Coverings of Spermatic Cord 435 



with serum exuded from the congested vessels. This condition corre- 

 sponds to the oedema of the arm associated with malignant invasion of 

 the axillary glands ; it is called diffuse hydrocele of the cord, and is 

 more frequently described in books than observed in practice. 



The nerves of the testis are derived from the aortic and renal 

 plexus, and it is probable that a few filaments from the communication 

 with the anterior trunks of the lumbar nerves pass down with the 

 sympathetic fibres. The free association of the spermatic nerves with 

 the great pre-vertebral system of the sympathetic system of the 

 abdomen explains the sickness, faintness, or collapse which may ac- 

 company a blow upon the testis, symptoms which occur also on rupture 

 of the stomach or kidneys. The pain extends into the loins, and the 

 patient is 'doubled up' ; that is, he slackens his abdominal muscles 

 so as to take all pressure from the inguinal canal and from the abdo- 

 minal plexus. The close association between the renal and spermatic 

 plexuses is further shown by the neuralgia -or the acute inflammation 

 of the testis which may be caused by the passage of a renal calculus, 

 and by the pain in the back which follows the injection of a hydrocele, 

 or the dragging of a tumour of the testis. 



Leeching the front of the scrotum in acute epididymitis affords 

 relief through the anastomosis existing between the vessels of the 

 gland, the cord, the tunica vaginalis, and the scrotum ; the leeches 

 should be chiefly placed along the course of the cord. 



The supervention of orchitis on mumps has not yet been satis- 

 factorily explained. All that is known is that there is a strange 

 association between the parotid gland and the testis, or the ovary, 

 and also with the inguinal and genito-urinary region generally 

 Parotitis sometimes follows operation on these parts a parotitis 

 which is not, apparently, septicasmic in origin. 



In castration the testis is thrust well forwards by the grasp of 

 the left hand, which is behind the scrotum, and an incision is made 

 from the external abdominal ring down to the bottom of the scrotum. 

 The cord is laid bare and raised, tightly ligated, and divided ; the 

 lower piece of the cord, the testicle, and the tunica vaginalis are then 

 enucleated. The structures divided to lay bare the cord are the skin 

 and the superficial fasciae (which latter, in the scrotal part of the 

 incision, constitute the dartos); the thin inter-columnar fascia derived 

 from the aponeurosis of the external oblique ; the cremasteric fascia 

 from the internal oblique ; the infundibuliform fascia from the fascia 

 transversalis ; and a little loose connective tissue. If the unobliterated 

 funicular process of peritoneum be encountered it must be tied along 

 with the cord. In reaching the cord, branches of the superficial 

 epigastric and external pudic arteries, and the cremasteric twig of the 

 deep epigastric artery, may be divided ; also some twigs of the super- 

 ficial perineal arteries. The ligature around the cord secures the 

 following blood-vessels : the spermatic artery, from the abdominal 



