TESTICLE (ABNORMAL ANATOMY). 



much enlarged ; its head was filled with soft 

 concrete matter, surrounding an irregular 

 cavity with which a fistulous sinus com- 

 municated ; its tail contained a similar sub- 

 stance without any external opening. The 

 various appearances described are depicted in 

 the adjoining figure, which was taken from 

 the recent specimen. Similar appearances to 

 those noticed in this case have been described 

 and figured by Cruveilhier, in his*" Anatomic 

 Pathologique."* He considers that the dis- 

 ease proceeds from the head of the epicli- 

 dymis towards the tail, and that the body of 

 the testicle is affected only consecutively. I 

 believe, myself, that the yellow deposit is the 

 ordinary result of chronic inflammation of the 

 testicle in whatever way produced ; but that 

 the peculiar appearances noticed in the case 

 just related and likewise described by Cru- 

 veilhier, I mean the small isolated masses 

 in the substance of the gland, and radiating 

 towards the mediastinum, are only observed 

 in those cases in which the disease originates 

 in the epididymis, and thence spreads to the 

 body of the testicle, and in which the part is 

 examined before the organ has become ex- 

 tensively diseased. These appearances are 

 not often seen, because it is not often that it 

 becomes necessary to remove a testicle in 

 such a condition, which is indeed a curable 

 one unless complicated with suppuration. 

 Cruveilhier supposes that this matter is effu- 

 sed in the areolar tissue of the testicle, and 

 radiates along the fibrous prolongations from 

 the corpus Highmori. I feel satisfied, however, 

 from my own observations, that he is mis- 

 taken, and that the interior of the tubuli is the 

 original seat of the deposit. This yellow 

 substance has been called the yellow tubercle 

 of the testis ; but, as it differs from tubercular 

 deposit, the term is objectionable and liable 

 to lead to error. It is evidently coagulable 

 lymph, which becomes more solid in the 

 testicle than in most other parts, owing, per- 

 haps, to the condensation consequent on the 

 firm resistance offered to any enlargement of 

 the gland by the unyielding tunica albuginea. 

 This disease is often accompanied with effu- 

 sion of serum into the tunica vaginalis, seldom 

 amounting, however, to more than three or 

 four ounces. Lymph also is sometimes de- 

 posited, and the sac may become partially, or 

 totally obliterated by adhesions. 



The peculiar matter effused in this disease 

 under appropriate treatment undergoes com- 

 plete absorption, the testicle being left in a 

 condition to perform its natural functions. 

 It sometimes happens, however, that ulcera- 

 tion ensues in its tunics and integuments, and 

 that a fungous-looking growth gradually pro- 

 trudes through the opening which is thus 

 formed. This fungous growth is sometimes 

 termed granular swelling ; it has also received 

 the name of hernia testis, being formed in a 

 manner very analogous to that of a hernia 

 cerebri, in which the substance of the brain is 

 protruded through an ulcerated opening in 



* Liv. v. pi. b., and liv. ix. pi. i. 



1007 



the dura mater. It appears that the yellow 

 deposit after some time excites ulceration in 

 some part of the tunica albuginea. The tunica 

 vaginalis, and afterwards the skin, become 

 adherent at this spot, and likewise inflame 

 and ulcerate. The resistance afforded by the 

 dense unyielding tunica albuginea being'thus 

 removed, the adventitious deposit gradually 

 presses out the tubular structure, which forms 

 a projecting tumour consisting^of the tubuli 

 mixed up with this yellow substance, and also 

 of ordinary granulations which spring up from 

 the seminiferous structure. This projecting 

 growth presents an ash or yellowish-white ap- 

 pearance, varied by irregular patches of a pale 

 red hue, arid sometimes of black. It is closely 

 girt by the scrotum, the ulcerated edges of which 

 are often thickened and everted, (fig. 65 1 .) 



Fig. 651. 



The mass often projects so much that scarcely 

 any part of the organ is contained within the 

 scrotum. Though this hernial growth occurs 

 most frequently in an advanced stage of the 

 chronic form of inflammation, it is developed 

 in other diseases of the organ which occasion 

 ulceration of the tunica albuginea, and thus 

 afford an opening for the escape of its con- 

 tents. It is occasionally the result of an 

 attack of acute inflammation supervening 

 upon the chronic disease, and terminating in 

 suppuration in the substance of the gland. In 

 a case of this kind, in addition to the glan- 

 dular swelling, there are sinuses more or less 

 numerous, which burrow in the interior of the 

 organ, and discharge pus mingled with the 

 yellow matter. An attack of orchids, origin- 

 ally acute, going on to suppuration, is also 

 liable to be followed by a fungous protrusion 

 of the secreting structure of the gland. In 

 the latter case, the growth is not so exube- 

 rant, and the seminiferous structure is more 

 distinctly apparent, owing to the absence of 

 the yellow matter ; but there are generally 

 sinuses which furnish a purulent discharge, 

 sometimes mixed with semen. Tubercular 

 matter deposited in the testicle may also lead 

 to suppuration, and the formation of a granu- 

 lar swelling. 



A testicle after becoming somewhat en- 

 larged from chronic inflammation, often con- 

 tinues indolent and stationary for years, 

 giving rise to very little inconvenience. On 

 examining the organ in this state, the yellow 

 adventitious deposit is found to possess con- 



