TESTICLE (ABNORMAL ANATOMY). 



996 



rence of hydrocele the tunica vaginalis may 

 have been inflamed and contracted adhesions, 

 so that the testicle may be connected to the 

 membrane in front ; in which case the serum 

 accumulates on each side of or above and 

 below the organ. The position of the testicle 

 in front may also be owing to an original 

 inversion of the organ, in which the free sur- 

 face presenting backwards, the fluid collects 

 in that direction and presses the testicle to 

 the front of the sac. Sometimes there are 

 several adhesions producing a sacculated ar- 

 rangement and forming what is termed a 

 multilocular hydrocele. Occasionally the cysts 

 thus formed have no communication with 

 each other. In two instances I have seen 

 a membranous partition in the sac of a hydro- 

 cele, separating it into two distinct cavities, 

 formed by a layer of false membrane. There 

 is one kind of sac or pouch often met with 

 in hydroceles which is not commonly de- 

 scribed. It is situated on the inner side of 

 the testicle, but the opening into it is always 

 found on the outer side between the body of 

 the gland and the middle of the epididymis. 

 This sac, which varies very much in size, is 

 formed by the distention of the cul-de-sac 

 which I have described as existing naturally 

 at this part. Two examples of this kind of 

 pouch are contained in the Hunterian Mu- 

 seum. One of them is represented in the 

 accompanying figure. In large hydroceles 



Fig. 639. 



1, aperture of the pouch between the body of the 

 testicle and middle of the epididymis. 



the epididymis is usually elongated and dis- 

 placed ; and instead of a pouch being formed, 

 the central part of the epididymis is drawn 

 to some distance from the body of the tes- 

 ticle. In old hydroceles the sac is often a 

 good deal thickened, the tissues enveloping it 

 being condensed and converted into layers of 

 dense fascia, such as are commonly observed 



investing only hernial sacs. The fibres, also, 

 of the cremaster muscle, frequently become 

 remarkably developed. This, however, is not 

 constantly the case ; for in some instances of 

 hydrocele of large size I have found this 

 muscle atrophied. The thickened sac after 

 many years acquires a cartilaginous cha- 

 racter, and it sometimes even becomes os- 

 sified. In cases which have been frequently 

 tapped, the sac is often found closely ad- 

 herent to the skin of the scrotum at the 

 various points perforated by the trocar. In 

 the Hunterian Museum there is a prepar- 

 ation showing a long narrow band of ad- 

 hesion passing from the anterior part of 

 the testicle across the dilated sac of the 

 tunica vaginalis to the membrane in front, 

 which is supposed to have resulted from a 

 wound of the testicle in the operation of tap- 

 ping. In all large hydroceles the spermatic 

 vessels are separated and displaced. The 

 glandular structure of the testicle is sound, 

 and the organ capable of exercising its func- 

 tions. The disease is strictly confined to the 

 investing serous tunic. The testicle is, how- 

 ever, frequently somewhat altered in shape, 

 being flattened by the pressure of the confined 

 fluid ; and in some instances has been found 

 partially atrophied. 



Hydrocele is generally single, but some- 

 times occurs on both sides. It is commonly 

 said to form more frequently on the left side 

 than on the right. During the last few years 

 I have registered the new cases of hydrocele 

 coming under my notice in public and private 

 practice. Of one hundred and ten cases of 

 simple hydrocele, one hundred and four were 

 single, and six double. Of the former sixty- 

 two occurred on the right side, and forty-two 

 on the left. This result, which gives a decided 

 predominance to the right side, does not agree 

 with the observations of Velpeau, Gerdy, and 

 Dujat, who found the disease to be more 

 frequent on the left side. Hydrocele in young 

 infants is usually single, and in my experience, 

 more common on the right side. I have seen, 

 however, a few cases of double hydrocele at 

 this early period. When the fluid collected 

 in the tunica vaginalis is attended with en- 

 largement of the testicle, the swelling is termed 

 a hydro-sarcocek. This affection is generally 

 consequent on chronic orchitis, but it is occa- 

 sioned by other morbid changes, malignant as 

 well as innocent. In these cases the disease 

 of the testicle is the original complaint and 

 source of the irritation that excites an undue 

 secretion from the tunica vaginalis. 



Congenital hydrocele. In simple hydrocele, 

 the original communication between the ca- 

 vities of the peritoneum and of the tunica 

 vaginalis is permanently obliterated ; but it 

 sometimes happens that fluid accumulates 

 around the testicle in cases in which the 

 obliteration has not been completed, consti- 

 tuting the variety termed congenital hydrocele. 

 The opening of communication between the 

 two cavities is usually small in size, about 

 sufficient to admit a crow's or goose's quill. 

 There is rather a rare variety of congenital 



