TESTICLE (ABNORMAL ANATOMY). 



like crude tubercular deposit ; but on further 

 examination it will be found to be contained 

 in a distinct cyst, from which it may easily be 

 separated, and the structure of the testicle 

 will be perceived to be more or less altered 

 from its healthy state; whereas in tubercular 

 disease, the morbid deposit is in immediate 

 contact with the tubular structure, which, 

 though atrophied by pressure, is usually in 

 other respects sound. Concrete pus may 

 likewise be mistaken for the firm yellow mat- 

 ter effused in chronic inflammation. It differs 

 from it, however, in being friable and easily 

 broken up, and also in being enclosed in a 

 cyst, whereas the yellow fibrinous substance 

 is homogeneous and consistent, and almost 

 inseparably diffused amongst and connected 

 with the convoluted tubuli around it. The 

 distinctive characters just described will be 

 easily recognised on comparing the accom- 

 panying representation of concrete pus en- 

 cysted in the testicle withjfSg. 651. 



Fig. 648. 



I examined two enlarged testicles taken 

 from a man who died suddenly. Both 

 glands had formerly been attacked with 

 acute inflammation, and for some months 

 before death they had been the seat of 

 chronic pain. In the left testicle, which 

 was the larger of the two, from two to three 

 drachms of thick yellow inspissated pus were 

 contained in a distinct cyst, which occupied 

 the centre of the gland. There was no trace 

 of tubuli, but the remainder of the organ was 

 composed of a fibrous tissue : the sac of the 

 tunica vaginalis was obliterated by close ad- 

 hesions. The tunica vaginalis of the right 

 testicle contained about half an ounce of 

 yellowish serum and in the centre of the gland 

 there was a small concrete abscess, but the 

 tubular structure was apparent and very little 

 diseased. Pus existing in this concrete or in- 

 spissated state often keeps up pain and irrita- 

 tion for a long period, and renders the testicle 

 liable to repeated relapses of inflammation. 



Suppuration occasionally takes place in the 



1005 



epididymis. In several cases of consecutive 

 orchitis which have come under my care, at a 

 late period of the disease an abscess formed 

 in the areolar tissue around the termination 

 of the epididymis and inflected portion of the 

 vas deferens, and burst at the most depending 

 part of the scrotum. In many instances, 

 after acute orchitis has subsided, the testicle 

 is restored to its natural condition ; in other 

 cases, permanent changes of a serious nature 

 are the consequence. I have observed in 

 testicles that have been affected with inflam- 

 mation some time before, that the septa ap- 

 pear to be more distinct, and to enter more 

 largely into the composition of the gland than 

 is natural ; that the small seminal tubes are 

 less numerous and apparent ; and that a great 

 part of the organ is converted into a dense 

 white fibrous tissue, without the presence of 

 tubuli. In these cases the fibrinous matter 

 effused in the areolar tissue connecting the 

 tubuli, not having been absorbed after the 

 cessation of inflammatory action, had occa- 

 sioned partial atrophy of the proper structure 

 of the organ, and been converted into the 

 dense tissue just described. Complete atrophy 

 is one of the most serious results of acute 

 inflammation of the testicle. I have already 

 remarked that the disturbance in the organisa- 

 tion of the testicle consequent upon inflam- 

 mation is the most common cause of wasting. 

 Consecutive orchitis, if not checked in the 

 early stage, seldom subsides without leaving 

 behind distinct traces of its existence, which 

 never disappear entirely during the remainder 

 of the patient's life. The epididymis fre- 

 quently remains enlarged, presenting an in- 

 durated irregular knotty swelling, seated 

 usually at its lower part, which is occasioned 

 by the presence of a dense hard deposit be- 

 tween the convolutions of the duct and 

 around the inflected portion of the vas de- 

 ferens. On making a section of the epidi- 

 dymis in this state, I have often observed not 

 only a highly thickened condition of its duct, 

 but also, in some instances, very considerable 

 dilatation ; so that the point of a fine probe 

 might be introduced into the canal without 

 difficulty, its area being increased four or five 

 times. These effusions about the duct rarely 

 if ever produce its obliteration, the yielding 

 nature of the tissues preventing this injurious 

 result. In old cases the epididymis acquires 

 the density and consistence of cartilage, and 

 sometimes even of bone. These changes are 

 rarely found without the presence of old ad- 

 hesions, obliterating partially or completely 

 the sac of the tunica vaginalis. The coats of 

 the vas deferens are also found for some ex- 

 tent thickened and indurated. The alterations 

 noticed in the body of the testicle have been 

 observed, in some instances, coexisting with 

 those in the epididymis ; but in by far the 

 majority of cases, the glandular structure is 

 unimpaired. In only two cases in which the 

 epididymis was thus diseased, have I remarked 

 a decidedly atrophied condition of the organ. 

 The absence of pressure, owing to the unre- 

 sisting nature of the membrane investing the 



