Hydrocele

“ In an Hydrocele that happens to young Infants, the Opening may be made with a Lancet, to take away all the Water at once: But in Men, especially when there is a great quantity thereof, it is more expedient to do it with the sharp-pointed Pipe; but the Testicles are to be drawn back, for fear of wounding 'em with the Point of the Instrument.
If the Hydrocele be apparently Encysted, the Membrane containing the Water is to be consum'd with Causticks, which is done by laying a Cautery in the place where the Incision shou'd be made, and afterward opening the Escar with a Lancet. ”

“ Greek, ὑδροκηλικὸν κοπάριον.
On the cure of hydrocele Paul (VI. lxii) says:
‘When the fluid is in the tunica vaginalis we make the incision where the apex of the tunica makes its appearance, and, separating the lips of the incision with a hook, and having dissected off the fascia with the hydrocele specillum and the scalpel (ἐξυμενίσαντες τῷ τε ὑδροκηλικῷ κοπάριω καὶ τῷ σμιλίῳ) , we divide it through the middle with a lancet.’
Treating of the excision of varices (VI. lxxxii) he says ”

“ Hydrocele is occasionally complicated by the presence of hernia, when a careful examination must be instituted in order to understand the exact share each disease has in the production of the swelling. In cases of very slow increase, and in persons of advanced age, the vaginal coat and its investments are not unfrequently much thickened, so as to obscure the sense of fluctuation, and destroy the transparency of the tumour. Sometimes deposit of earthy matter takes place between the layers of the membrane, rendering it hard, rigid, and in a measure osseous ”

“ The serous spermatic tube remains open in all quadrupeds; but their natural prone position renders them secure against hydrocele or hernial protrusion. It is interesting to notice how in man, and the most anthropo-morphous animals, where the erect position would subject these to the frequent accident of hydrocele or hernia, nature causes the serous spermatic tube to close. ”

“ The affection of an organ is not a necessary consequence of that of its serous membrane, and reciprocally the organ is often affected and the membrane does not become diseased. For example, in the operation for hydrocele, the testicle remains almost always sound in the midst of the inflammation of its tunica vaginalis. The inflammation of the mucous membrane of the intestines is not a consequence of that of their peritoneal covering ”

“ In the milky fluid obtained by tapping such a hydrocele we may find filarial embryos.
Besides chylous hydrocele we may have a chylous ascites or a chylous diarrhoea. Where there is no obstruction to the thoracic duct there is less fat and the condition is more properly a lymphocele rather than a chylocele. The same distinction is applicable to the other conditions connected with lymphatic varices due to lymphatic obstructions other than that of the thoracic duct. ”

“ The testicles, thus suspended, have two coats, one adhering closely, and the other loosely surrounding the former—between the two, a lubricating fluid is secreted, whereby the various movements of the body are permitted [16] without injury; it is between these coats that water is secreted occasionally, constituting the disease known as hydrocele. The closely fitting coat is termed from its whiteness and density Tunica Albuginea—the other Tunica Vaginalis. These coverings are formed of that extensive membrane in the abdomen called the Peritonœum. ”

“ It is a disease incident to every period of life, but more commonly met with in grown persons. The ordinary formation of hydrocele is unattended with pain; and the patient [70] accidentally discovers the existence of the swelling, but oftentimes not until it has attained a considerable magnitude. The tumor, when large, produces an unsightly appearance, and forms a hindrance to sexual intercourse, from the integuments of the penis being involved therein, and thereby preventing a perfect erection of that organ. The disease may appear to originate spontaneously ”

“ The liquid was promptly drawn oft by tapping, and a stimulating injection was made into the scrotum to prevent re-accumulation. We mention this case only because it is one among a very large number who have consulted us supposing that they were suffering from enlargement of the testicles, cancer, or some other morbid growth within the scrotum, when a slight examination has shown the affection to be hydrocele, a disease which is speedily cured by tapping, with a little after treatment. The operation is perfectly safe and almost entirely painless. ”

“ Besides, what opposes also this rupture, is a kind of locomotion of which it is capable; so that if too violently142 drawn, it displaces that which is contiguous to it, draws it towards itself, and thus becomes less stretched. We see this phenomenon in a remarkable manner in the swellings of the testicle, in large hydrocele. ”

“ In some animals the ovarian sac is much better developed than in the human female. In the hyena it forms a complete tunic to the ovary, the cavity of the sac communicating with the peritoneum by a small opening. In rats and mice the sac is complete, and the Fallopian tube communicates with the ovarian sac, but not with the general peritoneal cavity.
Ovarian hydrocele occurs in women when the abdominal ostium of the Fallopian tube opens into a well-formed ovarian sac and the common cavity becomes distended with fluid. ”

“ According to Morgagni, the too frequent return of venereal ideas will produce varicocele and hydrocele. Some authors, also, place venereal excesses among the causes of the first of these two diseases, and also of circosele. We have seen several cases of varicose dilatation of the spermatic cord and testicle in onanists. This fact is also confirmed by Breschet, in his memoir read at the Academy of Sciences, Jan. 13th, 1834. He thinks that circosele and varicocele are by 157 no means diseases of adult and old age, but that they are seen most frequently in young men. ”

“ Abdominal dropsy and hydrocele were treated by tapping with a trocar; and varieties of hernia were understood, omental hernia being removed by operation on the scrotum. Aneurisms were known, but not treated; the use of the ligature on the continuity of an artery, as well as on the cut end of it in a flap, is the one thing that a modern surgeon will miss somewhat noticeably in the ancient surgery of the Hindus; and the reason of their backwardness in that matter was doubtless their want of familiarity with the course of the arteries and with the arterial circulation. ”

“ Rhubarb five grains, opium half a grain, every night. Flesh diet, with small beer, or wine and water. The disease continues some months, but at length subsides by the treatment above described. A bath of about eighty degrees, as Buxton Bath, is of service; a colder bath may do great injury.
11. Hydrocele. Dropsy of the vagina testis. Dropsies have been divided into the incysted and the diffused, meaning those of the cellular membrane, the cells of which communicate with each other like a sponge, and those of any other cavity of the body. ”

“ N42.8 Other specified disorders of prostate N42.81 Prostatodynia syndrome Painful prostate syndrome N42.82 Prostatosis syndrome N42.89 Other specified disorders of prostate Cyst of prostate N42.9 Disorder of prostate, unspecified N43 Hydrocele and spermatocele Includes: hydrocele of spermatic cord, testis or tunica vaginalis Excludes1: congenital hydrocele (P83.5) N43.0 Encysted hydrocele N43.1 Infected hydrocele Use additional code (B95-B97) , to identify infectious agent N43.2 Other hydrocele N43.3 Hydrocele, unspecified N43. ”

“ Surgeons know that sarcoceles, hydroceles by effusion, varicoceles and all the diseases of the testicles are as rare before the period of puberty, when nutrition only is going on in these glands, as they are common in the subsequent years.
It appears that it is the mucous glands which are then the most commonly affected and are consequently in the greatest activity. The lachrymal glands are also very frequently in action. The infant weeps more often than the adult; we might say that all the passions which agitate this age have but one uniform mode of expression, and this mode is weeping. ”

“ Microscopically the enlargement would seem to be due rather to hyperplasia than to hypertrophy. The bladder, except for absence of the opening of one ureter, was generally normal. In a large number of cases there were associated deformities of the organs of generation, especially of the female organs, and these were almost invariably on the side of the renal defect; they affected the conducting portion much more than the glandular portion—that is, uterus, vagina, and Fallopian tubes in the female, and vas deferens or vesiculae seminales in the male, rather than the ovaries or testicles. ”

“ The fluid is generally glairy, sometimes thick and gelatinous, often turbid and dark coloured. Not unfrequently the main cyst is subdivided, either by membranous septa, or by an aggregation of smaller cysts of the nature of hydatids. The swelling is at first on one side, and gradually rises out of the pelvis; often it remains long moveable; it increases, becomes more fixed, and ultimately fills the abdomen, displacing the viscera, and giving rise to feelings of much uneasiness, deformity, and loss of health. ”

“ The series of outer tubules are called Kobelt’s tubes. They are free and closed at the distal extremity, while at the proximal extremity they join the longitudinal tubule. The larger longitudinal tubule is called the duct of Gärtner. It may sometimes be traced traversing the broad ligament to the uterus, and through the walls of this organ and of the vagina to its termination at the urethra. It corresponds to the vas deferens in the male. When persistent in the vaginal wall it may become the starting-point of a vaginal cyst. ”

“ The inner aperture of the funnel is on a level of the middle of the testicle or ovary, the outer within the ureter; and it is a noteworthy fact that only at certain periods of the life of the fish this outer aperture is found to be open,—at other times the peritoneal funnel appears as a closed blind sac within the ureter. The mode of passage of the semen into the funnel is not known.
In Polypterus and Amia, proper oviducts, with abdominal apertures in about the middle of the abdominal cavity, are developed; they coalesce with the ureters close to the common urogenital aperture. ”

“ The pedicels of the glands which are situated close to the slit-like orifice, both those on the valve and on the collar, are short; whereas the pedicels of the more distant glands are much elongated and project inwards. The glands are thus well placed so to be washed by any fluid coming out of the bladder through the orifice. The valve fits so closely, judging from the result of immersing uninjured bladders in various solutions, that it is doubtful whether any putrid fluid habitually passes outwards. But we must remember that a bladder generally captures several animals ”

“ Congestions, irritation and even inflammation of the Urinary Organs often occur in men, either alone or as a complication of Seminal Disease and Weakness. The Seminal Vesicles lie just behind the bladder, while the Seminal Ducts pass through the body of the Prostate Gland, and open into the urethra (or urine channel) upon its surface (see Fig. 5) . Hence, any inflammation or congestion of this large gland that lies at the root of the organ and neck of the bladder, is almost certain to produce Seminal Weakness, Losses and Impotence. ”

“ The salivary glands are the modified nephridia of the segment of the oral papillae.
The male generative organs (fig. 10) consist of a pair of testes (te) , a pair of seminal vesicles (v) , vasa deferential (v.d.) , and accessory glandular tubules (f) . All the above parts lie in the central compartment of the body cavity. The ovaries consist of a pair of tubes closely applied together, and continued posteriorly into the oviducts. Each oviduct, after a short course, becomes dilated into the uterus. ”

“ The body-cavity is by this means kept tensely filled with fluid, and the stone-canal is enabled to draw on it for the supply to the water-vascular system, thus rendering the external madreporite supererogatory. A large-stalked sac—the Polian vesicle (Fig. 256, 4) —multiplied in many species, hangs down from the water-vascular ring and serves as a reservoir of fluid.
All the podia, including the feelers, have ampullae. In the feelers a semicircular valve is situated just where the external part passes into its long ampulla. ”

“ As the production of seminal fluid is more or less constant in man and some animals, while its discharge is intermittent, the vesiculæ seminales serve as reservoirs for the fluid, preserving it until required, or allowing it to undergo absorption. Some claim that the zoösperms are matured in these organs. They always contain seminal fluid after the age of puberty. During coition, their contents are forcibly expelled by a spasmodic contraction of the muscles which surround them and the ducts leading from them. ”

“ At this place, the aponeurosis, thus constituted of fibres disposed crossways, is elongated into a canal, forming an envelope for the cord, K. This elongation is named the “external spermatic fascia,” and is continued over the cord as far as the testicle. In the female, a similar canal encloses the round ligament of the uterus. From the above-mentioned facts, it will appear that the so-called “external abdominal ring” does not exist as an aperture with defined margins formed in the tendon of the external oblique muscle. ”