TESTICLE (ABNORMAL ANATOMY). 



1013 



as the inguinal canal, and as low down as the 

 epididymis. In examining the testicles of a 

 young man who died of pleurisy, I found a 

 quantity of fat along the cord, and around the 

 epididymis, and some also beneath the tunica 

 vaginalis covering the posterior part of the 

 testicle. In another case I met with small 

 isolated masses of fat, coupled with a small 

 encysted hydrocele of the conj. When de- 

 veloped in considerable abundance this de- 

 posit sometimes forms a tumour either in the 

 groin or in the scrotum. A tumour of this 

 kind in the scrotum has been mistaken for 

 omental hernia. I once dissected a tabulated 

 fatty tumour, surrounded by the thickened 

 sheath of the spermatic cord, on the body of 

 a man upwards of eighty yei.rs of age, which 

 was very similar in appearance to a portion of 

 omentum contained in a hernial sac. A 

 mass of fat, however, in the cord may form a 

 more defined and distinct swelling. Such a 

 tumour is preserved in the Museum of the 

 College of Surgeons. (No. 2461.) It is em- 

 bedded about an inch above the testicle, in 

 the tissues of the spermatic cord and loosely 

 connected with them. Its shape is oval ; it 

 measures four inches in length, and consists 

 of numerous lobes of soft fat, closely held 

 together by their thin fibro-cellular par- 

 titions. An interesting case of large fatty 

 tumour in the scrotum, originating in the 

 spermatic cord, was seen by several surgeons, 

 in 1844, much difficulty having been ex- 

 perienced in making out the nature of the 

 swelling. The tumour, together with the 

 testicle, was excised by Mr. Lawrence.* 

 Another of the same character, but of smaller 

 size, subsequently formed in the remains of 

 the cord in the groin, and was excised by me 

 in May, 1849. Collections of fat in the 

 scrotum have been known from the time of 

 Galen by the term steatocele. I suspect that 

 they all originated from the spermatic cord. 



MORBID ANATOMY OF THE SCROTUM. The 

 morbid appearances presented by the scrotum, 

 when the seat of oedema, inflammation, and 

 mortification, so closely resemble those of 

 other parts where loose areolar tissue abound, 

 that they require no particular description. 



Elephantiasis. This disease of the scro- 

 tum is rarely seen in Europe, but is of very- 

 common occurrence in many other parts of the 

 globe. It consists in a morbid thickening, or 

 hypertrophy of the tissues of which the scro- 

 tum is composed. The epidermis becomes 

 thickened, rough as in icthyosis, and inter- 

 sected with fissures, or chaps. The corium 

 is excessively consolidated, and often nearly 

 an inch in thickness, and very dense. The 

 chief bulk, however, of the tumour, is formed 

 by the conversion of the loose areolar tissue 

 of the scrotum into a large mass of fibrous 

 tissue, infiltrated with a thick jelly-like fluid, 

 evidently albumen, as it coagulates on the ap- 



* Vide accounts of this case by Lawrence, Me- 

 dical Gazette, May 30. 1845 ; by Brodie, Lectures 

 on Pathology, p. 271. ; by Edwards, and myself, in 

 Provincial Med. and Surg. Journal, June 25. 1845. 



plication of heat, acid, or alochol, and some- 

 times on cooling after its removal from the 

 body. The areolae of this tissue vary a good 

 deal in size, but some of them have been 

 found large enough to admit the extremity of 

 the little finger. Examined in the micro- 

 scope this structure exhibits the white and 

 yellow elements of the areolar tissue, in some 

 instances mixed with fat cells. When the 

 part is condensed by inflammation, there are 

 often hardened masses in the substance of the 

 tumour, which has a lardaceous appearance 

 when cut, or resembles cartilage; they some- 

 times undergo conversion into bone. The 

 testicles are buried in the morbid mass to- 

 wards its posterior part, but they are usually 

 sound in structure. Occasionally there is a 

 small quantity of serum in the tunica vagi- 

 nalis. In a case operated on in Calcutta, 

 there was a hydrocele on both sides imbedded 

 in the diseased parts, the largest of which 

 contained between five and six pints of fluid.* 

 The spermatic cords are elongated several 

 inches, owing to the testicles being gradually 

 dragged downwards during the growth of the 

 tumour, but the cords are not otherwise 

 diseased. In the remarkable case of Hoo 

 Loo, a native of China, operated on by Mr. 

 Key, in Guy's Hospital, the cremaster mus- 

 cles were nearly as thick as the finger. The 

 morbid growth is not very vascular. Its 

 arteries are derived chiefly from the external 

 pudic and perineal vessels ; but these, owing 

 to the magnitude of the tumour, become 

 greatly increased in size. The veins are 

 numerous, large, varicose, and very tortuous. 

 The integuments of the penis are often 

 affected with a similar disease, and enlarge in 

 the same ratio as the scrotum. In cases 

 where the disease is confined to the scrotum, 

 the penis becomes drawn in and ultimately 

 disappears, being completely imbedded in the 

 tumour ; whilst the prepuce being elongated, 

 opens by a navel-like aperture on the anterior 

 surface of the tumour, as may be seen in the 

 subjoined woodcut. In confirmed cases of 

 elephantiasis, the tumour increases until in the 

 course of years it attains an enormous magni- 

 tude. As this takes place, the skin is bor- 

 rowed from the lower part of the abdomen, 

 so that the hair on the pubes becomes thinly 

 scattered on the front and upper part of the 

 tumour. The tumour assumes an oval or 

 pyramidal form, the apex being superior, and 

 is attached to the body by a thick peduncle 

 extending from the pubes, occupying the 

 whole of the perineum, and terminating pos- 

 teriorly at the verge of the anus. There is 

 scarcely any limit to the size which the 

 tumour may attain. It has been known to 

 acquire such a magnitude as to weigh more 

 than two hundred pounds -j-, exceeding the 

 weight of the rest of the body. It has been 

 found to measure more than four feet in cir- 



* Calcutta Quarterly Journal, No. 3. 



f Case cited from Ephemerides d'Allemagne, by 

 Larrey. Meinoires de Chirurgie Militaire, t. ii. p. 

 115, 



3T 3 



