TESTICLE (ABNORMAL ANATOMY). 



happens between the years of two and ten.* 

 Of the twelve cases mentioned by Wrisberg, 

 in which one or both testicles were retained 

 in the abdomen, in one the descent took place 

 the day of birth, in three on the day after, in 

 three others on the third day, in two instances 

 on the fifth day, and in one on the twenty- 

 first day : in the other cases, the testicles had 

 not appeared at the fourth or fifth week after 

 parturition, -j- My own observations lead me 

 to believe, that if the passage does not take 

 place within a twelvemonth after birth, it is 

 rarely fully and perfectly completed afterwards, 

 without being accompanied with rupture. For 

 the causes which operate at this late period 

 tend as much to promote the formation of 

 hernia as the transition of the testicle. In 

 cases where the testicle makes no appearance 

 before puberty, uneasiness is often experienced 

 at that period, owing to the enlargement of 

 the gland being restrained by the rings and 

 parts composing the inguinal canal. At the 

 same time also, it is often protruded outside 

 the external ring by the movements of the 

 abdomen in respiration. 



The causes of a failure in the transition of 

 the testicle have not been much investigated, 

 and as considerable doubt has long prevailed 

 respecting the mode and agency by which 

 this change is effected, no satisfactory explana- 

 tion could 'be expected of the circumstances 

 interrupting or preventing it. When we re- 

 flect on the nature of that process, as my 

 researches have led me to describe it, it is 

 clear, that there must not only be a perfect 

 adaptation of parts, a due relation between 

 the body displaced and the structures which 

 it traverses, but also corresponding power in 

 the agent by which it is accomplished. There 

 are few muscles in the human body whose 

 development in different individuals varies in 

 a greater degree than that of the cremaster. 

 And if such be the case after birth, it is not 

 unreasonable to presume that similar differ- 

 ences exist in the foetus before the gland 

 changes its position, and that a failure in the 

 process may be the result of deficient power 

 in the musculus testis to accomplish the pas- 

 sage. It is not improbable that this muscle 

 is sometimes paralysed, and that the faulty 

 transition is owing to a want of a due supply 

 of the nervous energy, which we know is often 

 denied to other muscles during foetal exist- 

 ence, and is the cause of deformities in the 

 feet and other parts, with which infants are often 

 ushered into the world. I think, indeed, we 

 may fairly enumerate paralysis and defective 

 development of the cremaster amongst the 

 presumed causes of the imperfect transition 

 of the testicle. Peritonitis occasionally at- 

 tacks the foetus in uteroj, and produces ad- 

 hesions between the various abdominal viscera. 

 It is well known that in congenital hernia the 

 testicle is frequently united to a portion of 



* Lib. cit. p. 15. 



f Lib. cit. p. 203. 



J Vide Contributions to Intra-uterine Pathology, 

 by Dr. Simpson, Eclinb. Med. and Surg. Journal, 

 nos. cxxxvii. and cxl. 



989 



intestine or omentum, and that the formation 

 of these adhesions previous to the transition 

 of the testicle is sometimes the cause of the 

 displacement, the viscera being drawn, together 

 with the gland, into the scrotum. Many facts 

 seem to show that similar adhesions are, on 

 the other hand, an occasional cause of the 

 temporary and permanent retention of the 

 testicle, the cremaster being insufficient to 

 overcome this obstacle to its passage. 



In the examination of a man, age sixty, I 

 found the right testicle just external to the 

 abdominal ring ; it was small in size, and 

 closely adherent to a portion of omentum. 

 A young man was under my care for many 

 months, on account of an imperfect transition 

 of the testicle on the left side. The gland 

 moved backwards and forwards through the 

 external abdominal ring. By pressure above, 

 it could be forced down sufficiently to admit 

 of being examined. This testicle was much 

 smaller than the right, which was in the 

 scrotum, and I could distinctly make out 

 a portion of intestine closely adherent, which 

 accompanied the organ in all its movements. 

 It is probable that the smallness of the 

 opening in the internal abdominal ring is 

 sometimes a cause of the detention of the 

 testicle, especially in those cases in which the 

 organ is retained within the inguinal canal. 

 Mr. Wilson, an accurate anatomist, was of 

 this opinion*, which is supported by the fact, 

 that the testicle is oftener found in the groin 

 than in the cavity of the abdomen. M. Dela- 

 siauve mentions a case, in which, he states, 

 the organ was retained by the border of the 

 outer column of the ring, f Mr. Hunter was 

 inclined to suspect that the fault originates in 

 the testicles themselves. It is difficult to un- 

 derstand how this can be, for as the gland is 

 passive in this process, it can offer no obstacle, 

 unless it grows too large to pass the opening 

 in the abdominal parietes ; whereas, it is ad- 

 mitted that the gland when retained is usually 

 below the natural size. Nor does it appear, 

 that the interruption is owing to any want of 

 proper length in the vas deferens, for in a case 

 of imperfect transition in a boy, whose body 

 I examined, I particularly noticed that this 

 duct was so long as to be doubled on itself, 

 and tortuous, a circumstance which has been 

 remarked in other cases by Mr. MayoJ, Rosen- 

 rnerhel$, and others. It may be concluded 

 then, that the causes of a failure in the pas- 

 sage of the testicle are various ; that this 

 imperfection may result from want of power, 

 or paralysis of the cremaster muscle; from 

 adhesions retaining the gland within the ab- 

 domen ; and from a contracted state of the 

 opening of the external abdominal ring. 



Mr. Hunter states, that when one or both 

 testicles remain through life in the belly, he 

 believes that they are exceedingly imperfect, 



* Lectures on the Urinary and Genital Organs, 

 p. 405. 



t Revue Medicale, Mars, 1840, p. 363. 



Human Physiology, 3d edit. p. 411. 



Ueber die Kadicalcur des in der Weiche liegen- 

 den Testikels. 



