We pass over the sections on the "spermatic fluid" and on the "functions of the testis;" the latter of which, at least, might have been omitted, as everything of practical importance connected with the subject is fully discussed in other parts of the work.

PART SECOND treats of Diseases of the testis, and the first chapter is devoted to the consideration of Congenital imperfections and malformations, under the several heads of Numerical excesses and defects, Deficiencies and imperfections of the vas deferens, and Imperfect descent of the testis; to which last subject we shall confine our observations on this chapter.

Mr. Curling is of opinion, from his own observations, "that if the descent (of the testicle) does not take place within a twelvemonth after birth, it is rarely or never afterwards fully and perfectly completed without being accompanied with rupture." (p. 68.) This opinion has been entertained by several authors, and when we look to the mechanism of the process it might be anticipated that a late descent of the testicle. must be always followed by rupture, but it is a curious fact that this is by no means uniformly the case, even when the descent is postponed to a very late period. Malgaigne, for example, (Anat. Chirurg., t. ii. p. 266,) mentions the case of a boy, aged thirteen, who being thrown from a height of seven feet, the left testicle suddenly descended from the abdomen, but was not followed by a rupture.

Mr. Curling considers at some length the causes "of a failure in the descent of the testis," (p. 68,) which have not, he observes, been much investigated, and could not have been satisfactorily explained, while the agency by which the descent of the organ is effected was unknown. Our author's views respecting that process, together with the facts that "there are few muscles in the human body whose development in different individuals varies in a greater degree than that of the cremaster," and that "a due supply of nervous energy is often denied to other muscles during foetal existence, and is the cause of the deformities in the feet and other parts with which infants are often ushered into the world," lead him to conclude that " we may fairly enumerate paralysis and defective development of the cremaster amongst the causes of the imperfect descent of the testis." (p. 69.) But he admits, with preceding writers, that adhesion of the gland to a portion of intestine is an occasional cause, as is also a contracted state of the external abdominal ring, especially when the organ is retained within the inguinal canal.

The condition of the undescended testis is a subject of considerable importance, inasmuch as, to quote Sir A. Cooper's words, "when the testis remains within the abdomen, it makes a strong impression on the patient's mind that his virility is lessened or destroyed. In a case of this kind I have known the unfortunate subject of it commit suicide." (Obs. on the Structure and Diseases of the Testis, part i, p. 45.) It is, we believe, pretty generally known that the case alluded to by Sir A. Cooper does not stand alone, at least we have always understood that one who promised to become a distinguished ornament of our profession committed suicide, though his virility was unimpaired, in consequence of labouring under this infirmity-if infirmity indeed it can be called.

Some of the older authors, to whom we cannot at the moment refer, conceived that the detention of the testicles in the abdomen augmented

the virile powers, because of the parts being nourished and comforted by the warmth of the viscera. We cannot say who first impugned this consoling doctrine, but Hunter promulgated a directly contrary opinion, and his authority led to a pretty general belief that an undescended testicle is imperfect both in its organization and its functions. Mr. Curling considers this question, and we shall endeavour to follow him as briefly as may be.

Mr. Curling observes that the only case Hunter met with in which both testicles remained in the abdomen contradicted his own doctrine, as the virility of the individual was unimpaired. He also quotes Mr. Owen's commentary on Hunter's views, in which it is argued that the retention of the testicles within the abdomen cannot necessarily impair their efficiency, inasmuch as they constantly remain in the abdomen in many animals, while according to Hunter's own observations, their continuance in the abdomen in those animals in which they naturally pass into a scrotum "is accompanied only with a difference of shape and size," which, Mr. Owen remarks, "may influence the quantity, but not necessarily the quality of the secretion.' It is, however, important to ascertain not merely from analogy, but by actual examination, how far the organization of the human testicle is influenced by being retained in the abdomen. Mr. Curling says but three cases have been hitherto recorded in which the anatomical condition of a testicle situated within the abdomen is described. In the first of these (J. Cloquet, Recherches sur les Causes et l'Anat. des Hern. Abdom.,) the gland was of its natural shape and size. In the second, (Cooper, op. cit. p. 45,) the testicles, which were both within the abdomen, were nearly, if not quite, the natural size. In the third, (Bright, Guy's Hosp. Reports, vol. ii, p. 258,) the retained gland was much smaller than natural, but its structure was perfect. Mr. Curling has had an opportunity of adding a fourth case to this list; in it, the right testis of a lad named J. West, aged sixteen, situated about an inch and a half above the internal ring, was very small, not larger than that of a child two years of age, and on cutting into it the gland presented the granular appearance usually remarked at that early period. . .. the left testis which was in the scrotum was four times the size of the right." (p. 75.) We are not aware of any other cases, besides those mentioned by Mr. Curling, in which the precise condition of the testicle has been particularly described; but we must observe that Sir A. Cooper, in his account of the case above referred to, says generally that he has examined others, several we must presume, in which, as in it, the testicle "was nearly of the same size as a healthy testis when deprived of its tunica vaginalis; and the seminiferous tubes were full of semen," that is to say, the organs were unquestionably fit for procreation.

It has been already observed that virility was unimpaired in the case of non-descent of both testicles seen by Hunter; but on the other hand, Mr. Wilson mentions a case in which a young man similarly affected, had never evinced any sexual passion. This, Mr. Curling observes, is, so far as he can ascertain, "a solitary case of impotency occurring under such circumstances, and when we consider how various are the defective sexual power, this single instance, and the case of West, are scarcely sufficient to confirm the opinion of John Hunter, or to invalidate the general conclusion that retention of the testes in the abdomen does not incapacitate them from performing their proper functions, a point on

which it is obviously of great importance that surgeons should have it in their power, to give a confident and satisfactory opinion, and relieve the anxiety of parents." (pp. 75-6.)

This passage affords an example of the want of precision with which Mr. Curling sometimes writes, which occasionally renders it somewhat doubtful what his real opinion finally is. The weight of the evidence adduced, and the general tenor of Mr. Curling's reasoning on that evidence go to invalidate Hunter's opinion, yet here and there something is said that insinuates a doubt. Thus in the passage last quoted, the cases referred to are said to be scarcely sufficient to confirm Hunter's opinion, a phrase which implies that they are very nearly sufficient to do so. Again the author says, " in all cases of imperfect descent of the testis, whether the gland be arrested in the abdomen or groin, it is nearly always small in size," though in two of the only four dissections referred to, this was not the case, "and it cannot be doubted, that the natural situation of the testis is the one best adapted for the efficient performance of its function." (pp. 81-2.) Finally, however, Mr. Curling states that "the surgeon may confidently assure his patient that the detention of the testes in the abdomen is perfectly compatible with his virility, and in cases where there are no external marks of effeminacy or other grounds for suspecting impotency, and the patient is subject to erections, I should not consider the imperfection as offering any bar to marriage." (p. 82.) We may perhaps be thought by some to have devoted too much space to the discussion of this question, but its importance we think warranted us in considering it rather fully; especially as Mr. Curling's work, which merits, and we are satisfied must command, a very extensive circulation, though it contains all the elements for coming to a right conclusion respecting it, and ultimately inculcates that conclusion, yet does so with a degree of hesitation and doubt, which we cannot perceive any grounds. for.

When a testicle is permanently arrested in the inguinal canal or in the groin, it is unquestionably in a worse predicament than when it remains within the abdomen, as in the former situation it is liable to pressure, friction, blows, or other injuries which may impede its nutrition or cause the supervention of inflammation or other disease. Hernia too very usually accompanies a late descent of the testis. For these reasons, says Mr. Curling, "and as the descent is seldom perfectly accomplished when delayed beyond the age of ten or twelve, I think it becomes a serious consideration in cases where the gland does not make its appearance till this late period, whether the well being of the patient would not be best consulted by our employing some mechanical means to prevent the escape of the organ from the abdomen." (p. 80.) We shall presently endeavour to estimate the value of this suggestion, but must first advert to the much more important case, where a hernia occurs while the testicle is within the abdomen.

Mr. Curling does not give a very definite opinion as to the treatment that should be adopted in this latter case. He first mentions an interesting case, in which a child a year old, neither of whose testicles had descended from the abdomen, had an inguinal rupture at both sides: Mr. Curling being consulted "in accordance with the usual practice, objected to the application of any truss." This advice was followed, and

when the boy had attained the age of eight, the rupture on the right side had disappeared spontaneously, that on the left protruded very slightly, but there was no appearance of either testicle. Respecting this case Mr. Curling takes occasion to say,

"If it be granted that a testis situated in the abdomen is in a better position than one placed in the groin, that it is productive of less inconvenience, and exposed to fewer causes tending to impair its structure, that its subsequent descent, if it ever takes place, is frequently if not commonly attended with rupture, it must, I imagine, be admitted, that the advice usually given in these cases is unsound and injudicious. Had a different practice been adopted in the case of the boy just described, and a truss applied, I cannot think it would have contributed much more to his health and comfort, than leaving him for several years subject to all the inconveniences and dangers of an unrestrained double rupture." (p. 81.)

Mr. Curling however, as is too much his habit, clogs this opinion with qualifying expressions sufficient to insinuate distrust as to the general applicability of the practice he seems to prefer, but yet not sufficient to suggest rules for guidance in particular cases. Thus he follows up the passage last quoted, by saying "it must not however, be inferred, that the arrival of the testicle in the scrotum is a matter of slight importance,' and a few lines further on adds, "when there is no reasonable hope of the descent into the scrotum being fully and completely accomplished, and when the patient is exposed to the serious inconveniences of hernia," a truss should be applied. And thus the reader who takes Mr. Curling for his guide is left in doubt as to what practice he should adopt in a case of the kind now under consideration. The passage first quoted, in which the case above mentioned is commented on, would induce him to apply a truss to a boy a year old; the last two extracts would incline him to wait until there was no reasonable hope" of the descent of the testicle occurring, but he will in vain search for any interpretation of the vague phrase "reasonable hope," for any statement of the period when hope ceases, or of the signs by which we may know that it has not fled.

It is not easy to explain satisfactorily why many most eminent and truly excellent surgeons have recommended the practice of allowing a patient to encounter all the perils of an unreduced hernia, with the view of favouring the descent of a testicle. Pott says "I do not know of any particular inconvenience arising from the detention of a testicle within the cavity of the belly," (Surgical Works by Earle, vol. ii, pp. 235-6,) but most inconsistently tells us elsewhere," while there is a testicle in the groin, or even within the abdomen, the application of a truss would be highly improper, for fear of bruising, or of preventing the descent of the gland," (Id. Op. vol. ii, p. 117;) that is to say, the rules of surgery and of common sense are to be violated, by permitting a patient to labour under a dangerous disease, for, as we shall presently see, the chance of remedying a condition of things not attended with " any particular inconvenience." Sir A. Cooper, we have seen from pages already quoted, describes an undescended testicle as scarcely, if at all, diminished in size or impaired in organization, and therefore fit for procreation, but of " a testis late in descent, and protruded by a hernia" he says, it "is often lessened in bulk, but the testis on the other side, with this diminished organ is sufficient for the procreation of children." (Op. cit. p. 46.) We may just observe, that "the testis on the other side" without the di

minished organ would be quite sufficient for procreation, but our object in quoting this passage is to show that Sir A. Cooper unquestionably intimates that a testicle protruded by a hernia is very likely to be in a worse condition than if it remained quietly within the abdomen, and yet he adds "in those cases in which the testicle has not descended at birth, it often happens that a hernia becomes the means of its descent; and such hernia should remain without a truss being applied, until it has brought down the testis into the scrotum." (p. 46.) Even those who adopted Hunter's views were not quite consistent in their anxiety for the descent of the testicle, for as they attributed its late descent, and still more its complete detention within the abdomen, to an original imperfection of the organ, instead of attributing the supposed imperfection to its residence in the abdomen, it is not easy to see why, on their own hypothesis, they should object to a hernia being retained by a truss, on the grounds that the exit of the testicle would be thereby prevented.

Mr. Curling, as we have seen, questions the propriety of the practice against which we contend, but not, we think we have shown, either with sufficient precision or sufficient decision. Mr. Curling must be aware that he could have fortified his views (which however he omits doing,) by high authority. Not to multiply references we shall merely cite Boyer, (Traité de Malad. Chirurg., t. viii,) and Jobert (de Lamballe), (Traité théor. et pratique des Malad. Chirurg. du Canal Intestin, t. ii, p. 338,) who recommend us to apply a truss to a reducible hernia when the testicle is in the abdomen, with the view of obliterating the hernial opening, without being at all uneasy respecting the testicle, which will perform its functions just as well in the abdomen. If a testicle descended with a rupture, and was adherent to the intestine we believe no surgeon would hesitate to return both into the abdomen if he could effect it, and the liability to such adhesion constitutes another objection to permitting the protrusion of a testicle by a hernia, for if the ring will not permit the return of the gland, the state of the patient is then truly miserable. Another point, to which Mr. Curling does not allude, though his own case above adverted to affords an example of it, is, that after exposing the patient to all the mischiefs of an unreduced hernia, the rupture may fail to bring down the testicle, in which cases, of course, a very serious evil is incurred without obtaining the very questionable advantage for the sake of which that evil has been inflicted. Mr. Curling's proposal to apply a truss on the inguinal ring, when a testicle has not made its appearance at the age of ten or twelve, (years we presume, though this is not specified,) is, so far as we know, original, and we need scarcely say that we think it a very judicious suggestion, but if this precaution is to be adopted, we think it should be taken at a very much earlier age, for we trust we have shown that the great point in those cases is, not to procure the descent of the testicle, but to prevent or remedy rupture.

The only real disadvantage of imperfect descent of the testicle is its liability to injury if in the groin; while, if in the abdomen, disease originating in the testicle may extend throughout that cavity, "there is no shut sack, no distinct tunica vaginalis restricting the limits of inflammation when set up." (p. 84.) This evil, however, cannot for a moment be put in competition with those of an unreduced hernia. Mr. Curling gives two cases as examples of its occurrence. The subject of one of these