ENDEMIC FUNICULITIS 



1941 



etiology. — Among Ceylon practitioners the disease was con- 

 sidered by some to be of traumatic origin; others believed it to be 

 of venereal origin, and yet others to be a malarial affection. Castel- 

 lani found in all the cases virulent diplo-streptococci, and in some 

 cases, one in 1904 and the others in 1909, and later, a microfilaria. 

 This microfilaria is morphologically identical with Microfilaria han- 

 crofti, but in our cases, though provided with a sheath, it showed 

 translation movements. The cocci are practically indistinguishable 

 from the ordinary streptococci but for the fact that some decolourize 

 by Gram in sections of the tissues and in smears from the pus, 

 while they are Gram-positive in cultures. According to Coutts 

 these micrococci are often found in the urethra of natives. He 

 regards the suppurative condition of the cord as due to the extension 

 of an infection from the urethra by way of the vas deferens. Wise 

 has found in his cases F. hancrofti and numerous streptococci. 

 Pfister believes the disease to be connected with bilharziosis. We 

 are inclined to consider the malady to be a filarial condition with a 

 superadded streptococcus infection. The 

 filaria probably plays the more impor- 

 tant or only role in the subacute or 

 chronic cases, while the streptococcus is 

 probably the causative agent of the 

 acute symptoms and the suppuration, 

 and of the symptoms of septicaemia. 



Predisposing Causes. — ^A certain impor- 

 tance must be given to a sudden chill 

 or to some form of traumatism. In 

 nearly all the Ceylon cases the disease 

 begins abruptly after taking a cold bath ^g^, „ Transverse 



when feeling tired. In some cases the Section Inflamed Cord. 

 patient gives a history of having made (Actual Size.) 

 an effort, such as in lifting a weight, etc. 



Pathology— The whole of the spermatic cord is highly inflamed 

 and infiltrated. The circumference of the cord may be as much as 

 3 to 3j inches. The tunica vaginalis is hyperaemic, but in most 

 cases there is no collection of fluid. On making a transverse 

 section of the cord, yellow creamy pus will exude from the opened 

 veins of the pampiniform plexus, as well as from the vas deferens. 

 The inflammation is not localized to the cord only; it ordinarily 

 extends to the epididymis. In two very recent cases of ours, how- 

 ever, the epididymis was normal. The testicle proper remains 

 generally unaffected; there is occasionally some effusion of clear fluid 

 into the tunica vaginalis. The histological lesions are, briefly, the 

 following: The veins of the pampiniform plexus are much dilated, 

 and present a cellular infiltration of all the coats, the lumen of some 

 veins being occupied by pus cells or thrombi. The vas deferens 

 also presents a well-marked cellular infiltration of its mucous mem- 

 brane and various muscular coats. The type of cellular infiltration 

 as noted by Coutts and Castellani is mostly mononuclear. 



