322 Diseases of the Genital Organs 



means for diagnosis. As is well known, tuberculin has its 

 limitations, and may fail. If the patient responds to tuber- 

 culin, the evidence of tuberculous epididymitis or orchitis 

 is not complete. There may be tuberculous lesions in other 

 organs, causing the response to tuberculin, while the lesions 

 in the epididymis and testis may be non-tuberculous. When 

 but one testicle is involved, its removal and histo-biologic ex- 

 amination offers by far the most reliable means for diag- 

 nosis. If the disease has existed for some time, the re- 

 moval of the testis is in no case an economic waste, because 

 as a general rule chronic epididymitis or orchitis signifies 

 permanent loss of function of the involved gland. Its re- 

 moval is the best curative measure and the greatest avail- 

 able protection for the other testicle and for the breeding 

 life of the bull. 



The path of tuberculous invasion of the epididymis and 

 testis has not been clearly learned. The infection is not 

 primary. It does not seem to be secondary to penial infec- 

 tion. While I have observed several cases of primary penial 

 tuberculosis, I have not noted subsequent tuberculous epidi- 

 dymitis or orchitis. It appears highly improbable that the 

 tubercle bacilli would traverse the long urethra and vas 

 deferens and reach the epididymis without leaving behind 

 evidences of its passage in the form of penial or urethral 

 tuberculosis. When the infection is wholly within the tu- 

 bules of the epidymis or testis, as appears usually to be the 

 case, the invasion is apparently not direct from the perito- 

 neum. When the scrotal peritoneum is first involved, it 

 would appear probable that the invasion occurred from the 

 peritoneal cavity through the open inguinal ring. Appar- 

 ently most instances of tuberculous epididymitis and or- 

 chitis are referable to hematogenic sources and constitute a 

 part of generalized tuberculosis. 



The prognosis for the involved gland is hopeless. If only 

 one gland is involved, it may be successfully removed, leav- 

 ing the bull perfectly fertile. The difficulty is that, since 

 the tuberculous epididymitis or orchitis is usually a second- 

 ary rather than a primary lesion, the basic lesion remains 



