1012 



TESTICLE (ABNORMAL ANATOMY). 



minous conceal the gland, encroach on the 

 septum, and extend to the other side of the 

 scrotum. In a specimen which I carefully 

 examined, the vessels were arranged in three 

 clusters (fig. 655). One formed of the 

 larger vessels proceeded from the inferior ex- 

 tremity of the testicle ; the second, in which 

 the vessels were less in size, but more numer- 

 ous and tortuous, arose from the upper ex- 



Fig. G55. 



tremity of the testicle ; whilst the third and 

 smallest cluster surrounded and accompanied 

 the vas deferens ( 1 ). The dilatation is not con- 

 fined to the veins exterior to the gland : even 

 those in the organ itself are varicose, and 

 enlarged veins may often be distinctly seen 

 ramifying between the tunica vaginalis and 

 tunica alhuginea. The veins occasionally con- 

 tain phlebolites which are lodged in dilatations 

 of the vessels. The veins of the left testicle 

 are more subject to vark-ocele than those of 

 the right. In upwards of 120 operations per- 

 formed by Breschet, in only one instance was 

 the varicocele on the right side.* Pott met 

 whh this disease on both sides of the body in 

 only one instance. The disease, however, is 

 far from being so rare on the right side as is 

 generally supposed, and often exists on both 

 at the same time, although the varicose state 

 of the right spermatic veins is always much 

 less than that ot the left. Of the causes of 

 varicocele, some operate on both sides, others 

 only on one. The most influential of the 

 former is the hydrostatic pressure consequent 



* 



Landouzy, Du Varicocele, p. 24. 



upon the depending position of these veins, 

 which have to support the weight of a column 

 of blood extending from the testicle to the 

 second dorsal vertebra. The absence of valves 

 is mentioned as a circumstance conducing to 

 this disease ; but this is an error, for the 

 larger spermatic veins are always furnished 

 with valves, though the dilatation which 

 takes place -in varicocele prevents them per- 

 forming their office. There are several anato- 

 mical circumstances, which, taken together, 

 are sufficient to explain the frequency of vari- 

 cocele on the left side. On the right side the 

 spermatic vein joins the vena cava nearly 

 parallel to the axis of that vessel, so that the 

 blood enters in the course of the circulation ; 

 but on the left side the spermatic vein termi- 

 nates in the emulgent vein at a right angle, 

 and in a direction perpendicular to the venous 

 current from the kidney, which is less favour- 

 able to the return of blood from the testicle, 

 since the two currents pursue a different di- 

 rection. The left testicle hangs lower than 

 the right, consequently the veins must be 

 longer, and the pressure produced by the 

 column of blood greater on the left side than 

 on the other. The accumulation of the feces 

 in the sigmoid flexure of the colon previous 

 to an evacuation tends to produce pressure 

 on the spermatic vein, and impede the return 

 of blood from the left testicle, especially in 

 persons whose bowels are habitually con- 

 stipated. Some persons subject to varicocele 

 suffer from it only when the bowels are in this 

 condition. But even the natural daily accu- 

 mulation may be sufficient to produce ob- 

 struction. To this cause, we must chiefly 

 attribute the circumstance that a varicose di- 

 latation of the veins of the ovary in the 

 female is nearly always confined to the left 

 side. 



In the slight degree and chronic state in 

 which we most frequently meet with this 

 affection, no injurious effect is produced on 

 the testicle; but when highly or rapidly de- 

 veloped, the dilatation of the veins interferes 

 so much with the nutrition of the gland as 

 to occasion wasting. A partial atrophy of the 

 gland, coexisting with varicocele has come 

 under my notice in, more than twenty 

 instances ; indeed, in nearly all cases in 

 which there was a decided dilatation of the 

 spermatic veins on one side only, the testicle 

 of that side was the smaller of the two. In a 

 man, aged fifty-six, with a varicocele on the 

 left side, the testicle was so reduced that it 

 scarcely exceeded the usual size of the organ 

 in an infant. Some years ago, a tall sailor was 

 under my care on account of a varicose ulcer 

 on the left leg, who had a large varicocele on 

 the left side, and a testicle so wasted, that it 

 could scarcely be felt through the tunica 

 vaginalis, which was loosely distended with 

 fluid. The period of puberty is the time at 

 which varicocele most cemmonly occurs. I 

 have met with very few cases before that age. 

 Adipose tumours. The spermatic cord 

 may be the seat of abnormal depositions of 

 fat. They occur at different parts, as high up 



