(From water, and a tumour). This term is employed when water is contained in ruptures; but particularly is applied to a dropsy in the scrotum; hydrops testis, hernia aquosa, oscheocele,andoscheofihyma. By oscheocele Vogel means a rupture which descends into the scrotum; Dr. Cullen places this genus in the class cachexia, and order intu-mescenyiae, which he defines a soft, fluctuating, pellucid tumour of the scrotum, not painful.

There are two kinds: in the first the water is lodged in the cells of the membrana cellularis scroti; and it is a symptom of anasarca. The second, and only proper species, is formed by water lodged within the tunica vaginalis of the testicle. The first tumour retains the impression of the finger, the second is elastic.

The second, our only object at present, is a morbid accumulation of the water separated on the internal surface of the tunica vaginalis, to moisten or lubricate the testicle.

From its first appearance it seldom disappears or diminishes, but generally continues to increase, sometimes rapidly, at others more slowly. In some it grows to a painful degree of distention in a few months; in others it continues many years, with little disturbance. As it enlarges it becomes more tense, and is sometimes transparent; so that if a candle is held on the opposite side, a degree of light is perceived through the whole bulk of the tumour; but the only certain distinction is the fluctuation, which is not found when the disease is a hernia of the omentum or intestines, or an inflammatory or a scirrhous tumourof the testicle.

If the water is lodged only in the cellular membrane, scarifications may be made in the legs, as in an anasarca; but if it is a proper hydrocele, and occasioned by no other disorder, a lancet, or the trochar, may be employed to discharge the fluid; and as the testicle lies always on the posterior part of the tumour, the perforation must be made into the anterior and lower part of it. This is, however, only a palliative remedy.

Mr. Bell proposes the use of a flat trochar in preference to a lancet. The patient being sealed, the operator, with his left hand, should grasp the tumour on its back part, so as to push the contained fluid into the anterior and under part of the swelling. An opening must then be made through the skin and cellular membrane, about half an inch long, with a lancet; the trochar introduced through the tunica vaginalis, and the stillette withdrawn, that the water may be discharged. After this the canula may be also withdrawn, and a piece of adhesive plaster should be applied to the orifice. A compress of soft linen may cover the scrotum, and the whole may be firmly supported by a T bandage.

Mr. Pott proposes a radical cure, by exciting an artificial inflammation in the tunica albuginea, and the tunica vaginalis, by means of a seton, which will produce an obliteration of the cavity, in consequence of the inflammation. Mr. Else prefers the application of a caustic (see Causticum opiatum) to the fore and lower part of the scrotum; and Mr. Bell recommends an incision into the upper and fore part of the scrotum, to be directed downwards. We shall add a general account of these three methods, referring to the works of the respective authors for further particulars.

Mr. Pott's method, by a seton. - The object of this is to excite the necessary degree of inflammation, if possible, without producing slough or abscess, the hazard of a gangrene, or that alarming degree of symptomatic fever which sometimes attends both the caustic and the incision. The seton requires confinement to bed only for a few days," after which the patient may lie upon a couch to the end, which will be in about a month; and during the whole time the common remedies of inflammation are only necessary. The manner of performing it is as follows: -"Choose a time when the vaginal coat is moderately distended; and having pierced it with a trochar of a tolerable size, draw off the water; when that is done, introduce into the canula a probe armed with a seton, consisting of ten or twelve strings or threads of silk; pass the probe as high to the upper part of the vaginal coat as you Can, and on the end of that probe make an incision of such a size as to enable you to to pull it out easily, together with a part of its annexed seton; then cut off the probe, and tie the silk very loosely, covering the orifices with pledgets. By the next day the seton will be found to have contracted such an adhesion to the tunica albuginea as would cause a great deal of pain to detach; but this it is perfectly unnecessary to do, and it should be suffered to remain without molestation. In about forty-eight hours the scrotum and testicle begin to swell and inflame; the patient should then lose a little blood, and have a stool or two, and the whole tumefied part should be wrapped in a soft poultice and suspended in a bag truss. The disease from this time bears the appearance of a large hernia humoralis, and must be treated in the same manner, by fomentations, cataplasms, etc. The adhesion of the seton to the albuginea generally continues firm, and I never meddle with or move it till it becomes perfectly loose, which it seldom does for the first fortnight, or until the inflammation is going, and the humours subsiding. By the time the seton becomes loose, the coalition of parts is universally and firmly accomplished. I then withdraw it, and heal the orifices with a superficial pledget."

Mr. Else's method, by a caustic. -"My method is this: - to lay a small caustic upon the anterior, inferior part of the scrotum, taking care to avoid the testicle: a large caustic is quite unnecessary, and every advantage may be derived from one whose eschar will be no bigger than a shilling. The loose and pendulous situation of the scrotum renders the application of a bandage so very inconvenient, that we cannot easily prevent the caustic from spreading somewhat; for this reason, I cover no more than the size of a sixpence, on a presumption that it may make an eschar as broad as a shilling, though it commonly makes one of the size of a half crown. The intention is, that it shall affact, and, if possible, penetrate through the tunica vaginalis; so that the time it is suffered to lie on is proportioned to the supposed thickness of the cyst. The caustic should never remain on less than five hours; but if it be Buffered twenty-four hours, it can do no mischief when properly guarded. On the removal of the caustic, digestives may be applied to the eschar, or the common cataplasm of white bread and milk. The scrotum must be suspended in a bag truss; and the patient had best be confined to his bed, though even this circumstance is sometimes omitted without detriment. Sometimes, immediately after removing the caustic, at other times within twelve or twenty-four hours, or even at the distance of two or three days, the patient begins to complain of a pain in the scrotum and loins, has now and then some colic pains, and the pulse a little quickened, and the tongue whitish. At different periods of time, from the removal of the caustic, but generally within forty-eight hours, an alteration is perceptible in the scrotum; the tumour, upon grasping, feels more tense and hard than it was before, and this hardness answers to the figure of the tunica vaginalis in its whole extent; and a little attention will convince an observer, that it is this membrane alone which gives the sensation of tension and hardness, and no other part. The colic pains and fcbricula seldom continue more than twenty-four or forty-eight hours; and very frequently are so inconsiderable as to require neither evacuation nor any internal medicines. If, however, the pulse be quickened a little, the pain of the back and the colic distressing to the patient, they will be speedily removed by one or two bleedings, and the injecting one or two clysters. As soon as the pain of the back (except what arises from the weight of the scrotum), the febrile heat, and other symptoms are removed, for they commonly go off altogether, the patient need no longer be confined to his bed, but may be suffered to get up and walk about the room, provided the scrotum be suspended. In a few days the eschar of the scrotum will loosen and come away, exposing to view the tunica vaginalis, which bears evident marks of its having been affected by the caustic, and prepared to slough off; and when pressed with the finger, the undulation of the water may be felt within it. As the cure proceeds, the sloughy tunica vaginalis will project more and more through the orifice of the scrotum; and when it appears ready to burst, it may be punctured with a lancet, and for this reason only, that it will relieve the patient from the weight of the tumour; for no other advantage can be derived from it. If the water is discharged by a puncture, the scrotum by degrees collapses, and the orifice in it is filled up with slough, which prevents the access of external air to the testicle. These sloughs continue to come away with the dressings daily for about four, five, or six weeks; and in proportion to their discharge, the hard tumour of the scrotum lessens. Upon casting off the last slough, the hardness is entirely gone, the wound immediately cicatrizes; and the cicatrix being about the size of a finger's end, adheres strongly to the body of the testis, which has never come in sight, nor has had any application brought in contact with it during the whole process."