1008 



TESTICLE (ABNORMAL ANATOMY). 



siderable firmness and consistency ; the tunica 

 albuginea is thickened, and in some places as 

 dense and indurated as cartilage ; and the 

 surfaces of the tunica vaginalis are closely 

 connected by old adhesions. The glandular 

 structure is partly displaced and atrophied by 

 the pressure of the yellow matter ; and it 

 often happens after some time, that both 

 undergo a slow process of wasting, so that an 

 enlarged and indurated gland is progressively 

 reduced, until scarcely any thing remains 

 beyond a mere nodule of the size of a nut 

 at which the spermatic cord terminates. I 

 found, on examination of the body of a man 

 who some few years previously had suffered 

 from chronic inflammation of the testicles, 

 both glands much indurated, but about the 

 natural size. In both, the tubular structure 

 was very deficient, its place being supplied by 

 a dense fibrous tissue. At the upper part of 

 the right testicle there was a yellowish de- 

 posit almost as dense as cartilage, and ex- 

 hibiting very little trace of vascularity. In 

 these indurated testicles the epididymis often 

 escapes the morbid alteration affecting the 

 body of the gland ; in other cases, however, 

 the epididymis is also found nodose, irregular, 

 and hard. It will be perceived, from the pre- 

 ceding observations, that the tendency of 

 this chronic disease is gradually to destroy 

 the integrity of the testicle. If the inflamma- 

 tion be checked in an early stage, the gland is 

 left unimpaired ; if its course be not arrested 

 until a later period, the secreting structure is 

 partly disorganised and reduced in size ; but 

 if the disease be allowed to continue un- 

 checked by treatment, the organ is totally 

 destroyed, either by ulceration of its tunics 

 and the escape of the glandular structure in 

 the shape of a fungous growth, or by the 

 slower process of wasting and absorption. 



Syphilitic orchitis is essentially of the same 

 nature as the chronic orchitis just described. 

 It commonly commences in the body of 

 the gland and rarely terminates in suppur- 

 ation, or in the production of a hernial 

 fungus. Sir A. Cooper states that in the 

 majority of cases the disease attacks both 

 testicles. The eight examples recorded in his 

 work do not, however, bear out this remark; 

 for in only two of them does it appear that 

 both organs were attacked. According to my 

 observation, the disease is more commonly 

 confined to a single gland, though it occasion- 

 ally affects both : this appears to be the 

 opinion also of Ricord.* The appearances on 

 dissection correspond with those observed in 

 chronic inflammation. 



Tubercular Disease. In the testicle,"~this 

 deposit is met with in the crude state, form- 

 ing a yellow caseous substance similar to the 

 tubercular matter occurring in the lymphatic 

 glands. It is sometimes developed in a single 

 mass ; at other times several distinct deposi- 

 tions are formed in different parts of the 

 organ : in both cases at the expense of its 

 glandular structure, which becomes atrophied 



k Traite Pratique des Mal;ulies Ve'neriennes, p. 640. 



as the disease advances. The epididymis is 

 more frequently affected than the body of the 

 gland. In a specimen taken from a man who 

 died of phthisis, I found the whole of the 

 epididymis occupied by tubercular matter, with 

 scarcely any trace of tubuli; whilst the body 

 of the gland, though small, was perfectly 

 sound and unaffected, (fg. 652.) In some 



Fig. 652. 



cases I have seen two, three, or more distinct 

 tubercular deposits, separated by portions of 

 healthy gland. This was the case in both 

 testicles removed from a middle-aged man 

 who died of phthisis. In some instances 

 these isolated masses appeared to be con- 

 tained in cysts formed by the processes from 

 the tunica albuginea which separate and sup- 

 port the lobules. Sometimes the separate 

 deposits seemed to be coalescing and joining 

 together, so as to form one continuous mass ; 

 and I have found a single mass of tubercular 

 matter surrounded by glandular structure ex- 

 panded into a thin layer. In other specimens 

 the whole testicle was occupied by a homo- 

 geneous cheesy mass, without any trace re- 

 maining of the original structure of the gland. 

 In some instances in which the disease was 

 thus advanced, there was very little increase 

 in the size of the testicle; it only felt heavier 

 and harder than in the natural state. In 

 others, again, there was either a general uni- 

 form enlargement, or an irregular swelling at 

 some part, commonly at the head of the epi- 

 didymis. Some of these testicles, in which 

 the disease was not much advanced, when 

 injected made beautiful preparations, the 

 yellow inorganic tubercular matter contrasting 

 in a marked degree with the vermilion hue of 

 the intervening sound portions of the organ. 

 On several occasions I found a small quantity 

 of serum in the tunica vaginalis, with partial 

 adhesions and depositions of lymph. In a 

 further stage of the disease, the characteristic 

 deposit becomes softened down, and converted 

 into a yellow pultaceous substance, evidently 

 tubercular matter mixed with pus. The ab- 

 scess extends to the scrotum ; and after it has 

 burst and the matter has escaped externally, 

 cavities and sinuses are left which may be said 

 to resemble the tubercular cavities in the 



lungs. 



The course of the disease, however, 



