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fully, and not depending on their simple statements. Supposethis boy had purchased a truss at a chemist’s, as is often done;the mentioning of a swelling in the groin would have beensufficient, the truss applied on the undescended testis, and thepatient consigned to a series of evils, which might have led toa very unpleasant termination. It is probable that the actualhernia with which he became subsequently affected neverproduced enough protrusion to attract his attention. InMr. Lloyd’s patient, with whom the testicle was likewiseabnormally placed, the disposition was different, for the organhad not descended lower than the inguinal canal. Herefollows the case, from the notes of Mr. Stretton, Mr. Lloyd’shouse-surgeon.

Inguinal Hernia on the right side; Imperfect Descent of theTesticle on the same side; Strangulation; Formation of aWatery Cyst; Operation; Recovery.

(Under the care of Mr. LLOYD.)William D-, aged thirty-seven, and a baker by trade,

was admitted into Bentley ward, March llth, 1852, under thecare of Mr. Lloyd. The patient’s countenance was pale andanxious, and he complained of much pain in the abdomen;the skin was cool; pulse 72, of moderate volume; tongue clean,and bowels said to have been freely open on the evening before eadmission. While walking in the street on the morning ofhis reception into the hospital, he had been suddenly seizedwith copious vomiting.On examination, a large swelling was found in the right

groin, measuring about seven inches in length and four inwidth; its surface was uneven and tense, except at one point,near the anterior superior spinous process of the ilium. Herewas situated a smaller tumour, about the size of a walnut, andgiving the hand the sensation yielded by a bag of fluid. Thisswelling, according to the patient’s statements, used to remain unchanged in size when the hernia, before the present attack, Iwas returned into the abdomen. The external ring is free,but the right testis is not in the scrotum, and is supposed tolie in the inguinal canal with the herniated intestine. Thislatter circumstance was not thoroughly ascertained, as theslightest manipulation gave the patient exquisite pain, thelatter then radiating all over the abdomen.The man said, on being questioned, that he had been subject

to hernia for the last fifteen years, that he had always worn atruss, and had never had any difficulty in returning the in-testine until the morning of his admission. On that day, whilein the street, he had suddenly been seized with pain in theright groin, and violent sickness, and upon examining thatregion, he found that the tumour had escaped from under thepad of the truss, and was much larger than usual. A surgeonwas immediately consulted, who employed the taxis for twohours without success, and then advised the patient to seekadmission into this hospital.Immediately after the patient’s reception, chloroform was

administered, and gentle attempts were made, when he wasfully narcotized, to reduce the hernia; but these proving un-successful, the operation was at once performed.

After the usual incisions, the testicle was found in front of,and close to the external ring; the sac was much congested,and the stricture situated at its neck, just at the internal ring.It was now thought necessary to open the sac, which measurebrought into view a large coil of intestine of a dark-red colour.This was easily returned as soon as the stricture was divided,and the wound was carefully closed up over the undescendedtesticle. Mr. Lloyd now punctured the small swelling situatedover the crista ilii; it at once collapsed, discharging a trans-parent citrine-coloured fluid. The patient was now conveyedto bed, and took five grains of calomel and one of opium.The progress was pretty favourable until the next day in

the afternoon, when the man complained of considerable painin the chest; his respiration was hurried, the skin hot anddry; tongue moist; pulse 120, small and jerking, and abdo-minal tenderness considerably increased. There had beencopious pultaceous evacuations. Mr. Lloyd ordered twenty-four leeches to be applied to the abdomen, and two grains ofcalomel with half a grain of opium to be given every sixthhour.

It was found on the next day that the leeches had consider-ably relieved the pain; the patient had slept well, and wasaltogether in a more favourable condition. The sutures wereremoved in the evening of this, the third day, and the woundlooked very healthy. The further features of the case do notcall for any special description, for matters proceeded in theusual way, and the patient was discharged in good conditionabout five weeks after admission.

As, very probably, the entrance into the scrotum is oblite-rated in both the foregoing cases on the side where the testishas failed to descend, it would be useless, during operations ofthe above-described kind, to attempt giving the arrestedtesticle its normal situation. The patients must thus continueto remain in the state in which they were found, at least as faras the position of the testicle is concerned; but they now havethe immense advantage of knowing the real state of things,and will be able to take the proper precautions, in order toshield the delicate and useful organ from injury. Indeed, aspecial protective apparatus should, we venture to suggest, becontrived for patients of this kind.When it is considered how obnoxious to injury is the testis

in both the situations which it holds in the two precedingcases, one is inclined to pay a new tribute of admiration to thearrangement of parts in the human organism. The scrotum,with its power of rugose contraction, the tunica vaginalis,ever lubricated, and allowing the organ to accommodate itself £to the most varied positions, &c., appear in great contrast withthe situation of the testis in the instances just related-one atthe upper part of the thigh, the other in the groin. It mightjustly be said that the testes would be, perhaps, more pro-tected by remaining in the abdomen, in which cavity they arelodged before birth; but it will be seen at a glance, that allthe derangements occurring in the abdominal viscera wouldthen have a direct influence on these organs, and that, bybeing shut out from the peritonseal cavity, they have an inde-pendent existence, favourable to the performance of theirfunctions.The patient of Mr. Lloyd is said to have worn a truss; we

suspect it was one producing very gentle pressure, as it is noteasy to understand how the apparatus might, without inflict.ing pain or injury, have pressed both on the hernial sac andthe testicle. It is probable that the latter organ, by thefacility with which it glides, even in an abnormal situation,eluded the pad of the truss. We are inclined to think thatthe cyst by the crista ilii was caused by pressure from thesteel of the truss, and cannot conclude without adverting tothe long efforts at the taxis which are sometimes made inprivate practice. In the above case, for instance, if thepatient’s statements are correct, these efforts were continuedfor two hours; this is decidedly too much, and the evil was somuch the greater in the present case, that the testicle was in-cluded in the mass which was for such a long time subjectedto the manipulations of the taxis.

Cases of non-descent of the testicle are by no means so veryrare as is sometimes thought; we saw, a short time ago, aman, among Mr. Curling’s patients, at the London Hospital,with whom the same imperfection existed. Here also therewere inguinal hernia and strangulation, but the herniated masswas returned without operation.

LONDON HOSPITAL.

Inguinal Hernia; Imperfect Descent of the Testicle; Strangu-lation; Reduction without Operation.(Under the care of Mr. CURLING.)

NORMAN U-, aged twenty-six, of a pretty healthyaspect, light hair and eyes, and a shoemaker by trade, wasadmitted Sept. 1, 1852, under the care of Mr. Curling, withvery severe symptoms of strangulated inguinal hernia.

It was elicited from the patient, that inguinal hernia of theleft side had existed since he was five years of age, .andthat he had never worn a truss. His health has always beenextremely good, and he stated incidentally that he had nevertaken any medicine in his life, (with the exception, veryprobably, of the indispensable and unavoidable teaspoonful ofcastor-oil soon after birth.) He had never found any difficultyin returning the greater portion of the hernia when ithappened to assume, upon some exertion, a greater bulk thanusual; but the size of th tumour was generally equal toabout a small fist. Thus the patient had reached his twenty-sixth year without suffering very great inconvenience fromthe state of his left groin, but he had, for the last few years,perceived that his scrotum contained but the right testicle,and that the left was situated in the inguinal canal.About a fortnight before his admission the tumour suddenly

increased to double its ordinary size; he had much troublein returning it, succeeded but partially, and was seized withgreat pain in the abdomen, and obstinate constipation. Atlast he effected reduction by his own efforts, and had severalalvine evacuations without the aid of any medicine.

This attack recurred on the evening before admission in anaggravated form, without any straining, effort, or irregularity