998 



they constitute the form of hydrocele, called 

 from its original seat, encysted hydrocele of the 

 epididymis. I have observed this description 

 of hydrocele in all its various modifications, 

 from the enlargement simply of a single cyst to 

 the complication occasioned by the varied de- 

 velopment of several. As a cyst enlarges the 

 epididymis becomes flattened, and displaced 

 to one side, whilst the testicle is found either 

 in front or at the bottom. It is sometimes at 

 the side, but rarely at the posterior part of the 

 swelling. 



In the above woodcut (fig. 640.) of a spe- 

 cimen in the London Hospital Museum, the 

 cyst is above the testicle, which is so dis- 

 placed by it that its anterior edge is directed 

 downwards. The tumour is generally of 

 smaller size than a simple hydrocele, the fluid 

 commonly not exceeding three or four ounces 

 in quantity. I have, however, removed as 

 much as thirty-two ounces from a single cyst. 

 When the hydrocele is composed of several 

 cysts, they are seldom of large size, but form 

 a cluster more or less complicated and irre- 

 gular, according to their size and number. 



A curious sacculated arrangement produced 

 by the development of numerous contiguous 

 cysts may be seen in the annexed figure, (Jig. 

 641.) taken from a preparation dissected by 



Fig. 641. 



TESTICLE (ABNORMAL ANATOMY). 



myself: part of the walls of the cysts are cut 

 away to exhibit their interiors. The cysts are 

 liable to inflammation, which causes more or less 

 alteration in the quality and appearance of the 

 fluid contained in them. The fluid may become 

 albuminous and assume the straw or amber 

 colour of ordinary hydrocele; and the cyst 

 may contain lymph, form adhesions, or be 

 lined with a false membrane, the fluid being 

 thick and turbid. The cysts sometimes also 

 become filled with blood, constituting a variety 

 of haematocele. 



2. A cyst may form between the tunica 

 albuginea and the visceral layer of the tunica 

 vaginalis, separating the two membranes which 



are naturally closely adherent to each other. 

 This is a very rare form of hydrocele. A spe- 

 cimen which I discovered accidentally in dis- 

 section, is represented in the annexed wood- 

 cut, (fig. 642.) The cyst contained about two 



Fig. 642. 



drachms of fluid, and is situated along the front 

 of the testicle ; it is a little thickened. A sec- 

 tion of it is preserved in the Hunterian Museum. 

 Sir B. Brodie has described a very similar 

 specimen.* In the museum of St. Thomas's 

 Hospital there is a specimen of a small cyst 

 apparently developed from the epididymis : in 

 its subsequent growth it had extended on the 

 fore-part of the testicle, separating the tunica 

 vaginalis from the tunica albuginea. 

 r 3. In examining a healthy testicle I once 

 found six or seven small cysts about the size 

 of currants, studding the surface of the loose 

 portion of the tunica vaginalis. Two of them 

 were situated in a part of the membrane ex- 

 tending up the cord. They projected in- 

 ternally, and contained a limpid fluid. I have 

 twice since seen a similar kind of cyst in the 

 same portion of the tunica vaginalis. Similar 

 adventitious cysts have also been observed on 

 the internal surface of the sac of a simple 

 hydrocele, and a preparation of the kind is 

 contained in the Hunterian Museum. If a 

 cyst developed in this membrane were to 

 increase to any size, it would constitute a 

 swelling which might be appropriately termed 

 an encysted hydrocole of the tunica vaginalis. 



A circumstance of much interest in con- 

 nection with encysted hydrocele of the tes- 

 ticle, is the occurrence of spermotozoa in the 

 fluid contents of the cyst, a discovery made 

 by the late Mr. Listen in 1843. During the 

 last six years I have met with them in as 

 many as twenty cases of encysted hydrocele : 

 indeed, in the majority of instances in which 



* Lond. Med. and Phys. Journal, vol. Ivi. p. 522. 



