TESTICLE (ABNORMAL ANATOMY). 



1002 



supported, appears to be highly favourable 

 to the occurrence of hernia and the extension 

 of the sac, by dragging down the peritoneum. 

 Oscheo-hydrocele is not an uncommon 

 complication. In most of the cases which I 

 have met with, the hydrocele was placed be- 

 low and free of the rupture, and in a few only 

 in front of it. I have never found the hernial 

 sac covering the fore part of a hydrocele. 

 The ordinary relations of hydrocele and scro- 

 tal hernia may be seen in the accompanying 

 woodcut. In figure 638., the sac of an in- 

 guinal hernia is represented at some little 

 distance above a small hydrocele. Dupuytren 

 states that, when a hydrocele is placed in 

 front of a hernia, a part of the omentum or 

 intestine sometimes descends into a cyst, 

 which projects into the hydrocele, and is 

 formed of the hernial sac and serous fold 

 of the tunic of the testicle.* This complica- 

 tion is of the nature of the hernia infantilis, 

 described by Mr. Key, and called by Sir A. 

 Cooper encysted hernia of the tunica vaginalis. 



Hcematocele. This is a term applied to the 

 swelling occasioned by effusion of blood in the 

 sac of the tunica vaginalis, or in a cyst connected 

 with the testicle ; it is also applied to tumours 

 produced by extravasation, either in the sub- 

 stance of the spermatic cord, or in the sac of 

 an encysted hydrocele of this part. Hcema- 

 tocele of the testicle, in which blood is effused 

 into the tunica vaginalis, is by far the most 

 common form of this affection. The extra- 

 vasation may take place in a healthy state of 

 the parts, or it may succeed, or be combined 

 with hydrocele. The first variety occurs from 

 the accidental rupture of some blood-vessel, 

 probably one of the vessels ramifying between 

 the tunica albuginea and tunica vaginalis 

 testis, owing either to a blow or a violent 

 straining effort. The second variety, in which 

 the extravasation takes place in combination 

 with hydrocele, is of more frequent occur- 

 rence than the first. It may also be produced 

 by a blow, or by the wound of some vessel, 

 in the operation of tapping. A blow occa- 

 sions a slight rupture of the tunica vaginalis, 

 and of some of the enlarged vessels ramifying 

 outside it, and the blood which escapes passes 

 into the sac and mixes with the fluid of the 

 hydrocele, producing a sudden increase in the 

 size of the tumour. The liability to this ac- 

 cidental effusion of blood is increased by a 

 diseased condition of the arteries, such as is 

 commonly met with in old people. The quan- 

 tity of blood effused under these circum- 

 stances varies considerably. It may be merely 

 sufficient to impart a red tinge to the serum. 

 In general, however, it is greater in amount, 

 and coagula are formed, which remain undis- 

 solved in the fluid. A haematocele may be 

 produced in the operation of tapping a hydro- 

 cele, in two ways. It may be occasioned by 

 the accidental wound of some vessel rami- 

 fying over the tunica vaginals, which, instead 

 of bleeding externally, or into the areolar 

 tissue of the scrotum, pours its blood into 



* Lesons Orales. Brussels edit. t. iv. p. 233. 



the sac of the hydrocele ; or it may be caused 

 by the trocar or lancet penetrating too far, 

 and wounding the testicle or spermatic 

 artery. 



In haematoceles which have existed for a 

 long period, the blood becomes changed into 

 a substance resembling coffee grounds, of a 

 brownish-red, or chocolate colour, and more 

 or less fluid. The coagula sometimes present 

 a cellular or honeycomb appearance, the cells 

 being filled with a reddish serum. Occasion- 

 ally the blood is found converted into a solid 

 fibrinous substance, of a yellow or fawn colour, 

 arranged in firm layers, similar to the coagula 

 lining the sac of an aneurism. In many in- 

 stances the effused blood is felt as a foreign 

 body, and produces inflammation in the tunica 

 vaginalis, which becomes coated with l)mph, 

 and this mixing with blood and serum modi- 

 fies the appearance of the contents of the 

 cyst, rendering it turbid and of a lighter 

 colour. Sometimes the inflammation goes on 

 to suppuration, in which case pus is also 

 found in the sac. The inflammation usually 

 extends from the tunica vaginalis to the areolar 

 tissue and fascia external to the sac, which in 

 recent cases are found infiltrated with serum 

 and lymph, and in cases of old standing be- 

 come greatly thickened, indurated, and com- 

 pacted. In a case of haematocele, occasioned 

 by the wound of a vessel in tapping a hydro- 

 cele in which I was consulted, the inflamma- 

 tion which ensued caused, in the course of a 

 fortnight, great thickening of the tissues ex- 

 ternal to the sac, and the formation of an 

 abscess in the scrotum on one side of the 

 haematocele. I have found the tunica vagin- 

 alis and tissues investing it as much as half 

 an inch in thickness, and very firm and dense. 



These changes in the sac are produced by 

 a more chronic form of inflammation of the 

 fascia and areolar tissue investing the sac. In 

 these old cases, the internal surface of the 

 tunica vaginalis instead of presenting its na- 

 tural smooth and polished surface, is rough, 

 granular, and irregular, and feels as dense and 

 tough as a piece of leather, having lost all 

 the characters of a serous membrane. In 

 haematocele, the testicle preserves the same 

 relation to the remainder of the tumour as 

 in simple hydrocele, being situated at the 

 posterior part, and rather below the centre. 

 Its position, however, is liable to similar al- 

 terations as occur in hydrocele, and they are 

 dependent upon the same causes. A young 

 man had a hydrocele, which had succeeded to 

 an attack of secondary orchitis, occasioning 

 an adhesion of the gland to the front of the 

 sac at its lower part. The case became con- 

 verted into a haematocele by the wound of a 

 vessel in the operation of tapping. Inflam- 

 mation ensued, and it became necessary to lay 

 open the sac. The surgeon, in carrying the 

 incision to the lower part of the tunica va- 

 ginalis, divided the vas deferens and severed 

 the sound testicle nearly in two with his bis- 

 toury, the thickening around the sac having 

 prevented him from detecting the gland in 

 its unusual situation. In haematocele, the 



