1004 



it are thickened, brawny, and adherent toge- 

 ther. In the Hunterian Museum there is a 

 specimen (No. 2460.) of old encysted haema- 

 tocele of the spermatic cord. A good-sized 

 cyst, lined by a membrane, polished and a 

 little wrinkled, is filled with a soft, tawny- 

 looking granular matter, resembling the altered 

 coagulum of blood observed in ordinary 

 haematocele after long maceration in spirit. 

 The tissues around the cyst are thickened 

 and indurated, just like those around an old 

 haematocele of the testicle. There is a hernial 

 sac immediately above it, and a h) 7 drocele 

 below, with the sac open for some distance 

 up the cord as far as the cyst of the haema- 

 tocele. The latter does not communicate 

 either with the tunica vaginalis, or the hernial 

 sac. In the Musee Dupuytren at Paris, 

 I also saw a preparation of this affection, 

 which occurred in the practice of the late M. 

 Blandin. 



Orchitis. Inflammation of the testicle 

 occurs in two forms, acute and chronic ; and 

 it may commence either in the body or secre- 

 ting part of the organ, or in the epididymis. 

 Inflammation beginning in the body of the 

 testicle may be idiopathic, or may be excited 

 by external violence: the disease is at first 

 confined to the interior of the organ, the 

 epididymis and tunica vaginalis being affected 

 only secondarily, and sometimes entirely es- 

 caping. Orchitis is far more frequently a 

 consecutive affection than a primary, the in- 

 flammation being transmitted from the urethra 

 along the vas deferens. In this latter form 

 of orchitis, which is familiarly known by the 

 term hernia humoralis, the epididymis is first 

 attacked, and the tunica vaginalis generally 

 participates in the disease. 



Acute Orchitis. Few pathologists have 

 examined a testicle in a state of acute inflam- 

 mation, and I am unacquainted with any au- 

 thentic account of the alterations in structure 

 from inflammation originating in the body of 

 the gland. I have twice had the opportunity of 

 examining a testicle affected with acute se- 

 condary orchitis ; and the folio wing description 

 of the pathological appearances is drawn up 

 from these investigations, and from the ac- 

 count of the dissection of two testicles affected 

 with gonorrhosal inflammation recorded by 

 M. Gaussail.* The tunica vaginalis is more or 

 less distended with lymph or albuminous 

 matter, infiltrated with reddish serum, which 

 form loose adhesions between the opposed 

 surfaces of the membrane ; these adhesions 

 are so slight as easily to admit of being broken 

 down with the finger. The membrane is in- 

 jected with a multitude of minute red vessels 

 which ramify in various directions and form a 

 compact network. At a later period red ves- 

 vels may be traced proceeding from the free 

 surface of the tunica vaginalis to the false 

 membranes forming the adhesions. The vo- 

 lume of the testicle appears very little if at 

 all increased, the great bulk of the tumour 



* M^moire sur 1'Orchite Blennorrhagique, Ar- 

 chives Generates de Medecine, torn, xxvii. p. 210. 



TESTICLE (ABNORMAL ANATOMY). 



being occasioned by the swollen epididymis 

 and effusion into the serous sac. When cut 

 into, the gland appears somewhat darker than 

 natural, from a congested state of its vessels. 

 The epididymis, particularly the lower part, 

 is enlarged to twice and sometimes thrice its 

 natural size, and feels thick, firm, and in- 

 durated. This enlargement is produced by 

 the effusion of a brownish deposit in the 

 areolar tissue between the convolutions of 

 the duct. The coats of the vas deferens are 

 thickened, and the vessels ramifying near them 

 injected, sometimes along the whole extent of 

 the duct. Albuminous deposit is found in the 

 areolar tissue around the tortuous part of the 

 vas deferens and tail of the epididymis, which 

 frequently forms the bulk of the swelling ob- 

 served in these cases. Owing to the epidi- 

 dymis being the part chiefly and most con- 

 stantly affected in consecutive orchitis, some 

 of the modern French writers have denomin- 

 ated the disease epididymitis. 



In treating of the acute inflammatory 

 changes in the tunica vaginalis, 1 particularly 

 remarked that the inflammatory action was very 

 liable to extend to the substance of the epidi- 

 dymis, but not to the body of the testicle, and 

 I noticed the pathological law enunciated by 

 Gendrin, by which the circumstance was ac- 

 counted for. We find, too, that inflammation 

 of the epididymis is much more readily pro- 

 pagated to the tunica vaginalis than inflam- 

 mation originating in the glandular structure 

 of the testicle. When inflammation com- 

 mences in the body of the gland, the enlarge- 

 ment takes place slowly, and is seldom con- 

 siderable until the disease has existed for 

 some length of time, which is easily explained 

 by the unyielding texture of the tunica albu- 

 ginea, and the circumstance of the tunica 

 vaginalis remaining unaffected. Suppuration 

 occasionally takes place in this form of orchitis, 

 whereas in consecutive inflammation the form- 

 ation of pus in the substance of the gland is 

 of rather rare occurrence. I do not mean, 

 however, to assert, that the glandular struc- 

 ture of the testicle never suffers in consecutive 

 orchitis, for I believe that it does so in some 

 instances ; but, according to my observations, 

 and I have paid some attention to the sub- 

 ject, it very commonly escapes, the inflamma- 

 tion not extending further than to the epidi- 

 dymis. When inflammation terminates in 

 suppuration, the matter is so slow in making 

 its way externally, owing to the density, thick- 

 ness, and low organisation of the tunica al- 

 buginea, that it generally burrows in vari- 

 ous directions, producing numerous sinuses 

 throughout the gland, and disorganising its 

 delicate structure. The matter sometimes be- 

 comes encysted, forming a separate abscess. 



In these cases, when the matter effused is 

 small in quantity, after all inflammation has 

 subsided, the more fluid particles are absorbed, 

 and the pus remains for a considerable time 

 in the form of an indolent concrete mass, 

 which has been mistaken, after death, for tu- 

 bercular deposit. The pus when found in 

 this concrete state appears at first sight very 



