TESTICLE (ABNORMAL ANATOMY). 



999 



I have searched for them. They were found in 

 subjects of various ages from 30 to 75, and in 

 cysts of all sizes from that of a filbert to the 

 largest which the hydrocele attains. The fluid 

 in some instances contained these bodies in 

 remarkable abundance ; in others they existed 

 sparingly. When very numerous, they give 

 to the fluid an opaline opacity, or an appear- 

 ance resembling cocoa-nut milk which is so 

 characteristic as to enable the surgeon to pre- 

 dicate their presence from the appearance of 

 the fluid alone without minute examination. 

 If the fluid be allowed to remain at rest in a 

 glass vessel, the spermatozoa subside to the 

 bottom, rendering the lower portion more 

 opaque than the upper. The fluid also ex- 

 hibits slight traces of albumen, when tested in 

 the usual way, which is not the case with the 

 ordinary pellucid colourless fluid of encysted 

 hydrocele. The spermatozoa were often as 

 lively as in fresh semen. They were observed 

 more frequently in the larger cysts than in the 

 smaller. I once found them in fluids removed 

 from two distinct cysts connected with the 

 epididymis of a man about sixty years of age. 

 1 have detected them in the fluid from en- 

 cysted hyclroceles tapped for the first time, 

 and also in the examination of small cysts 

 connected with testicles removed after death. 

 I removed from an old man aged 75, who had 

 had encysted hydrocele for eight years, and 

 which had never been tapped before, as much 

 as thirty-two ounces of fluid, which contained 

 an abundance of spermatozoa. They were 

 also detected in fluid taken from a man aged 

 54<, who stated that the tumour had existed for 

 eight years, and had never been operated on. 



Various opinions have been broached to 

 account for the existence of spermatozoa in 

 the encysted form of hydrocele of the testicle. 

 The explanation which seems to me the most 

 reasonable and probable, is that which I 

 offered shortly after the occurrence of sper- 

 matozoa in encysted hydroceles was first dis- 

 covered*, viz. that their presence is probably 

 owing to the accidental rupture of a seminal 

 canal, and the escape of its contents into the 

 cyst of an existing hydrocele. The close 

 proximity of the efferent tubes, the slight tex- 

 ture of the ducts and delicate walls of the 

 cyst, and the liability of the part to contusion 

 and injury, when a swelling even of moderate 

 size exists, seemed to me to favour this 

 view. The circumstance that spermatozoa are 

 never found in very small cysts show that 

 they are not originally formed there, but are 

 a subsequent addition to their contents. Since 

 my attention has been drawn to this subject 

 I have investigated the history of the cases of 

 encysted hydrocele containing spermatozoa, 

 which came under my notice. In nearly all 

 instances the patients assured me that the 

 swelling had gradually formed after an injury 

 to the tes f icle ; and in two cases it was clear 

 that a small cystic swelling had long existed 

 in a stationary state, but after a slight blow 



* Practical Treatise on Diseases of the Testis. 

 Appendix, p. 541. 



had begun to enlarge. I strongly suspect 

 that, in these cases, a duct had been ruptured 

 by the contusion, and that the irritation con- 

 sequent on the injury, and perhaps on the 

 addition of such lively bodies as spermatozoa 

 to the fluid contents of the cyst, had led to 

 its further development. I have, it is true, 

 failed in establishing the fact of a communica- 

 tion between the duct and the cyst by ana- 

 tomical examination. In two instances of 

 large encysted hydrocele containing sperma- 

 tozoa, which I had an opportunity of examin- 

 ing, I injected the vas deferens with coloured 

 size, but the duct was so clogged with semen 

 that the fluid could not be made to reach the 

 head of the epididymis, to which the cyst was 

 attached. In a preparation of large encysted 

 bilocular hydrocele containing spermatozoa, 

 shown me by Mr. Busk, the vas deferens had 

 been injected with mercury, but none of the 

 metal reached the upper part of the epididymis. 

 The cyst evidently arose from the head of the 

 epididymis, and was embedded a little in its 

 substance. In these cases no opening com- 

 municating with a duct could be discovered 

 on examination of the cysts, but this is not 

 surprising, since the communication must be 

 extremely minute, so as readily to escape 

 detection, or it may even have been obliter- 

 ated. 



Spermatozoa are stated to have been found 

 in some two or three instances in fluid re- 

 moved from the tunica vaginalis. It is not 

 improbable that these cases may have been 

 encysted hydrocles mistaken for simple. The 

 diagnosis is sometimes very difficult, and in 

 the case of the cyst examined by Mr. Paget,* 

 this error was made before death by a hospital 

 surgeon. I have, however, found spermatozoa 

 in the sac of the tunica vaginalis, and the fol- 

 lowing case will account for their presence. 

 A man aged fifty-four died in the London 

 Hospital of disease of the kidneys, of one of the 

 ureters, and of the bladder, which appeared to 

 be consequent on a severe blow on the loins 

 about six weeks before. The tunica vaginalis 

 of one of the testicles contained two ounces 

 and a half of slightly opaque fluid, in which a 

 few spermatozoa were found. There were 

 three small cysts containing fluid immediately 

 connected with the epididymis, and also at one 

 spot an irregular ragged membranous appear- 

 ance, evidently caused by the rupture of a 

 cyst. It is most probable that the spermatozoa 

 had escaped from this cyst, which may indeed 

 have been burst at the time of the injury. I 

 have examined the fluid from the tunica vagi- 

 nalis in a large number of instances without 

 finding these bodies, and I believe their occur- 

 rence in the common form of hydrocele to be 

 extremely rare. 



Diffused Hydrocele of the Spermatic Cord. 

 Mr. Pott has given an admirable account of 

 this affection, under the denomination of hy- 

 drocele of the cells of the tunica commvnis.^ it 

 has likewise been particularly described by 



* Medieo-chinirgical Trans., vol. 27. p. 398. 

 t Vide his Treatise on Hydrocele. 



3s 4 



