468 



APPLIED ANATOMY. 



results. It is for this reason that urinary infiltrations are to be at once incised, and 

 in operations the greatest care is exercised to stop every bleeding vessel. Infec- 

 tion of this region is particularly troublesome and a strict technic is necessary in 

 operating to avoid it. In some cases of varicocele with pendulous scrotum a portion 

 of the scrotum is excised in order to support the testicles. 



TESTICLES. The testicles begin to develop early in fetal life about the third 

 month below and in front of the kidneys, opposite the second lumbar vertebra. 



Descent of the Testes. The testis is covered by peritoneum, which is prolonged 

 at its upper and lower ends. The lower reaches down to the internal ring and later 

 contains fibrous and muscular tissue and passes through the inguinal canal to the 

 lower part of the scrotum: it is called the gubernaculum testis. It reaches its highest 

 development in the sixth month and its remains attach the testicle to the lower part 

 of the scrotum as the ligament of the scrotum. As the testicle descends, the upper 

 peritoneal band covers the spermatic vessels from the region of the kidney down. 

 The lower portion of the gubernaculum sends branches to the regions of the pubes, 

 perineum, and saphenous opening. The testicle is preceded in its descent through 

 the inguinal canal by a fold of peritoneum the "vaginal process which forms the 

 tunica vaginalis over the testicle, the part above atrophying. 



Practical Applications. The testicle may be arrested in some portion of its 

 course, forming an undesccnded testicle, or it may be displaced, as has been suggested, 

 by an abnormal development of one of the subsidiary bands of the gubernaculum. 

 Hence it may be found, not in the scrotum, but in the perineum, in the femoral 

 region, or in the pubic region. It may go through the femoral canal instead of the 

 inguinal. If it is undescended it may IDC arrested in the abdominal cavity, in the 

 inguinal canal, or at the external ring. 



The vaginal process may not entirely close, so that the peritoneal fluid passes 

 down to the tunica vaginalis covering the testicle; this is called a congenital hydrocele. 

 If the opening is large enough for intestine to enter, it forms a congenital hernia 

 (see page 383). If the opening is closed above, usually at the external ring, and 

 fluid accumulates in the tunica vaginalis it forms an infantile hydrocele. If a portion 

 of the vaginal process persists somewhere along the spermatic cord between the 

 internal ring and top of the testis it forms a cyst and is called an encysted hydrocele 

 of the cord. The vaginal process closes at its upper portion just before birth and in 

 those cases which are patulous after birth (congenital hernia and hydrocele) there 

 is a tendency to spontaneous closure, hence operative measures are usually deferred. 

 The vaginal process also descends into the inguinal canal in the female and a hydro- 

 cele of it is called a hydrocele of the canal of Nuck. 



Size, Position, etc. The normal testicles are 4 cm. (1^2 in.) long, 2.5 cm. 

 (i in.) wide, and 2 cm. (f in.) thick. They are firm to the touch. If larger they 

 are either hypertrophied or diseased. If hypertrophied their consistence is not ma- 

 terially altered, if diseased they are usually harder. If smaller they are usually 

 atrophied and besides the lessening of size are also softer and flabby in consistency. 



They lie attached at the inner posterior portion of the scrotum and their long 

 axis points upward, slightly forward, and outward. In all cases of hernia and hydro- 

 cele the testicle is to be felt for at the inner posterior aspect of the swelling. In 

 rare instances the testicle is placed anteriorly instead of posteriorly and is liable to 

 be wounded in introducing a trocar into the tunica vaginalis to empty a hydrocele. 

 To avoid this accident the position of the testicle can be determined not only by 

 touch but also by seeing the outline of the testicle by means of a light placed on the 

 opposite side of the scrotum. As the testicle is almost always low down the puncture 

 should be made higher up and preferably on the outer side. 



Epididymis. The vas deferens descends to the lower end of the testicle and 

 becoming much convoluted forms the globus minor or tail, thence ascends, forming 

 the body, and finally at the top, receiving the efferent ducts, forms the globus major 

 or head. Between the body of the epididymis and testis is a pocket or depression 

 called the digital fossa. Attached to the upper end of the testis is a small flat body 

 in front of the globus major and attached to the globus major itself is a small cystic 

 pedunculated growth. Both are known as the hydatids of Morgagni, and the former is 

 the remains of the duct of Miiller, while the latter is derived from the Wolffian body. 



