[Reprinted from The Medical News, August 18, i88§.) 
TREATMENT OF H Y D R 0 C E L E B Y IN CIS10 N OF 
THE TUNICA VAGINALIS AND BY A 
NEW PROCEDURE. 
By W. F. McNutt, M.D., M R.C.P. Ed., 
PROFESSOR OF PRINCIPLES AND PRACTICE OF MEDICINE IN THE UNIVERSITY 
OF CALIFORNIA, CONSULTING SURGEON AND PHYSICIAN TO 
st mary's hospital, etc. 
In The Medical News of April 7, 1888, my old 
friend, Dr. W. W. Keen, of Philadelphia, contributes 
an article on the "Radical Cure of Hydrocele by 
Excision of the Tunica Vaginalis," the article 
having been read at the Philadelphia Academy of 
Surgery, March 5, 1888. In the discussion which 
followed the reading of the paper (as reported in 
The Medical News), Dr. Gross, of Philadelphia, 
begged leave to correct Dr. Keen in regard to the 
history of the operation and says : 
" The history of the operation is briefly as follows: In 
1873, Volkmann resorted to incision of the tunica vagi- 
nalis, with drainage and suture of the edges of the tunica 
vaginalis to the edges of the scrotum. In 1875 he in- 
cised the tunica vaginalis, united it with sutures, and 
also passed deep sutures, bringing the surfaces of the 
tunica vaginalis together. He was, therefore, the first to 
excise, as he was the first to incise, etc." 
During the discussion Dr. Keen also makes use of 
the expression "the incision of Volkmann." From 2 
this language I have no doubt that Volkmann was 
the first to announce or report the incision of the 
tunica vaginalis as a remedial measure for the cure 
of hydrocele. He was not, however, by any means, 
the first to practise it. 
I commenced the study of medicine, in 1859, 
with Dr. Samuel Muir, of Nova Scotia, who enjoyed 
a very extensive surgical practice, being well and 
favorably known throughout the lower provinces. 
Shortly after I commenced my studies, a patient came 
into his office with hydrocele. Dr. Muir remarked 
that this was a case of hydrocele upon which he 
had already operated three or four times by tapping 
and injections of diluted tincture of iodine, and that, 
having failed to make a cure, he would now proceed 
to make a free incision, laying open the sac, which 
he would brush with pure tincture of iodine, also 
saying that this was the proper treatment in all such 
cases in which the injection failed to cure or in which 
the injection was followed by suppuration. As he said 
nothing about the procedure being new or original 
with him, my attention was never called to the 
literature of this operation until I read Dr. Gross's 
statement. 
I have treated, in all, quite a number of cases of 
hydrocele and have found it necessary to follow my 
old preceptor's method on two occasions. The first 
case was that of a French marketman, age about forty, 
who consulted me in 1869; he had been operated 
on by tapping and injections several times, and a 
great deal of inflammation and pain had followed 
the last injection, about three months before. The 
MCNUTT, TREATMENT OF HYDROCELE 
3 
hydrocele was large and the scrotum thickened 
and infiltrated ; he was unwilling to have the 
operation repeated, on account of its frequent 
failures and the pain and inflammation caused by 
the last. I made a free incision and brushed the 
tunic with tincture of iodine; the result was a perfect 
cure. I saw the man a few years ago; he remained 
well. The second case on which I operated by free 
incision was for inflammation and suppuration which 
followed aspiration and injection. 
Recently I have adopted a new and, so far as I 
know, an entirely original method of treating hydro- 
cele, viz., to puncture the sac with Southay's dropsy 
trocar, leaving the canula in.; after the fluid is all 
discharged applying absorbent cotton; covering 
with oiled silk and retaining with a suspensory 
bandage. As yet I have only aspirated four times; 
one case was cured, the canula remained in ten or 
twelve days, there being a few drops of pus in and 
about the canula. One case disappeared, canula and 
all; in one case the canula worried the patient and I 
removed it; and in the fourth case the canula dropped 
out. In both the latter cases the fluid reappeared, 
and I have repeated the operation since with the 
small canula, not leaving it in, but simply to relieve 
the patient. They both objected to injections. 
I have had a canula made by Folkers Brothers, a 
quarter of an inch longer and with a double bulb. 
In operating I intended to force the first bulb 
through the scrotum into the sac, so that it will re- 
main there until it is removed. I attempted to tie 
the little Southay canula in but failed. 4 
MCNUTT,TREATMENT OF HYDROCELE. 
Any one familiar with Southay's dropsy trocars 
will readily understand what is meant by a double 
bulb, as each little canula has a bulb on its distal 
end to prevent it from passing through the skin and 
being buried in the cellular tissue. The object of 
leaving the canula in situ is to drain off the fluid as 
it accumulates, thus allowing the surfaces of the sac 
to remain in contact, when it is expected that they 
will soon adhere, effecting a radical cure. It is prob- 
able that in most cases adhesions would take place 
after tapping were it not for the reaccumulation of 
the fluid separating the membranes.