THE MALE EXTERNAL GENITALS. 469 



Practical Application. Inflammation of the testis proper is called orchitis; of 

 the epididymis, epididymitis. When the testicle as a whole is enlarged, if it is due 

 to syphilis or new growth, the testis itself is mainly affected and it is then called 

 sarcocele. Inflammations, the result of injury, may produce a true orchitis, but when 

 arising from infections they involve the vas deferens and epididymis and produce 

 an epididymitis. This is the case in gonorrhoea and tubercle, and to a less extent in 

 mumps. An enlarged epididymis can be outlined by careful palpation as being dis- 

 tinct from the testis proper. Advanced tubercle may invade the testis subsequently. 



Cystic disease is fairly frequent ; it involves the epididymis, especially the globus 

 major. The cysts may be very numerous and may spring either from the ducts of 

 the globus major or from the hydatids of Morgagni. 



Coverings of the Testicle. The tunica vaginalis comes from the peritoneum, 

 the tunica albuginea is the continuation of the transversalis fascia (infundibuliform 

 fascia); it is strong, dense, and inelastic. Over this are a few cremasteric fibres from 

 the internal oblique and the intercolumnar fascia from the external oblique. The 

 dartos is continuous with the fascia of Scarpa of the abdomen. 



Application. The tunica vaginalis being a closed sac may become distended with 

 serum, forming a hydrocele. The precautions to be taken in tapping it have been 

 alluded to above. It is treated radically by excising the parietal layer and leaving the 

 visceral layer covering the testicle and epididymis. The questions of hemorrhage and 

 skin inversion have also been discussed. Inflammation causes intense pain on account 

 of the unyielding character of the tunica albuginea. To relieve it multiple fine punc- 

 tures are sometimes made. Abscess (tuberculous) of the testicle opens the tunica albu- 

 ginea and the testicular tissue protrudes, forming a hernia testis. Such testicles are 

 often excised, but if not the hernia eventually shrinks and reduces itself (Holden). 



SPERMATIC CORD. The left spermatic cord is longer than the right, hence the 

 left testicle hangs lower. The cord is composed of the vas deferens with its artery, a 

 branch of the superior vesical, and veins; the spermatic artery with its veins; the 

 cremasteric artery; and the layers derived from the abdominal wall (the same as pos- 

 sessed by the testicle). It also possesses nerves, the genital branch of the genitocrural, 

 and branches of the sympathetic, and lymphatics. The vas deferens is a small, round, 

 hard cord lying posteriorly. It can be seen when the elements of the cord are sep- 

 arated and can be distinctly felt even through the scrotum. The deferential artery 

 accompanies and lies on the cord. The deferential veins go with the artery. They 

 unite and form three or four trunks (pampiniform plexus) which pass through the 

 inguinal canal to join and form at the internal ring one large vein, the spermatic, which 

 accompanies the spermatic artery; the right empties into the venacava, while the left 

 empties into the left renal vein. They possess but few valves, which are imperfect. 



The spermatic artery, from the aorta, descends in front of the vas deferens and is 

 accompanied by the pampiniform plexus of veins. It lies in the plexus with most of 

 the veins in front of it. These vessels lie in loose, fatty connective tissue derived from 

 the subperitoneal tissue along with the atrophied remains of the peritoneum (ligament 

 of Cloquet). 



These structures are covered by the sheath of the cord, composed ( i ) of the 

 transversalis fascia (infundibuliform fascia), (2) cremasteric fibres and fascia from 

 the internal oblique, and (3) intercolumnar fascia from the external oblique. 



Application. - The cord is involved in operations for varicocele, hernia, and cas- 

 tration. In varicocele after the skin incision is made a second incision is required to 

 open the sheath of the cord. This having been done the pampiniform plexus of veins, 

 which are the ones enlarged (varicose) in varicocele, come into view. As many of 

 these as desired are then drawn out, ligated at both ends, and removed. In doing this 

 the spermatic artery may likewise be tied. The circulation is afterwards carried on 

 by the artery and veins of the vas, the cremasteric artery being in the sheath externally. 

 It is wise not to remove all of the enlarged veins. The vas deferens is recognized pos- 

 teriorly both by sight and touch and is not to be disturbed. In hernia the vas deferens 

 sticks close to the sac, on the posterior and inner side. It must be sought for and care- 

 fully isolated. In castration the testicle is so movable that it can be pushed up into the 

 inguinal region and the incision through the skin for its removal made in that locality. 

 If done for malignant disease a large portion of the vas is removed. This can be done 



