- in its texture, it must of course be removed. If a violent contusion is followed by ecchymosis, leeches, slight compression by dressings dipped in a stimulating lotion, as one of camphor or ammonia, position, diet, and a gentle emetic to prevent the sympathetic affection of the stomach, are the measures employed by M. Larrey with success.

2. Inflammation of the Testicle. This may be either from over exertion or sympathetic. The first is rather rare, and is the only one, according to M. Larrey, for which leeches ought to be applied. After these, discutient and sedative lotions with gradual compression effect a cure. The swelling of the organ occasioned by extreme continence and retention of the seminal secretion is characterized by the size of the part, the tensive pain, the rapid dilatation of the spermatic veins, and the great inconvenience experienced in walking. Baths of cold water, even ice, cooling drinks, and the horizontal posture speedily relieve the symptoms. M. Larrey denies that great continence is so injurious as some authors have supposed.

In the sympathetic inflammation of the testis from gonorrhoea, the membranes are affected as well as the gland itself; if left to itself it may terminate in abscess, but rarely in sloughing. Sanguineous evacuations or leeches are, in M. Larrey's opinion, more injurious than beneficial, and seem to give rise to abscess in some, to hydrocele in others. We doubt whether many practitioners on this side of the Channel will agree with the Baron on these points. His practice consists in introducing into the urethra a small elastic bougie, spread thickly with a gummy preparation of opium, and in giving sedative demulcent drinks, with pills of camphor or of nitre and hyosciamus. An embrocation of camphorated oil of camomile is rubbed upon the scrotum, and slight compression applied by means of a flannel suspensory. When resolution is commencing a gentle emetic is prescribed. This mode of proceeding is hardly to be compared with the more energetic one adopted in this country.

When suppuration takes place, which

is usually in the epididymis, we should encourage it by fomentations, and open it as early as fluctuation can be felt. The abscess generally heals without difficulty, excepting when the body of the testis is affected; this is usually deeply disorganized and destroyed.

3. Nervous Affection, or "Irritable Testis." M. Larrey has only seen two cases of this kind, one in an officer of the guard, and the other in a young Parisian lawyer. It was characterised by violent pain extending from the cord to the testicle and occurring in variable paroxysms, retraction of the testis during the latter, moroseness and despondency of temper, and loss of sleep. M. Larrey has remarked, as Sir Astley Cooper has done, that depletion is injurious. If the pain attacks the loins, M. L. uses cupping and moxa, and the latter may be applied in the course of the cord. These means succeeded perfectly in the two cases already adverted to.

This

4. Wasting of the Testicle. has been remarked by Sir Astley Cooper as a consequence of inflammation, and by Mr. Brodie, if we remember right, of indulgence in masturbation. Baron Larrey gives a more detailed account of the several causes of this curious affection. Sometimes, when the swelling produced by mechanical injury has subsided, the testicle gradually diminishes in size until it completely wastes. In some cases which our author relates in another part of the work, a wound in the back of the neck, affecting the cerebellum, has been followed by more or less wasting of these organs. The abuse of venery; the employment of preparations of opium, whether applied externally or injected into the urethra for gonorrhoea; and especially immoderate indulgence in alcoholic liquors containing much narcotic matter, are very active causes of the complaint.

At the end of the first campaign in Egypt, a number of the soldiers of the French army complained of the almost total disappearance of their testicles, without any venereal affection to account for it. They remarked that they began by losing the sensibility of the generative organs, which no longer

preserved their vigour or their form, but gradually softened. So slow and insensible was the change, that they usually only discovered the malady when the testicles had nearly disappeared. On examination at this period, they were found near the ring resembling beans, whilst the cord was equally diminished and wasted. When both testicles were affected, the patient was deprived of his sexual powers and desires; he became melancholic; the voice was altered; and the beard ceased to grow. Nearly fifty soldiers were judged incapable of service on these accounts.

M. Larrey attributes the disease to the extreme heat of the Egyptian climate and the laborious marches through the desert, which softened the texture of the testicle, and occasioned at first a kind of enlargement, succeeded by the wasting in question. M. Larrey also assigns a destructive effect to the use of alcoholic and narcotic substances, but cannot explain very clearly their modus operandi. Into the composition of the brandy of the country, made from dates, there enter several plants of the class of solanum, such as the pimento and the berries of the cherry laurel. M. Larrey thinks it probable, that the action which such substances exercise on the nerves of the stomach, is transmitted sympathetically to the testicles, and occasions their absorption. The ancients, it is said, procured the same thing by the application, for a length of time, of the concrete juice of hemlock to the scrotum. These conjectures of the Baron's must be taken for what they are worth, but it is not improbable that the immoderate use of such substances, combined with fatigues in a burning and enervating climate, may exercise a mysterious agency on the glands of the testes.

When the wasting is complete, art possesses no power to renovate the organ. In the earlier stages of the malady, we may, perhaps, effect some benefit by withdrawing, as far as possible, its causes, and by employing some vapour-baths, with dry friction on the surface of the body, irritation in the lumbar and sacral regiors, tonics, and generous food. Spirituous liquors should be

avoided, or, at all events, procured without adulteration. A suspensory ought always to be worn in warm climates, and frequent ablutions of the body with cold vinegar and water, and abstinence from immoderate venery, are necessary as preventive measures. M. Larrey has had several soldiers affected with this complaint under his care in France. It pursued the same course as in Egypt, and the patients confessed that they had been addicted to immoderate indulgence in venery, and strong, adulterated spirituous liquors. In one of these individuals, both testes in a short time almost disappeared. From being originally of a very robust constitution, he lost his beard and manly features, and looks like a woman. A soldier, whilst landing from a vessel in Egypt, received a violent blow upon the back of the neck, after which the testicle wasted to the utmost degree. These facts collected by the Baron are curious and worth perusal.

5. Hypertrophy of the Testicles. An excessive growth of the female breast, without any appreciable change of structure, is not a very uncommon circumstance, but we were not previously aware of the existence of such an affection of the testicle. M. Larrey has seen it twice in the Hospital of the Guard. The first patient was 26 years of age, and both the testicles had acquired considerable volume, without exhibiting any perceptible morbid alteration, or occasioning inconvenience, except from their weight. The penis was incapable of erection, but the general health was good. Frictions on the scrotum and in the course of the cord with "double Neapolitan ointment,” in smail quantities and at long intervals; embrocations of camphorated oil of camomile; uniform compression by a flannel suspensory; slight diaphoretics, combined with bitters, and the horizontal position, reduced the testes in three months to their natural size. In the other case, the testicles were as large as the fist, and, although in excellent health, this patient also had lost the power of erecting the penis. The same treatment as before, continued for six months, was perfectly successful.

XLIV.

WESTMINSTER HOSPITAL

ULCERATION OF THE TONSILS-DEATH. SECTIO CADAVERIS.

admitted

WILLIAM PIMLETT, æt. 51, April 24th, 1830, under Dr. Roe. Complains of severe cough and great difficulty of swallowing in consequence of a sore throat. He is very much emaciated, his pulse slow and feeble, countenance anxious, and the surface of his body cold. He is a coal-porter, and states that four months ago he caught a severe cold, attended with cough and dyspnoea, and two months afterwards he felt his throat affected. Opening

medicines were administered, and he

used gargles, but he felt himself grow worse. Three weeks ago the disease had advanced so far that it was with the greatest difficulty he could swallow any thing, and he became in consequence much debilitated. His cough has become more frequent lately, and expectoration plentiful. He does not sleep at night, and his appetite is impaired. Immediately on his admission he was ordered the warm bath.

29th. Passed a tolerable night; there is less anxiety of countenance-pulse full and quick-tongue clean-bowels confined. Haust. aperiens st.

B. Pulv. hyd. cum cretà,
Ipecac. c. aa gr. v.

ft. pulv. bis in die sumendus.

B. Decoct. cinchon. 3j.

Acid. nitr. M. x.—ter in die. C. c. jugulo ad 3vj.-Arrow-root and milk daily.

30th. Slept well during the nighthas less pain in the throat, and not so much difficulty in swallowing-cough less frequent-pulse softer-bowels open.

Moxa applicet. jugulo. May 1st. Hirudines xij. jugulo et rep. moxa.

May 4th. He slept better last night, and has less difficulty in swallowing

there is also less anxiety of countenance, but he complains much of debility.Pulse is feeble but regular. Tongue clean-bowels confined. Haust. purg. st. et cont. mist.

May 6th. The moxa was re-applied to-day. He is ordered beef-tea.

8th. He complains that he experiences great pain in swallowing the medicine.

The dose of nitric acid is diminished to m.v.

B. Pil. hyd.

Pulv. opii, äā gr. j.—bis in die. 10th. He is evidently worse— the difficulty of swallowing is increased, anxiety. Pulse very feeble, surface of into the oesophagus through the nostrils the body cold. A tube was introduced and four ounces of wine administered ; the tube it was obliged to be withdrawn from the great irritation produced by before more could be passed. Two pints of milk boiled up with two ounces of arrow-root, and the same quantity of port wine were thrown up the rectum this morning, and repeated again in the evening.

and his countenance expresses great

11th. He appears to have rallied again. He enjoyed a little sleep in the night, and his pulse has gained a little power. Tongue clean-bowels opencountenance less pale and anxious. He has attempted to swallow some beeftea, and a tube has been passed into the oesophagus, and about half a pint of strong beef-tea introduced.

12th. He swallowed nearly a pint of the arrow-root last night by the natural efforts. He articulates more distinctly, but his pulse is still feeble. He has inhaled the fumes of the factitious linaria twice, and is to repeat it daily.

13th. He is evidently sinking, and is unable to swallow any thing.

14th. He died this afternoon. 16th. Sectio Cadaveris. The body presented a very emaciated appearance. On examining the thorax the lungs were found adherent throughout the surface to the sides. The upper and

middle lobes were completely tuberculated, and the inferior approaching to a state of hepatization. In the superior parts the tubercles were in a state of suppuration, and in the left apex there was a small vomica.

The mucous membrane of the bronchiæ and trachea was natural-the bronchial tubes were nearly filled with a muco-purulent fluid-the whole interior surface of the larynx presented a granulated surface, which had evidently secreted a quantity of pus. The ligamentous portions of the larynx were much thickened, and there appeared a general amalgamation of the tissues. The epiglottis especially was much thickened, and the posterior portion enlarged and uneven. Abdomen healthy.

XLV.

HOPITAL ST. ANTOINE.

I. CASES OF INTERNAL STRANGULATION OF INTESTINES, FOR WHICH AN OPE

KATION IS PROPOSED.

Casel. A young woman was admitted into the St. Antoine Hospital on the 28th February, 1830, with vomiting, pain in the epigastrium and right iliac region, diarrhoea, and symptoms of phthisis pulmonalis. Leeches were applied to the epigastrium and iliac region with relief, but on the night of the 3d, she was seized again with violent pain in the belly, vomiting, and no stools; the pulse was small, frequent, and regular. A bleeding procured alleviation, but the symptoms returned next day, and were met by active antiphlogistic measures. On the 5th, the pain continued, and the neighbourhood of the umbilicus was tympanitic; incessant vomiting was experienced during the night; and castor oil produced no stools. The vomiting ceased, but there was extreme tender ness in the right iliac region, and the patient expired on the 14th, having experienced for many days the most excruciating sufferings.

* Journ. Hebdomad. No. 95.

Sectio Cadaveris. On opening the abdomen the small intestines appeared much distended. The omentum had contracted adhesions in the right iliac fossa, and formed a flattened band, adhering towards the middle of the mesentery, and forming an arch beneath which the distended intestine passed twice. The gut, where pressed on by the band, exhibited a depression, but not of sufficient depth to prevent fæcal matters from travelling onwards. Beneath the two convolutions, the ileum, about two feet from the valve, formed two other turns, united to the neighbouring parts, and remarkably contracted opposite the band of the omentum. Had the latter been divided the stran- ' gulation would have ceased. this part the intestines were distended, below they were shrunken and empty. At the point of constriction the intestine was livid but not gangrenous; the peritoneum was somewhat injected and shewed recent lymph; the lungs were filled with tubercles.

Above

Case 2. Pierre Foyer, ætatis 24, brass-founder, was admitted on the 20th October, 1829, having suffered for some time from the colic of his trade. For three days it had been particularly severe, with tension of the belly, nausea, and constipation; the pulse was quiet, the tongue natural. Some croton oil was given him, but next day the belly was rather more tense and painful, the pulse more frequent; he had vomited twice, and had not had a stool for seven days. Leeches, lavements, warm-baths, and demulcents, were the means resorted to without relief. The pain on the 22d was very severe and increased by pressure; there was tension in the left iliac region and depression in the right, and the fever was augmented. Bleeding and leeches were employed with no benefit. The umbilicus and especially the left iliac region became prominent and tense, the patient could only recline on the right side or with the body bent forwards, and the aspect betrayed extreme anxiety. Bleeding procured a temporary respite from pain, and so did leeches, but he sank at one o'clock next morning.