TESTICLE (ABNORMAL ANATOMY). 



above the testicle in close contact with the 

 tunica vaginalis. Immediately above this cyst, 

 but quite distinct from it, there was a narrow 

 and empty serous sac three inches in length, 

 with a contracted neck, and communicating 

 with the abdomen. They are figured in the 

 accompanying engraving, with the hernial sac 



Fig. 644. 



laid open, and part of the parietes of the 

 encysted hydrocele cut away to expose their 

 interiors. The position of the testicle is so 

 changed that its anterior border is directed 

 downwards. In the examination of the body 

 of a man who died of disease of the heart, I 

 found on the right side a thickened and empty 

 serous pouch, extending for about an inch 

 and a half below the external abdominal ring. 

 Directly below it was an independent cyst, 

 capable of containing a walnut, similar in 

 structure to the hernial sac, but lined by a 

 thin false membrane. The tunica vaginalis, 

 which was healthy in structure, extended up 

 the cord as far as the cyst, from which it was 

 separated by a thick and firm partition. In 

 opening the body of a sailor who died with 

 ascites, I noticed at the internal ring a small, 

 delicate, transparent, pedunculated cyst, not 

 larger than a nut, projecting into the cavity 

 of the abdomen. In the spermatic cord, there 

 was a large serous cyst, which extended into 

 the inguinal canal, and contained a small 

 quantity of transparent fluid. A small orifice 

 at its upper part opened into the peduncu- 

 lated cyst, which proved to be a process from 

 the cyst in the cord. In fig. 644., I have 

 given a representation of an inguinal hernia, 

 combined with an elongated encysted hydro- 

 cele of the cord ; and in fig. 647., a repre- 

 sentation of an encysted haematocele of the 

 cord, in which the tunica vaginalis remained 



1001 



unobliterated as far up as the cyst, whilst a 

 hernial sac is situated immediately above it. 

 These dissections confirm the view taken by 

 Sir A. Cooper, and now commonly adopted, 

 of the mode of origin of encysted hydrocele 

 of the spermatic cord in the adult. 



Complications of hydrocele. The following 

 are the principal : 1. Simple hydrocele, com- 

 bined with encysted hydrocele of the testicle. 

 2. Simple hydrocele, combined with encysted 

 hydrocele of the spermatic cord. 3. Simple 

 hydrocele, combined with diffused hydrocele 

 of the spermatic cord. 4. Oscheo-hydrocele, 

 including both simple hydrocele and encysted 

 hydrocele, combined respectively with inguinal 

 hernia. 



1. The first is not an uncommon compli- 

 cation. In the dissection of these parts, I 

 have often found the tunica vaginalis distended 

 with three or four drachms, and even an ounce 

 or two of serum, two or more small distinct 

 cysts being at the same time connected with 

 the upper part of the epididymis ; and I have 

 twice met with this complication in both sides 

 in the same individual. The small adventi- 

 tious cysts appear to be the original disease, 

 the irritation produced by them being in all 

 probability the cause of the increased quan- 

 tity of fluid in the tunica vaginalis. 



2. The second complication is somewhat 

 rare. In the pathological collection at the 

 London Hospital, there are two specimens of a 

 collection of fluid in the tunica vaginalis as- 

 sociated with an encysted hydrocele of the 

 spermatic cord. In one of them the tunica 

 vaginalis is unobliterated for about two inches 

 along the spermatic cord, and the encysted 

 hydrocele is immediately above it. In the 

 other preparation it is apparent that both sacs 

 have been the seat of inflammation, false mem- 

 branes being contained within them. This 

 complication sometimes occurs in infants. 



3. Simple hydrocele associated with dif- 

 fused hydrocele of the cord is also rare. A 

 good delineation of this complication is given 

 in Scarpa's work. 



4. Scrotal hernia may be combined with 

 hydrocele. A voluminous hydrocele, if un- 



Fig. 645. 



