Mr. Bell's method, by incision. -"The patient being placed upon a table of a convenient height, and being properly secured by two assistants, with the scrotum lying nearly upon the edge of the table, the operator, with one hand should grasp the tumour so as to hold it firm, and make it somewhat tense on its anterior part; and with a common round edged scalpel in the other, he is is now to divide the external teguments by one continual incision from the superior extremity of the tumour, all along its anterior surface, down to the most depending point of the swelling. By this means, as the divided scrotum retracts a little, the tunica vaginalis is laid perfectly bare, for the breadth of half an inch, or so, from one extremity to the other. An opening is now to be made with a lancet into the vaginal coat, just at its upper extremity where the first incision commenced. This opening should be of such a size as to receive the operator's finger, which being inserted, the probe pointed bistoury is to be conducted upon it, and by means of it the sac is to be divided to the very bottom, all along the course of the first incision. By making the first opening into the sac at the upper end of the tumour, much trouble and inconvenience are prevented, which making the first orifice below is sure to occasion: for, as we have before remarked, when the tumour is first opened below, the water is instantly evacuated; and as that produces an immediate collapse: of the tunica vaginalis, the passage through its cavity is not afterward easily discovered; whereas, by making the first opening above, as the water is thereby evacuated gradually, as the incision is extended downwards, the vaginal coat continues distended to the bottom till the incision is completely finished. The incision being completed in the manner directed, the testicle, covered with its tunica albuginea, comes into full view. Sometimes the testis protrudes from the wound altogether; in which case it must be replaced with great caution, and it ought by all means to be covered as quickly as possible from the external air; and, provided none of the tunica vaginalis is to be removed, this may be always done immediately, by finishing the dressing directly on the sac being opened. When the sac is not too much thickened, there is no necessity for removing any part ©fit; but when it is discovered to be otherwise, to be thick and very hard, the removal of a portion of it on each side of the incision makes the cure of the remaining sore more easy and expeditious. As in this hardened state the sac generally separates with great ease from the surrounding teguments, any quantity of it may be easily taken away with the scalpel, without the least hazard of wounding the scrotum." As soon as the incision has been made, Mr. Bell inserts, between the tunica vaginalis and the body of the testis, slips of soft linen, smeared with some simple ointment, which causes much less irritation than dry lint, and is much more easily removed.

Mr.Earle's method, by injection - Professoraiexander Monro, of Edinburgh, having supplied the hint of curing the hydrocele by inflammation, Dr. Monro, surgeon to lord Hume's regiment, attempted to make a radical cure by letting out the water of a large hydrocele, and injecting a little spirit of wine into the scrotum, which raised a violent and dangerous inflammation. When this was relieved by the usual remedies, he never had any return of the hydrocele. This violent inflammation induced him to try a milder remedy. Having let out the water, he injected some claret into the scrotum, by which means only a slight inflammation was raised; but still succeeded to his wish, by completing a cure. He has since made several radical cures by this remedy alone. See Monro on the Dropsy, p. 165, note (w), London, 1756.

Mr. Earle's method is so similar to this, that it can scarcely be doubted from whence his ideas were derived. If the tumour be very large, it should, he observes, be emptied, and the water afterwards suffered to accumulate till about six ounces are collected. . The cyst is then to be tapped in the usual mode, and as much of a mixture of red port wine, with one third of water made blood warm, is to be thrown in through the canula of the trochar as will distend the tumour to its original size. It is to be allowed to remain there for four or five minutes, and then to be pressed out: should the subsequent inflammation prove considerable, a common bread poultice may be applied.

Perhaps neither Dr. Munro nor Mr. Earle can claim the discovery; for the same method has been recommended by M. Lambert above a century ago, in his Oeuvres Chirurgicales, published at Marseilles. A strong solution of corrosive sublimate in lime water was the composition of which he made use; and he gave a variety of cases in which success was the consequence.

See Monro, on the Tumours of the Scrotum, in the Edinburgh Medical Essays, vol. v.; Pott's Account of the. Method of obtaining a radical Cure of the Hydrocele; Else, on the Hydrocele of the Tunica Vaginalis Testis; Bell's Surgery, vol. i. p. 403, etc.; London Medical Journal, xi.; White's Surgery, p. 328.

Hydrocele cystata resembles the common hydrocele; but the tumour does not extend to the testicle, which may be felt below or behind it, while in the hydrocele of the vaginal coat, when large, the testicle cannot be discovered. In this disease also the penis is not buried in the tumour. Sometimes the fluid is contained in two distinct cells; and this is discovered by little contractions in it. It is distinguished from thc anasarcous hydrocele by a sensible fluctuation, and the want of the inelastic pitting; from hernia, by its beginning below, from its not receding in an horizontal position, and not enlarging by coughing or sneezing. The cure is the same with that of hydrocele of the vaginal coat: in children it is often removed by spirituous applications.

Hydrocele funiculi. An hydrocele of the spermatic chord is usually a symptom of ascites; but is sometimes an anasarcous swelling of the surrounding cellular substance. It is owing to the usual causes of dropsy, and occasionally to the pressure of a truss. In an erect position it is oblong; in a recumbent posture flatter, and somewhat round. The swelling is generally confined to the groin, though it sometimes descends to the scrotum, and enlarges it to a considerable size. When a local complaint, the water may be discharged by a trochar or lancet.

Hydrocele peritonae'i. See Ascites.

Hydrocele spikalis. See Spina bifida.