434 The Testis 



subjects of varicocele are not liable to constipation. It is probably a 

 congenital defect, though its discovery is not made until puberty that 

 is until the rapid development of the generative apparatus is taking 

 place. 



The thickened and dilated veins feel just like ' worms in a bag.' 

 They give rise to a sensation of fulness in the cord, and up to the loin- 

 region. When they are much dilated before puberty they are likely 

 to prevent the due development of the testicle. 



In the palliative treatment of varicocele the bowels should be 

 kept thoroughly open so as to remove pressure from the spermatic 

 vein ; the scrotum should be sponged daily with cold water to brace 

 it up, and to stimulate the dilated veins a suspensory bandage should 

 be used. A light truss may be worn over the external abdominal 

 ring, to prevent the downward pressure of the long column of venous 

 blood. If these gentler measures fail, it may be necessary to excise 

 an inch of the veins, having tied them above and below ; but, as the 

 spermatic artery may possibly be entangled amongst the veins, the 

 operation may be followed by atrophy of the testis, even if this have 

 not already been determined by the defect in the venous return. The 

 reason for excising a piece of the packet of veins is that after a mere 

 ligation their continuity may not improbably be re-established. 



In the case of malignant disease of the testis the heavy mass 

 drags itself away from the external abdominal ring; in the case of 

 fluid collecting in the tunica vaginalis the fulness ascends along the 

 front of the cord towards the ring. 



In all cases of disease of the testis the scrotum should be raised, 

 so as to diminish the vascular supply. The patient should lie on his 

 back when the epididymis or testis is acutely inflamed, with the scrotum 

 supported over the pubes. 



The lymphatics commence in and upon the gland, and on the 

 surface of the tunica vaginalis ; they ascend in the cord to end in the 

 lumbar lymphatic glands. Unfortunately, when the surgeon is con- 

 templating the removal of the testis for malignant disease, he is 

 unable to inform himself whether the lymphatic glands are implicated 

 or not, because of their deep situation at the back of the abdominal 

 cavity. As a rule it is only when the cancer of the testis has invaded 

 the scrotum that the inguinal lymphatic glands are invaded, but in 

 rare instances it happens that they are implicated, and extensively 

 so, whilst the scrotal tissues are remaining sound. This is explained 

 by the lymphatic vessels of the testis having formed anastomotic 

 communications with those of the inguinal integuments a communi- 

 cation resembling that which exists between the spermatic artery and 

 the cremasteric branch of the deep epigastric. 



If there be much mechanical pressure upon the lymphatics or veins 

 of the cord, from malignant disease of the lumbar glands, or from any 

 other cause, the connective tissue of the cord may become infiltrated 



