1000 



TESTICLE (ABNORMAL ANATOMY). 



Scarpa.* The disease is of the nature of 

 simple oedema, a watery fluid being diffused 

 throughout the areolar tissue connecting the 

 vessels of the spermatic cord, and enclosed in 

 a sheath, which is invested by the musculo- 

 aponeurotic structure of the cremaster muscle. 

 When the complaint has lasted some time, 

 the sheath is found more or less thickened. 

 The areolar tissue within is infiltrated with a 

 limpid albuminous serum of a white or yel- 

 lowish colour, which flows out in the course 

 of the dissection. The cells infiltrated with 

 serum are converted into large vesicles, some 

 of which are big enough to admit the tip of 

 the finger. These cells are larger and more 

 delicate towards the base of the swelling, 

 where they sometimes disappear altogether ; 

 so that there is only one considerable cavity 

 at the lowest and more depending part. The 

 base of the swelling corresponds to the point 

 at which the spermatic vessels join the testicle, 

 and at this part a dense septum cuts off all 

 communication with the tunica vaginalis. Jn 

 some instances the effusion extends along the 

 cord into the abdomen, as in a remarkable case 

 related by Mr. Pott. In the annexed figure of 

 this affection, (Jig. 043.), taken from Scarpa, 



Fig. 643. 



the envelope of the cremaster is laid open, ex- 

 posing the pyramidal swelling enclosed in its 

 sheath of condensed areolar tissue. The tes- 



* Memoria sull' Idrocele de Cordone Spermatico. 

 Bertrandi, an Italian surgeon, in a memoir pub- 

 lished by the French Academy of Surgery, in 1778, 

 has given an accurate description of this affection, 

 which, however, he did not sufficiently distinguish 

 from the encysted hydrocele of the cord. He dis- 

 sected on the dead body a diffused hydrocele, which 

 contained twenty ounces of fluid. 



tide and tunica vaginalis are seen below it. 

 In general anasarca the areolar tissue of the 

 spermatic cord, as well as of the scrotum, is 

 frequently distended with serum ; but osdema 

 of the cord alone is a very rare affection. Sir 

 A. Cooper makes no allusion to it, and Mr. 

 Pott, to whom we are indebted for so good 

 and accurate a description of this species of 

 hydrocele, probably met with a greater num- 

 ber of cases of it than have occurred in the 

 practice of any surgeon since his day. 



Encysted Hydrocele of the Spermatic Cord. 

 A cyst containing fluid may be developed in 

 the loose areolar tissue of the spermatic cord. 

 The cyst is formed of a thin transparent 

 membrane, possessing the ordinary characters 

 of a serous membrane, and contains generally 

 a limpid aqueous liquid, having little or no 

 albumen, but sometimes a straw-coloured 

 serum similar to the fluid of simple hydrocele. 

 It is of an oval form, and its size, though 

 variable, seldom exceeds that of a hen's egg, 

 and is usually smaller. It is loosely attached 

 by areolar tissue to the vessels of the cord 

 which are situated at its back part, but be- 

 come separated and displaced by it. The cyst 

 is invested by the common integuments, super- 

 ficial fascia, musculo-aponeurotic sheath of the 

 cremaster muscle, and fascia transversalis. It 

 may occur either immediately above the tes- 

 ticle, in the middle of the cord, or just below 

 the abdominal ring, and even within the in- 

 guinal canal. Usually there is a single cyst, 

 but occasionally several are developed, and a 

 chain of them has been formed along the cord. 

 The cyst and its contents are liable to changes 

 consequent upon inflammation. Encysted 

 hydrocele of the cord appears to originate, 

 in general, in a partial or imperfect oblitera- 

 tion of the prolongation of peritoneum drawn 

 down at the period of the transition of the 

 testicle. I have already described the different 

 appearances presented by the remains of this 

 prolongation, which, it has been remarked, 

 sometimes consists of a single cyst, or of two 

 or more sacculi, moistened by a serous fluid. 

 When this fluid accumulates in any quantity, 

 an encysted hydrocele is the result. Such is 

 obviously the mode of origin of this affection 

 when occurring in infants, and no doubt in 

 adults it generally originates in the same way. 

 M. J. Cloquet has remarked that the remains 

 of the peritoneal process accompanying the 

 testicles in their descent were met with in 

 male subjects of all ages, and he mentions as a 

 singular circumstance, that they were nearly 

 as frequently found in the old as in the young 

 subjects.* My own dissections agree with the 

 observations of this accurate anatomist. In 

 the museum at the London Hospital there is 

 a preparation showing the tunica vaginalis 

 continued for about two inches up the cord, 

 and, immediately above it, an encysted hydro- 

 cele, which was taken from an adult subject. 

 In dissecting the body of a man, aged eighteen, 

 I found an encysted hydrocele of the cord 



* Description of the parts concerned in Inguinal 

 and Femoral Hernia, tr. by McWhinnie, p. 25. 



