MICHAEL RYAN, M.D. MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS IN LONDON, &c. &c. AND AN ASSOCIATION OF PHYSICIANS AND SURGEONS. Quærere verum.-HORACE. VOL. VIII. LONDON: PUBLISHED BY G. HENDERSON, 2, OLD BAILEY, LUDGATE HILL. 1836. 1 THE London Medical and Surgical Journal. No. 183. SATURDAY, AUGUST 1, 1835. VOL. VIII. SELECT LECTURES, FROM M. BROUSSAIS' Course of General Pathology and Therapeutics; BY JAMES MANBY GULLY, M.D. which it suspends. Mark well this phenomenon: you will find its analogy in many other circumstances, where you may see the prior inflammation leave surfaces far more extensive than is the urethra, while a more acute inflammation is developed elsewhere. Testicular inflammation may be communicated to the scrotum itself, and cause suppuration of it an 1 of the testicles, or even gangrene, especially in hot climates, and in individuals predisposed to inflammation. It is a mere pretence to assign a fixed march and termination to the affection in question. Diseases proceed according to temperaments and latitudes, and so does this-a truth that medical men, who have never left their own clime, have great difficulty in comprehending, and which is explicable by the degrees of irritation. If you refuse to admit it, you are driven to make as many morbid entities as there are individual temperaments, and this again will lead you to nosologies more rich in names than the dictionary of the Academy: you may do this if you please, but you will soon find how ridiculous it is. Urethritis and its Metastases-Vaginitis. SUCH is the most usual progress of urethritis; but do not imagine that such is its necessarily invariable progress, as I, who have seen it in various latitudes, and different modes of life, can testify. In the crowd of armies, in hot climates, I have seen this inflammation followed by serious consequences in men who seemed to brave it, and committed all manner of excesses during the time they were suffering under it. On such occasions I have seen it occupy the penis and prepuce with its utmost fury, produce phymosis and gangrene, occasion the loss of the penis, and even penetrate the interior of the body. At other times, when the patients used a stimulating regimen, and forced the secretory action of the testicles by the abuse of venery, the inammation passing along the ejaculatory anal, became communicated to the testicles, and occasionally even extended to the vesiculæ seminales, causing their suppuration. This last case is rare; but it is more common, after urethral inflammations thus exasperated, to see the vesiculæ obliterated and sterility ensue. As, however, these inflammatory extensions begin the history of cystitis-the vesiculæ being adherent to the bladder-I shall not proceed further with them at present, but confine myself to the testicle, in which, when the inflam mation has reached it, there is first of all injection of the epididymis, and then inflammatory gorging of the gland itself, or orchitis. The phlegmasia proceeds with varied rapidity, according to the violence of the inflammation in the urethra, as also according to the mode of life and treatment. But these are not all the unfortunate adIt is a revulsion from that of the urethra, vances of urethritis. When not combatted, VOL. VIII. In common cases, such as are seen in these climates, orchitis is confined to a swelling of the testicles, with redness of the scrotum, pain of the epididymis, and shining of the skin. Hydrocele is often a consequence of it: indeed, the majority of affections of that kind are the effects of urethritis transferred to the testicles. When there is hydrocele you must not think that the tunica vaginalis of the testicles is always distended like a sac, so as to become transparent; after yielding to a certain extent, it may suppurate, contract adhesions, harden and thicken all around. The testicle surrounded by this thick and rugged sac is then exhibited as a sarcocele, without, however, any destruction of its organization; but at other times it degenerates of itself, after being excessively swelled, and violently distending the tissues. By carefully following the increasing and decreasing progress of these inflammations, these different terminations of them will be recognized. B 18 MAR 1924 Hoe ber |