A Letter from Mons. le Cat, F. R. S. to Dr. Mortimer, Secr. R. S. Translated from the French, by Tho. Stack, M. D. F. R. S.

LI. A Letter from Mons. le Cat, F. R. S. to Dr. Mortimer, Secr. R. S. Translated from the French, by Tho. Stack, M. D. F. R. S. SIR, Rouen, April 3, 1750, N. S. Read Dec. 19, 1751. I look on it as a novelty in surgery, to find, 1st, hernias by rupture, having nevertheless a herniary sack; 2dly, hernias by dilatation, having two very distinct sacks. Wherefore I judged that these observations deserved to be communicated to the Royal Society. I. A hernia by rupture, having nevertheless a sack. On the 18th of February 1750, in giving a private course of operations to my English pupils, on the body of one Lewis le Clerc, a lad of eighteen years old, a weaver, of the parish of St. Maclou, I discovered the hernia represented in the figure. The aponeurosis of the musculus obliquus externus AA ran over the whole tumor BBC, and entirely cover'd it. At the anterior and lateral internal part of this tumor was the ring DE lengthened into the shape of a perpendicular button-hole; which had nothing to close it but a cellular lamina, of which g, h, are jags, and which covered all this bag, as being a continuation of the cellular membrana adiposa. Through the above-mention'd button-hole appeared the cellular coat, with which the peritoneum furnishes the spermatic vessels. vessels. The intestine occupied the rest of this bag; and at the bottom BE was contained the testicle, which consequently had never taken the way of the ring to come out of the belly, as it usually does; but having passed on one side, it had gradually pushed out the aponeurosis of the musculus obliquus externus; and the intestine having followed it, and broke the true lamina of the peritoneum, they had in concert formed this elongation. At least this is the most natural explanation that I can give of this singularity. That the testicles are originally in the belly, is a fact sufficiently known. I have dissected foetus's, in which I found them therein near the bladder. It is pretty common to feel them in the rings in children; and I have found them there even in lads of upwards of twenty years old. II. A hernia having two sacks. Continuing the above-mention'd course, on the 5th of March 1750, I found in the body of Nicolas Janaux, a bachelor of 48 years of age, by trade a cloth-worker of St. Owen de Longpaon, a rupture with a double herniary sack, the first of which was formed by the expansion of the aponeurosis of the obliquus externus, as in the preceding observation, excepting that this expansion was only on the outward side, that the ring was in its usual place, that the bottom of the bag formed by this expansion had some empty spaces, where the expansion was wanting. In a word, the bag was neither as complete, nor as thick as that of the foregoing observation; but on the other hand, there was a second bag, formed as usual by the true lamella of the peritoneum. III. Another sort of duplicity of the herniary sack. Francis le Monnier, coachman, of the Rue St. Laurent, about 65 years of age, had a rupture of long standing, of the strangulation whereof I had already cured him in 1748. Having taken off his trusfs, in order to get it mended, he was seized with strangulation the 19th of Feb. 1750. After applying all the remedies prescribed in such cases without success, I was obliged to perform the operation on the 21st at eight in the evening. Having laid the bag open in the usual manner, which contain'd a little watry humour in it, I was much surprised at discovering within this bag a second bag, or pocket, which could be nothing else, but either a second herniary bag, or an incomplete hernia; that is to say, a portion only of one side of an intestine elongated, and come down thro' the ring. The number of considerable blood-vessels on this pocket, its thickness and fibrous texture seemed to evince the latter. But first, upon pressing this bag, all its contents return'd into the abdomen; secondly, the patient assured me, even at the instant, that his rupture had kept up since its reduction in 1748; and I found this bag adhering, not only to the first bag, but also attached by old and strong adherences to the testicle and spermatic vessels; and it was impossible that this state should be the effect of three days of strangulation. However, as the patient might possibly have have deceived me in his account; and as it was dangerous to open a bag which had too near a resemblance with the gut of an incomplete hernia, I came to a resolution, which equally suited the two suspected cases. I separated the testicle and spermatic vessels from this sack, and pushed back this pocket, or second bag, into the belly. The patient having died on the 9th day after the operation, we found, that the pocket which had given us so much uneasiness, and which I had reduced into the belly, was really a herniary sack formed by the true peritoneum; and therefore that the first sack must have been either an interior aponeurotic lamina of the abdominal muscles, or the cellular membrane thickened by the long duration of the hernia and its strangulations. The considerable thickness of the true or second sack renders this notion very probable. I say that the first sack must have been formed by an interior aponeurotic lamina, and not from an exterior one, like that of the first observation; because, in this operation, I had freed the ring, in my usual manner, above this first sack, and without opening it. Then I passed the grooved catheter over this sack, under the aponeurosis or pillar of the musculus obliquus externus; and therefore this sack could not be a continuation of this external aponeurosis, but that of some more inward lamina, or of the cellular membrane of the very peritoneum, separated from the true lamina by the serosities which we found in it. To this letter I will add two observations made about the same time, I. A natural blind duct, being a production of the true lamina of the peritoneum by the rings. March 5, 1750, in the dead body of Magdalen Vauchel, wife of Thomas Fermant, 46 years old, I found this duct of the thickness of a goose-quill, being a production of the true lamina of the peritoneum stretched out by the rings; of which Swammerdam and Nuck dispute the discovery, and Blancard denies the existence. What made me discover this, was, that its extremity was widen'd into the shape of a bubble as big as the top of a finger, and full of a watery humour. This woman had never had a hernia, nor even the least tendency towards one. II. Strictures and carnosities in the urethra. Nothing is more common at this day than to hear people assert, that strictures and carnosities of the urethra are mere chimera's; that the bodies of persons, who were thought to have these strictures and carnosities, had been open'd, and that none of these had been found. I myself have made this observation, and I inferred thence, that there were urethra's, in which a phlogosis, a fungous inflation gave occasion to the deception, being taken for strictures and carnosities: but if I had drawn this general inference, that of all the urethra's, wherein these strictures and carnosities are thought to be found, not one has any thing in them, I should have been deceived, and would now make my recantation. One of my boarders preparing to perform the operation of cutting on the dead body of Michael Vassal, a bachelor, aged 45, the sound could not pass; the pupil forced, and made a false passage. I open'd this canal, and found, 1st. That a simple small stile could not pass into the urethra, by pushing it from the glans towards the prostate; but that it passed, by pushing it from the prostate towards the glans. 2dly. A little before the place, where the bulb becomes less thick, and begins to surround the urethra, that is, about a large finger's breadth from its beginning, there was a stricture entirely like that, which Dr. Willis discovered in the upper longitudinal sinus of the dura mater. 3dly. Some few lines lower down was a caruncle, or a fleshy firm bump, of the size of a pea; and below this bump, the urethra was extremely straightened. 4thly. The basis of this carnosity formed a kind of valve, and there I found the false passage, that went into the substance of the bulb. I have the honour to be, SIR, Your most humble, and most obedient servant, Le Cat.