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Case of Hydrodele, in Which a Needle Remained in the Tunica Vaginalis for Eleven MonthsSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 6, No. 148(Jul. 29, 1843), pp. 355-356Published by: BMJStable URL: http://www.jstor.org/stable/25492221 .

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PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION. - 355

justly lay claim to the credit that can no longer be withheld from it, that of having, by a large number of its representatives, struggled unceasingly for the

advantages of the great body of the profession, re

gardless of all the limited, but too often alluring, views which individual interest may suggest. Were illustration of this needed, we might proudly point to the PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION

as an incontrovertible and lasting evidence of its truth. Firm in purpose, united in effort, bearing the interests of the whole profession at heart, have the

members of the Association maintained, with untiring energy, the task they have allotted to themselves.

With one destined object in view, have they lost

sight of all others. Private interest and personal aggrandizement have never shackled their efforts, or drawn a single member from their ranks.

Few are they who would at the present day ask for

an exposition of the views and intentions of the Asso

ciation; and were it so, no other answer is needed than that which a retrospective glance at the endeavours that have been made, the amount of good that has been conferred, and the success already obtained,

would at once afford and paint in all its happiest

coloring the great object of the Association-make

scepticism change to confidence, and elicit an equal measure of applause and congratulation. From the Association much is to be expected-much has already been effected. It needs no better evidence than the result of its past labors to demonstrate its full com

petency, and not less its inclination, to aid the pro

gress of medical knowledge, and, by enriching to a vast extent the records of personal observation and

experience, furnish the chief and perhaps only certain

data for the future advancement and extension of

science. Never forgetful of this one and truly im

portant view, have the members of the Association

yet as carefully borne in memory that another object is also to be effected, that their labors are still to be

directed to another source-that the members of the

medical profession should maintain that high cha

racter and rank which the vast utility and the honor

able character of their duties entitle them to share.

Medical reform has ever been and is still one of its

most important objects; not that so-called medical reform which often actuates those who seek a short

lived notoriety by the assumption of such object, and strive to support it by the only weapons which they seem capable of wielding, vulgar vituperation and

ill-judged personalities, who seek no advancement but their own, no advantage but such as may accrue to

themselves. The members of the Association are none of these; with them medical reform, it is true, holds a prominent position, but it is not their only object; inseparable from it is the advancement of science and the increase of professional knowledge. The excellent result of this combination of objects, or

we might with equal truth say the cause of such

union, can be traced in the pleasing fact that every

member of the Assciation feels that he is also a mem

ber of a learned profession-a worikein the field of

science-and as such can adopt no measure, sanction

no means, nor advocate any principles, which have not

inseparably blended together the increase of medical

science and professional respectability. Unhesitatingly

may we turn to the "TransactionS' of the Association, and to the pages of this Journal, for., abundant evi.

dence of the truth of all this. If the excellence of

the past can be received as an earnest of the future

if the success already obtained may assure us of that

yet to come-we shall not hesitate to predict that ere

long the profession will date its elevated rank, and

not less its augmented treasury of knowledge, to the

efforts of the PROVINCIAL MEDICAL AND SURGICAL

ASSOCIATION, and hasten to proffer that meed of

thanks and of applause which was once but scantily

afforded. ^

We are now on the eve of another anniversary,

the TENTH, and look forward with equal pleasure

and certainty to the results of the meeting, andwould

but pause to express our hope that every member will

regard it as a duty to evince, by his presence, a

readiness to assist in the great work before him. It

will be our pleasing task to record, in our next Num

ber, the full detail of the proceedings, and on which

we may hereafter venture to make a few further

remarks.

We subjoin a notice of the meeting:

The PROVINCIAL MEDICAL AND SURGICAL ASSO

CIATION will hold their tenth anniversary meeting at

LEEDS, on Wednesday, the 2nd, and Thurday, thej4,

days of August next.

President, J. H. JAMES, Esq., Exeter.

President-elect, W. HEY, Sen., Esq., Leeds. The first general meeting of the Association will be

held in the theatre of the Philosophical Hall, on Wed

nesday morning, the 2nd of August, for receiving the

report of the council, and transacting other necessary business.

The retrospective address on surgery will be deli vered by William Hey, Esq., Jun., of Leeds, on Wed

nesday evening; and the retrospective address on

medicine, by Dr. Shapter, of Exeter, on Thursday morning.

CASE OF HYDRODELE, IN WHICH A NEEDLE REMAINED IN THE TUNICA

VAGINALIS FOR ELEVEN MONTHS.

The following case occurred in the practice of Mr.

Fergusson: Mr. S., a gentleman about fifty years of age, con

sulted me in February last for a swelling in the scro.

tum, which I had reason to know had originally been

a hydrocelc, but had now become a hamatocele. A

rew days before, a large quantity of bloody fluid had

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356 TREATMENT OF PROLAPSUS ANI.

been evacuated with a trocar and canula by my friend

Mr. Blyth, of the Melville Hospital, Chatham; and as doubts were entertained regarding the condition of the testicle, the patient came to town to take my

opinion on the subject. At this time, owing to a

fresh accumulation of fluid, the organ could not be

distinctly felt; and deeming it better to delay the use of the trocar and canula until the swelling had in creased somewhat, I declined giving a final opinion till I should have the opportunity of making an exa

mination immediately after evacuation of the fluid. At this time, however, I perceived a hard and sharp projection at the lowest and back part of the testicle, which I supposed to be an enlargement of the epi didymis.

In April, the patient returned with the scrotum so fully distended, that I at once tried the trocar and

canula, and after evacuating the cavity, was enabled to perceive that the testicle, though slightly larger than its fellow, was not in a state of disease. The sharp

point of what I supposed to be the epididymis was

still very distinct; but the principal swelling that now

remained was chiefly occasioned by the thickened

condition of the tunica vaginalis, and a quantity of

fibrin which could be squeezed from the interior.

As the disease had been present for upwards of twelve years, at first as a hydrocele, when it had

resisted two attempts at the radical cure, with port wine, and latterly, in the condition described, I ad

vised that the scrotum should be laid open, and the

parts subjected to the usual treatment for hematoid. To this practice the patient willingly submitted, and

a few days afterwards (19th April, 1843) I made an

incision into the scrotum, of sufficient size to enable me to remove the clots of fibrine with the point of

my finger. Towards the lower part of the cavity I

perceived resistance to the passage of the finger across

the cavity; and on squeezing it through the fibrine in this situation, came in contact with a hard substance,

which I immediately recognised as a needle such as

might have been used for acupuncture. By making a

slight extension of the wound I was enabled to extract

it, and have since found that it measures two inches in length, being an ordinary Whitechapel sewing needle. The point seemed lodged in the lower end of the testicle, and the other extremity was held fast in the thickened tunica vaginalis.

The subsequent treatment, which has been ably conducted by Mr. Alexander Blyth of the Wye Hos

pital Ship, has presented nothing worthy of notice here. I have since seen the patient in town, improved in health, with the wound nearly closed, and the

scrotum not much larger on the affected than on the

other side. Mr. Blyth informed me on the 3d instant, that the general health still improves, that an abscess

has lately formed in the scrotum, and that the swell

ing at present is much the same as when I saw it last.

Doubtless, the result will be such as it usually is in

similar cases.

The presence of the needle excited the patient's astonishment almost as much as it did mine. He

admitted, however, that he sometimes fancied that one might be present, and that it was the principal cause of the great additional pain which he had ex

perienced in the testicle for the last twelve months.

In 1836, acupuncture was first performed upon him

by his surgeon, and since then he had been in the

habit of using the needles himself at intervals of four

or five months, up to May, 1842, which was the last

time he had adopted such a proceeding. He had generally used six needles at a time, but on this oc

casion he introduced fifteen. He kept no count on

withdrawing them, and doubtless one had been al

lowed to remain, having possibly sunk beneath the skin whilst he was removing the others. Soon after

this he experienced great pain in the testicle; the hydrocele increased in size, and the scrotum was

tender externally. The latter condition gradually subsided, and for five months the weight and bulk of

the part constituted his chief annoyance. About this time the pain returned, and was distinctly of a pricking character, and was such as to induce considerable

fever. Some weeks afterwards the swelling was punctured with a trocar and canula, and, for the first

time, the fluid was of a bloody character. It is possible that one or more of the needles which

were last used had wounded some blood-vessels, and

thus caused the change in the character of the dis

ease; but it is more probable that the continued presence of the needle had produced this effect.

The sharp and hard projection which was noticed before, and supposed to be a portion of the epididy

mis, had been caused by the needle. It may appear

strange that this was not discovered previous to the

opening; but the absence of all suspicion regarding its presence, and the great thickness of the tunica vaginalis, caused its presence to be overlooked. The part had been frequently handled, and with some roughness too, yet the patient seemed to bear the

manipulation without any additional suffering.-Lond. and Edin. Monthly Journ. of Med. Sci.

PROLAPSUS ANI. Dr. Me Cormac has recorded the following observa

tions on the treatment of prolapsus ani in the " Dublin Journal

"

Procidentia, or prolapsus ani, is a complaint of con siderable frequency, both among adults and young persons, principally, however, the latter. Some cases are on record in which small doses of strychnia, it is

said, effected a cure; it is, however, an uncertain and even dangerous remedy, more especially with children.

Of late years, a kind of ivory truss, adjusted by means of a T bandage, has been introduced into prac tice; I found it to answer very well in the case of a

retired military man. Mr. Hey treated a very obsti nate case which had lasted from infancy, and was

attended with profuse hemorrhage and other inconve

niences, by removing a pendulous flap, which, to use his own words, " produced a more firm adhesion of the rectum to the surrounding cellular substance."

This operation was quite successful, but does not

very well apply to cases unattended with a circular

flap. Sabatier and others had recourse to excision of the

protruded portion-an operation, however, which may be productive of serious hemorrhage. These consi

derations probably led to the operation of Dupuytren; here, the patient being laid on his belly, the pelvis raised by pillows, the thighs separated so as to bring

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