the serous secretion. As for the complications, such as the stinging sensation in the testicle, the penetration into the cellular tissue, the suppuration, phlegmons, etc., they are all the exception rather than the rule and do not constitute any serious contra-indication; but the use of iodine does not insure one against a return of the malady. According to the statistics of Gleich, comprising cases operated upon at the clinic of Vienna since 1884, there were ten relapses out of a total number of fifty-seven. According to Wendling, out of one hundred cases of hydrocele, thirty of which were relapses, there were ten relapses afterward; Gosselin puts the proportion at 10 per cent. in one hundred and sixty. This proportion is large enough to be taken into consideration. Another inconvenient feature to the use of iodine is the fact that it is not always applicable; hematocele, suppurating hydrocele, affections the diagnosis of which are doubtful and cases accompanied by a thickening of the walls are contra-indicative of this fluid. In young people the proportion of cases of relapse has been large enough to make us have recourse to the use of other fluids. In short, the violent, prolonged pain, the length of time necessary for a cure, the possibility of a relapse are sufficient causes for the employment of other measures besides the puncture and injection of tincture of iodine in the treatment of hydrocele. Incision of the Incision of the scrotum is one of the other methods

which deserves special mention. Quite as old as hydrocele itself, this method has been resurrected under the form of the antisepsis of Volkmann. His procedure consists in incising the scrotum, the tunica vaginalis, evacuating the serous fluid, inspecting the gland, suturing the main part of the incised wound; in the inferior part of the wound, two or three sutures are fixed in the tunica vaginalis, a drainage tube is placed in position and left there for some days. This operation gives very good results, but the orifice of the drain cicatrizes before the cavity is obliterated, thus either giving rise to a relapse or to the formation of a fistula, which complicates or retards the cure. Bergmann counsels a more radical interference, removing the parietal layer of the tunica vaginalis up to the confines of the epididymus. Julliard has modified Volkmann's method: after making a large incision, he removes a very large portion of the tunica vaginalis, preserving just enough to cover the testicle. The edges of the resected layers are stitched together by catgut ligatures, the skin being sutured over this by the same means. One of the disadvantages of this method is that the cavity is not entirely suppressed and that relapse is possible; besides, hemorrhage into the cellular tissue of the scrotum often follows, after the relaxation of the dartos, succeeding the operation. As a remedy for this disadvantage, Nicaise advises that the serous and fibrous layers

be separated and that there should be left only enough of the tunica to cover the testicle. In this way the vessels are not opened and hemorrhage is impossible. To prevent a relapse, the edges of the wound should be rubbed with alcohol or with a solution (5-percent.) of carbolic acid. This prevents the hemorrhage and provides a cure by the irritation of the serous surfaces.

In the experience of the author, acquired in the treatment of hydrocele in his practice as assistant to the surgical clinic, he has become convinced of the efficacy of the radical cure of hydrocele by means of the bistoury; the patient having been washed, shaved, etc., at the point where incision is to be made, he injects several drops of a solution (1-per-cent.) of cocaine, A few minutes later the bistoury is passed into the vaginal cavity, the serous liquid spurts out and there is introduced into the passage made by the knife, which has been withdrawn, a grooved director. Upon this director about five or six centimeters of the skin of the scrotum and the tunica vaginalis is divided by the scissors. This part of the operation is made in a few seconds and is almost painless, thanks to the cocaine. The serous and visceral layers of the tunica are examined, likewise the gland, the granulations, etc., are excised, and the wound sutured so that there is communication between the cavity and the exterior; tampons of gauze, soaked with iodoform or glycerin

iodoform are placed in situ, also a dressing of moderate compression, held in place by a suspensory. The tampons become very adherent and it is difficult to detach them after a week, at which time the cure is generally accomplished. It is almost useless to add that this operation should be performed only with the strictest attention to asepsis and antisepsis. As for the advantages of this method, the author says that there is very little pain, that the large incision allows the surgeon to examine all the parts thoroughly and fully determine the necessity of surgical interference: After a week the patient can move around with only a suspensory upon the wound. Complete cure takes place in about three weeks, although a slight swelling, which is not serious, remains sometimes for a short time thereafter. There is no danger of a relapse, as the cavity will have been obliterated. Besides the advantages already mentioned, this method is the only one which can be employed in such cases as suppurating hydrocele, or hydrocele with hematocele, congenital hydrocele, in cases that are doubtful where an accumulation of the serous matter seems secondary to lesions of the testicle or the cord, in cases of relapse and in old cases with thickening of the walls.

In these later years attempts have been made to replace the methods by iodine irritation with other methods, chief of which the author cites, although he has not had any experience with them: