PATHOLOGICAL ANATOMY OF THE TESTICLE 485 



grippe have been reported. Wolbach reports an apparently toxic lesion, 

 with epithelial degeneration and fibrosis, in influenza. Mills describes a 

 lesion consisting of aspermatogenesis, epithelial degeneration, giant cell 

 formation, and slight fibrosis occurring regularly in autopsies of strepto- 

 coccus and pneumococcus pneumonias. It is apparently entirely benign 

 in those cases which recover. 



Rheumatic Fever. A few doubtful cases of orchitis are reported. 



Pyerma. Metastatic infections with staphylococcus, streptococcus, 

 etc., occur in pyemias and in localized infections with bacteriemia. The 

 pathological picture is described above. 



Meningitis. A few cases of orchitis are reported. 



Malta Fever. Several cases of orchitis are reported. 



Vaccinia. A few doubtful cases of orchitis are reported. 



Pyocyaneus. One case has been reported. 



Chronic Orchitis 



The lesions of the testicle which become chronic are usually hema- 

 togenous. 



Tuberculosis. Tuberculosis usually involves the epididymis first, and 

 extends to the testicle. Its spread in the testicle, therefore, is commonly 

 by way of the tubules. Miliary tuberculosis is of course an exception to 

 this rule. The microscopic picture is the familiar one of tuberculosis. 

 The testicle is enlarged and nodular. There may be caseation, with fistula 

 and even fungus formation, or healing with fibrosis and calcification. All 

 testicular elements are equally involved. The affected testicle shows 

 aspermatogenesis, but if a part is not involved, the interstitial cells there 

 retain their function until they are suppressed by fibrosis. Tubercle bacilli 

 have been found in the apparently healthy testicles of tuberculous patients. 



Syphilis. Syphilis may cause the formation of gummata or of a dif- 

 fuse fibrosis. Gummata resemble tubercules in their course and results, but 

 are distinguished by a greater vascular involvement, a later disappearance 

 of elastic tissue, and a slighter tendency to necrosis. In syphilitic fibrosis, 

 the entire organ is usually converted into 'a fibrous mass, with disappear- 

 ance of all normal elements. It may begin as a hyalinization of the 

 tubules, or as a fibrous overgrowth of the stroma, with round cell infiltra- 

 tion. A surprising feature is the frequent persistence of spermatogenesis 

 and fecundity when only a very small portion of the testicle is not involved. 

 The lesion may be bilateral or unilateral. The diagnosis from other 

 forms of fibrosis may be difficult, and often depends on concomitant mani- 

 festations of syphilis elsewhere in the body. 



Mycoses. Sporotrichosis may cause an orchitis, said to resemble that 

 of glanders. Actinomycosis very rarely causes a nodular, tubercle-like 



