.

It is worth observing, that upon examination of the several Hydroceles, it appeared evidently their Cure was wrought by an universal Adhesion of the Testicle to the Tunica Vaginalis, and again of that Coat to the Parts enveloping it; from which Observation it will not be difficult to conceive how it happens, that Discharges of bloody Water work a Cure; since Inflammations of Membranes almost perpetually produce Adhesions of the neighbouring Parts, and these Discharges are no other than a Mixture of Blood with the Water from the ruptured Vessels of the inflamed Tunick.

It has been suggested, that probably the exposing the Tunica Vaginalis to the Air, might occasion the abovementioned Disorders; but besides that the Case of the injected Sp. Vin. the Case of the Caustic, and the two Punctures, are sufficient Answers to that Opinion, the Instances I have seen of the whole Scrotum separating in a Gangrene from the Tunica Vaginalis, and leaving it naked a great many Days without any ill Effect, put it out of Dispute, that 'tis the mere Inflammation of the Tunick produces the Danger. I have castrated several Men whose scirrhous Testicles were accompanied with a Hydrocele, but the whole Tunica Vaginalis being carried off by the Operation, they all recovered without any bad Symptoms. I have here proposed an Incision only thro' the Tunica Vaginalis, as the Means to effect a radical Cure; but it has been said, that to cut off a large Portion of it is a more effectual and a less dangerous Operation; this Fact I have lately taken under Consideration, but have not yet had sufficient Experience to form a positive Opinion on the Subject.

I shall finish this Chapter with a further Remark on the supposed Variety of Hydroceles. Besides the imaginary one already specified between the Scrotum and inferior Membranes, there is mention made of a Species of Dropsy between the Cremaster Muscle and Tunica Vaginalis But I judge it more likely to be within side the Tunica Vaginalis of the Cord, which adhering in different Places to the spermatic Vessels, may form a Cyst or two between the Adhesions, of which an Instance has fallen under my own Examination. Indeed, if we reflect on the Cause of a Dropsy of this Part, we must necessarily confine it to the Inside of the Membrane, where only is that Order of Vessels which are the Subject of the Disease. The Dropsy of the Testis itself, is the last supposed Species, but it is what I have never seen; and from the Analogy of the Testis, to the Structure of other Glands, that are not pretended to become Dropsical, I am suspicious there is no such Distemper.

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