1942 DISEASES OF THE GENERATIVE SYSTEM 



Morbid Anatomy. — ^At the post-mortem examination of the cases 

 in which an operation has not teen performed in time, the lesions 

 found are those of a septicemic process. The skin is jaundiced, and 

 may present petechiae; the lungs often show hypostatic congestion; 

 the heart is flabby, and subpericardial haemorrhages are often seen. 

 The spleen is enlarged and soft. The liver is generally enlarged, and 

 may show fatty degeneration or cloudy swelling. The kidneys are 

 often congested. 



Symptomatology. — The disease begins suddenly, generally after 

 a hard day's work or severe exercise. In Ceylon the usual history 

 is as follows: The patient, after an extra hard day's work, comes 

 home in the evening very tired, but not feeling unwell, and takes a 



Fig. 783. -Endemic Funiculitis ^he inguinal region is occupied 



The swelling is very tender on pressure, and hard; the skin is not 

 affected. Generally the epididymis is somewhat enlarged and 

 tender, though in some very recent cases it may not appear to be 

 affected. In all cases the testicle proper appears to be normal; 

 there is, as a rule, no effusion in the tunica vaginalis. The affection 

 is generally localized to one side only, but occasionally attacks both 

 sides. On examination of the penis and scrotum no ulcers will be 

 found, no signs of gonorrhoea, and no signs of any traumatic lesions, 

 though in several cases the patient gives a history of having made 

 an effort of some sort. As a rule, the disease has no tendency to 

 spontaneous recovery. If an operation is not performed in time, 

 signs of general septicaemia usually set in. In such cr ses the skin 

 of the patient often becomes jaundiced, cutaneous haemorrhages 



cold bath as usual. After the 

 bath he is suddenly seized 

 with a shivering fit, the tem- 

 perature rising very high. He 

 feels very sick, and there is often 

 actual vomiting. At the same 

 time he complains of pain along 

 the cord and the epididymis. 

 The condition becomes rapidly 

 worse, and the patient is gener- 

 ally taken to hospital on the 

 second or third day of the 

 illness. On admission, it is 

 usually found that the general 

 condition is grave. There may 

 be continuous vomiting, and 

 occasionally hiccough; the tem- 

 perature is generally above 

 102° F., and the pulse small and 

 frequent. At the physical ex- 

 amination it will be seen that 



in a Sinhalese Man. 



by a large cylindrical swelling 

 in the direction of the cord. 



