Varicocele ; Hcewatocele 433 



toneum and rests upon the psoas and crosses very obliquely the 

 ureter and the external iliac artery. The right artery lies over the 

 inferior vena cava. Passing into the inguinal canal, the spermatic 

 artery joins in the formation of the spermatic cord, and communicates 

 with the cremasteric branch of the deep epigastric, and, when piercing 

 the back of the fibrous capsule of the gland, with twigs of the artery of 

 the vas deferens. Having entered the body of the testis through the 

 posterior part of the fibrous capsule of the testicle, the branches of the 

 spermatic artery spread out upon its inner surface, and upon the fibrous 

 septa in the interior. Sir Astley Cooper compared the vascular layer 

 to the pia mater, and called it the tunica vasculosa. 



As the spermatic artery lies in the back of the cord near the vas 

 deferens, the probability is that it will have been separated from the 

 veins before the latter are ligated in the radical treatment of varico- 

 cele. If it be included in the ligature, atrophy of the testis is likely 

 to follow (vide infra}. But as the spermatic artery anastomoses with 

 the artery of the vas deferens, and with the cremasteric branch of the 

 deep epigastric, the testis does not depend entirely on the aortic branch 

 for its supply. 



The spermatic veins return the blood from the tunica vasculosa, 

 and, leaving the gland through the back of the tunica albuginea, receive 

 branches from the epididymis. They are much twisted together and 

 communicate freely, and, though possessing valves, they maybe injected 

 in either direction. They are called the pampiniform plexus, from 

 their resemblance to the tendrils (pampinus) of a vine. They become 

 fewer as they ascend along the inguinal canal, and by the time that the 

 renal region has been reached there is usually but a single vein ; this 

 on the right side enters the inferior vena cava, on the left the renal vein. 

 In the development of the left testicle it would have been impractic- 

 able for its spermatic vein to pass over into the vena cava. 



Within the abdomen the spermatic veins are behind the peritoneum, 

 and those of the left side take their course beneath the sigmoid flexure 

 of colon. When this piece of the bowel is habitually overloaded the 

 return by these veins is impeded, and the dilated veins form a tumour 

 varicocele (varix, KrjXrj, tumour). A varicose vein is apt to burst 

 into the cavity of the tunica vaginalis, and so form an opaque blood- 

 tumour, hcematocele (ai/za, blood ; KTjAq, tumour). Rupture of a vein 

 into the cord may give rise to ' diffuse haematocele of the cord,' and 

 the extravasation may reach even to the renal region. Other reasons 

 have been suggested for varicocele usually occurring on the left side : 

 such as that the left spermatic vein is at times embarrassed in pouring 

 its blood, at a right angle, into the renal vein ; that, the left testicle 

 hanging somewhat lower than the right, the vein is longer and con- 

 sequently weaker. 



In all probability there is some developmental explanation for the 

 occurrence of the varix upon the left side. Certainly most of the 



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