SURGERY. 
731 
disorder. The direction which Sir A. Cooper gives for 
avoiding mistakes, is simple and good ; the patient is to be 
placed in a horizontal posture, and the swelling emptied by 
pressure; the surgeon is then to put his fingers firmly upon 
the abdominal ring: if the case be a hernia, the tumour can¬ 
not re-appear, as long as the pressure is continued at the ring; 
but, if the disease be a circosele, the swelling will appear 
again with increased size, on account of the return of blood 
into the abdomen being prevented by such pressure. 
A cirsocele may be really combined with a hernia; a case 
which is extremely perplexing, because the former complaint 
renders the patient incapable of wearing a truss. 
The testicle is liable to various chronic enlargements, 
which are all included in the general term sarcocele. The 
common sarcocele has the same structure as the ordinary vas¬ 
cular sarcoma. The testis becomes larger than natural; and 
this increased size, which, in some cases, is inconsiderable, 
in others, attains a degree, in which the part affected is as 
large as two fists. While the tumour is of moderate dimen¬ 
sions, the shape of the testisTs partly retained; the swelling 
being oval and flattened at the sides, with its larger end 
turned upward and forward, and its smaller directed down¬ 
ward and backward. Its weight is very considerable, in 
comparison to its size; and it is its nature to remain a long 
while indolent, giving but little pain, except it be left un¬ 
supported, when from the dragging of the spermatic cord, 
more or less annoyance is produced. The scrotum is of its 
natural colour, without any augmentation of its temperature, 
or any signs of fluctuation. At first the spermatic cord is 
unaffected, and of course the swelling does not extend quite 
up to the abdominal ring; but, after a time, the disease 
generally extends higher up, and the cord itself becomes en¬ 
larged. However fleshy and indolent a common sarcocele 
may be in its incipient stages, and even for years, the pos¬ 
sibility of its assuming a more painful and malignant nature 
should never be forgotten, because it is a fact, that ought 
always to be allowed to weigh in considering the propriety 
of persevering in attempts to save the part. The species of 
sarcocele which is liable to change into scirrhus and cancer, 
generally begins in the body of the testicle, and very seldom 
in the epididymis and spermatic cord, which parts, however, 
are often subsequently affected. 
The testicle is sometimes converted into a scrofulous, 
mass. It is enlarged in size; and when cut into, a whitish 
or yellowish coagulated matter is discovered, mixed with 
pus. 
Fungus haematodes, or soft cancer, sometimes attacks the 
testicle, and particularly demands the earnest attention of the 
surgeon, not only on account of its fatal character; but also 
because it is a distemper very insidious in its attack, and 
peculiarly liable to be mistaken for a common hydrocele. 
It is described by Dr. Baillie as sometimes much enlarged, 
and converted into a uniform pulpy matter, in which its 
natural structure is entirely lost. This sort of change has 
been sometimes mistaken for scirrhus, but it is very different 
from what is called scirrhus in other parts of the body, and 
what is found in the testicle itself. 
According to the excellent description given by Mr. 
Wardrop, the fungus haematodes of the testicle is mostly 
seen in persons under the age of thirty. In some cases, it 
begins in the body of the organ, while, in others, its origin 
is attended with a tumour in the epididymis. The progress 
of the disease is very slow, and, as the swelling of the gland 
increases, the tumour retains an oval, or globular form, and 
it becomes difficult, if not impossible, to distinguish the body 
of the testicle and epididymis from one another. The pain 
of the disease is generally so trifling as to excite little alarm, 
and there is no inequality, nor hardness in the gland, nor 
any change in the structure of the scrotum. When the tes¬ 
ticle has increased considerably in bulk, it becomes remark¬ 
able for its softness and elasticity, and produces a sensation, 
as if it contained fluid. Hence, the disease has often been 
mistaken for hydrocele, and punctured. 
Mr. Wardrop says, that the want of transparency in the 
tumour is one appearance in the fungus haematodes of the 
testicle, which might be expected to lead to an accurate 
diagnosis between it and hydrocele; but, as there are many 
collections of water in the vaginal coat of a dark colour, 
and sometimes even of blood, and as the vaginal coat is 
often very much thickened, this cannot be always regarded 
as a diagnostic symptom: The fungus haematodes of the 
testicle, when of considerable bulk, though resembling 
many of the more frequent varieties of hydrocele in shape, 
yet, on inquiry, will not be found to have had a similar 
progress. In hydrocele, the water begins to collect at the 
bottom of the scrotum, and the testicle may generally be 
distinguished at the posterior part, until the tumour has 
acquired a very large size; whereas, in fungus haematodes, 
the disease commences in the body of the testicle, or in the 
epididymis, and the whole gland gradually enlarges. The 
tumour, too, in hydrocele, is accurately circumscribed 
towards the ring, whereas, in the fungus haematodes, there 
is a gradual swelling, or fulness, extending up from the testicle 
along the spermatic cord. This fulness is described as being 
very different also from the unyielding hardness of a scir¬ 
rhous affection of the part. In judging of the nature of the 
disease, the comparative weight of the swelling, to that of 
an hydrocele of equal bulk, is likewise to be considered. 
A fungus haematodes of the testicle, when large, sometimes 
becomes hard at some points, and soft at others, where the 
swelling seems as if it were about to break. It is not com¬ 
mon for the scrotum to give way, and a fungus to protrude ; 
but, if the patient live long enough, the disease may follow 
such a course. 
The testicle often becomes scirrhous; it is found converted 
into a hard mass, of a brownish colour, and generally inter¬ 
sected by membranes, and sometimes there are cells in the 
tumour, filled with a sanious fluid. This is the truly scir¬ 
rhous testicle, which is attended with a great hardness, severe 
pains darting along the spermatic cord to the loins, and an 
unequal, knotty feel. The health commonly becomes im¬ 
paired. To use Mr. Pott’s words, sometimes the fury of the 
disease brooks no restraint; but, making its way through all 
the membranes which envelope the testicle, it either produces 
a large, foul, stinking, phagedenic ulcer with hard edges, or 
it thrusts forth a painful gleeting fungus, subject to frequent 
haemorrhage. These latter states of the disease are denomi¬ 
nated the cancer of the testis. 
Sooner or later, the scirrhous induration extends from the 
epididymis upward along the spermatic cord, even within 
the abdominal ring. In the latter case, the lymphatic glands 
in the loins usually become diseased; and this extension of 
mischief, together with the impossibility of removing the 
whole of the diseased cord, too frequently deprives the 
patient of every chance of getting well. 
“ It is now well known,” says S. Cooper, in liis First Lines, 
“ that various sarcomatous enlargements of the testicle, at first 
quite indolent, and exempt from pain, and every alarming 
complication, such as swelling and induration of the cord, 
tumours of the inguinal glands, and swellings within the 
abdominal parietes, are capable of assuming, in a very sud¬ 
den manner, a malignant and cancerous tendency; and that 
sometimes the scirrhous induration of the cord makes rapid 
progress upward. When these changes have taken place, 
attended with severe hectical symptoms, extreme emaciation, 
a pallid wan face, and a tendency to anasarca, no measures 
which the healing art can suggest, will now avail to save 
either the diseased part, or the patient’s life. Hence, that 
surgeon acts with prudence, who recommends an early ex¬ 
tirpation of every testis that is incurably diseased, and 
entirely deprived of its original organization.” This, of 
course, should never be done, until the general treatment 
of chronic inflammation has failed. 
There is a particular affection of the testicle, in which a 
fungus grows from the glandular substance of this body, and, 
in some cases, from the surface of the tunica albuginea. 
This excrescence is usually preceded by an enlargement of 
the testicle, in consequence of gonorrhoea, a bruise, or some 
species of external violence. A small abscess takes place and 
bursts, and, from the ulcerated opening, the fungus gradu- 
