676 INFLAMMATION OP THE SPERMATIC CORD. 



of the spermatic cord, though its true cause was not suspected until 

 Rivolta, in 1871, suggested that it consisted in infection with 

 microparasites, and later investigations have established that the 

 great majority of cases of scirrhous cord are due to botryomycotic 

 funiculitis. 



The scirrhous cords removed in the Berlin clinque were generally 

 found to contain botryomyces and staphylococci. Sometimes the 

 growth and thickening occur rapidly, and the spermatic cord may 

 attain the diameter of a goose's egg in a few months ; sometimes 

 the condition may exist for indefinite periods without marked in- 

 crease of size. 



Scirrhous cord is commoner in certain districts, perhaps because 

 the necessary conditions for infection are more favourable ; perhaps 

 because the method of castration there adopted favours infection. 



The following contributing causes of scirrhous cord are 

 recognised : — 



(1) Exposure of the cord after castration, and its projection 

 beyond the tunica vaginalis or scrotal wound. Sometimes this is the 

 result of applying clams too low, or using too heavy clams ; pulling 

 on the cord or violently tearing away the testicle ruptures the 

 peritoneal folds which support the cord within the abdomen and 

 allows the cord to protrude below the wound. Exposed to the air 

 the cord swells, and sometimes becomes strangulated in the narrow 

 skin incis.ion and in the tunica vaginalis. The portion lying beyond 

 the castration wound then begins to proliferate, and a condition 

 results which has been described as " Champignon " or chronic 

 funiculitis. In other cases the cord is withdrawn within the scrotum, 

 but in consequence of infection the wound persists, giving escape to 

 a greyish pus. The cord and tunica vaginalis are inflamed, swollen 

 and indurated, and if not checked the inflammatory process extends 

 upwards, frequently invading the abdominal portion of the cord. 



(2) All influences favouring pyogenic infection of the operation 

 wound promote development of scirrhous cord (Fig. 442). These 

 comprise, too small an incision, or an incision too far to one 

 side of the scrotum, both of which conditions impede drainage ; 

 too small a wound also favours strangulation of the cord and 

 formation of " Champignon," as shown by Trianon's experiments. 

 Castration by ligature is doubly dangerous if performed with 

 unsterilised materials. The ligature often remains in position a 

 long time, and therefore increases the danger of infection. In- 

 flammation spreads to the inner surface of the tunica vaginalis, 

 which soon becomes adherent to the spermatic cord; but the con- 



