function. Cases are occasionally met with in which the glands remaining in the abdomen have been small and undeveloped; but this imperfection could not be dependent on the unnatural position, as the analogy of animals and positive observation in men shows.

The vas deferens may be absent in a greater or less extent, and even the epididymis has been found in great part deficient. What is very remarkable is, that in several of these cases the testicle was fully formed, and though incapable of fulfilling its function, was scarcely less than the other. Experiments on animals have also shown that obliteration of their excretory ducts does not cause necessarily atrophy of the testes, nor efface in the individual the characteristic marks of the male sex. The most usual and least degree of this imperfection is that the vas deferens terminates in a blind extremity before reaching the vesicula seminalis. There is no such condition known as true hypertrophy of the testes; the gland may become greatly enlarged when attacked with inflammation, or when it is the seat of morbid growths; but while in the fullest activity of its function it does not exceed the normal size. This, no doubt, depends on its secretions, which of course may be formed in very varying quantities, rapidly passing of by the excretory duct. An increased production of semen by the testis would correspond to apparent hypertrophy of the thyroid by dilatation of its cavities.

Atrophy of the testis, either congenital from defective development, or acquired, is not unfrequent. Several instances are mentioned by Mr. Curling, in which the penis and testicles of persons arrived at the age of puberty, or of adults, did not exceed the size of those of children; two of these were of weak mind, but this condition is by no means the frequent accompaniment of cretinism or idiocy. A case recorded by Mr. Wilson shows the influence of aroused mental emotions in producing the due development of the generative organs, which had not taken place at the twenty-sixth year of age. The atrophy of the testis in old age comes on very gradually, the organ becomes flabby, and its tissues discolored, but is often little diminished in size.

Mr. Curling states that the ordinary weight of a sound testicle, in a healthy adult, is about six drachms, great individual differences, however, being often met with, as well as differences between the two glands; the left was heavier than the right in five cases out of six. If the weight fall below three drachms, the organ may be certainly said to be in a state of atrophy. "A testicle in an advanced state of wasting, not arising from disease of the gland, usually preserves its shape, but feels soft, having lost its elasticity and firmness. Its texture is pale, and exhibits few blood vessels; the lobuli and septa dividing the lobes are indistinct, and the former cannot be so readily drawn out into shreds as before. The epididymis does not usually waste so soon, nor in the same degree, as the body of the testicle. It sometimes, however, loses its characteristic appearance; and I have even found it reduced to a few fibrous threads. The fluid pressed out of the wasted testicle and epididymis is entirely destitute of spermatic granules, and spermatozoa. In many instances, adipose tissue is deposited behind the tunica vaginalis, and encroaches on the epididymis and the posterior part of the testicle. Fatty matter is also found in the glandular substance of atrophied tes

Fig. 301.

ticles. The structures composing the spermatic cord undergo a corresponding diminution, the cremaster muscle disappears, the nerves shrink, and the vessels are reduced in size and number. The vas deferens, though small, can generally be injected with mercury as far as the commencement of the epididymis. The testis of a man, aged thirty-four, dying of scrofulous disease of the lungs and kidneys, weighed little more than two drachms. The vas deferens and epididymis appeared healthy. The wall of the tubes had a fibroid aspect, and there were numerous fibreforming nuclei on their surface. Their epithelial lining was everywhere in a state of fatty degeneration; it was reduced to atrophied, sometimes fattily degenerated, nuclei, and small corpuscles made up of oily molecules. The aspect of the gland tissue was dirty yellow; it was soft and flaccid. A testicle atrophied from disease is not only of diminished size and weight, but is altered in shape, being uneven and irregular, and sometimes of an elongated form. The surfaces of the tunica vaginalis are adherent, and its cavity is partly or entirely obliterated. There is no, or very little, trace of the proper glandular structure, the organ being converted into fibrous tissue of a firm texture. It loses its peculiar sensibility to pressure, but is sometimes the seat of morbid sensibility." The causes of atrophy of the testis are very various: deprivation of its supply of blood from obliteration of the spermatic artery, injuries of the spinal cord, producing paraplegia, and probably therewith the loss of the nervous influence necessary for the gland, inflammation of its tissue, over-excitement of the organ, the long-continued use of iodine, which is said to affect the female breast similarly, tubercular elephantiasis, injuries to the back of the head and nape of the neck, the pressure of effusions, and of large herniæ, neuralgia-all appear, on good evidence, to be real causes of atrophy of the part in question. The most common cause is inflammation; and it is easy to understand how the effusion of fibrin within the unyielding capsule of the gland should compress and obliterate the blood vessels, as well as the tubuli seminiferi themselves.

Inflammation of tunica vaginalis, after application of

caustic; the aperture made by this is shown at*. There are

flocculi of lymph on the serous surface of the testis.-From Mr. Curling's article.

The serous covering of the testis, the tunica vaginalis, is liable to be attacked by acute inflammation, and then suffers as other serous membranes do. The membrane becomes thickened and injected with blood, and is coated with a more or less considerable quantity of fibrinous exudation. Serum is at the same time effused into the cavity, and is rendered turbid by flakes of fibrin floating in it. The exudation may take the form of pus, but this rarely occurs. The unabsorbed fibrin very commonly forms adhesions between the opposing surfaces, which, in time, become very firm and dense, and may obliterate the cavity. It is by no means rare to find adhesions, to some extent, in the tunica vaginalis; Mr. Curling observed such in nine out of twenty-four in

stances. The epididymis is prone to partake in the inflammation of the tunica vaginalis, and vice versa.

Hydrocele is a dropsy of the serous covering of the testis, and does not differ essentially from dropsies of other serous sacs. The fluid is usually clear, and of a straw color, sometimes turbid, with albuminous flocculi, and not unfrequently contains a considerable quantity of shining particles of cholesterin. Its quantity is sometimes very considerable; six quarts are said to have been withdrawn in the case of Gibbon. The serous membrane in old hydroceles may be more or less thickened, and even the seat of calcareous deposit. Adhesions formed between the two layers of the tunica vaginalis may, according to their length and extent, alter the usual position of the testicle, so that it appears in front, instead of lying at the posterior and lower part of the distended sac; or they may subdivide the cavity, and produce thus a multilocular hydrocele. The natural cul-de-sac which exists between the epididymis and

Fig. 302.

the body of the testicle, on the outer side, is sometimes much distended, so as to form a pouch, which projects on the inner side of the gland. The morbid action in hydrocele is confined to the serous membrane; the testis either remains natural, or is somewhat flattened, and, in some cases, partially atrophied by the pressure of the fluid. When, however, the original seat of disease is in the gland itself, the serous covering is often secondarily involved, so that serous effusion in the sac very often is associated with chronic orchitis, or other diseases of the testicle. This combination is termed a hydro-sarcocele. There is contradictory evidence on the question, whether hydrocele is more common on the right, or on the left. Mr. Curling's observations show that the right side is most often affected.

In congenital hydrocele the dropsical tunica Drawing of large hydrocele, vaginalis retains its foetal communication with

the peritoneal cavity.

Encysted hydrocele, as it is called, proceeds from the development of new cysts beneath the serous membrane. These are exactly similar to the simple cysts we have described, p. 183, having a wall of thin fibrous tissue, and a lining of tessellated epithelium, with usually limpid, fluid contents. They may be situated: (1) "beneath the visceral portion of the tunica vaginalis, investing the epididymis; (2) between the testicular portion of the tunica vaginalis and the tunica albuginea, which are thus separated from each other; (3) between the layers of the loose or reflected portion of the tunica vaginalis." In the two last-mentioned situations they rarely occur. When formed on the epididymis, they sometimes carry the serous membrane outwards as they enlarge, so that they become pedunculated, just as the small serous cysts in the neighborhood of the ovary often do with the peritoneum. Mr. Curling states that these pedunculated cysts do not acquire a large size, seldom exceeding that

of a currant. Several cysts may coexist in the same gland, and, when opened, produce the appearance of a sacculated arrangement. The walls of the cysts are liable to inflammation, which causes their contents to be mingled with various exudations of serum, fibrin, or even blood. Spermatozoa are very frequently present in the fluid of encysted hydroceles, to which they impart a milky or opaline opacity. They subside to the bottom of the vessel, where the fluid is left at rest, leaving the upper portion more transparent, but containing some albumen, which is not found in the limpid contents of ordinary cysts of this kind. It is extremely probable that they make their way into the cysts in consequence of rupture of some seminal canal lying in contact with them, just as a biliary duct sometimes opens into the sac of an hydatid. This opinion is confirmed by the circumstance that patients generally

report the swelling to have commenced after some injury to the testicle. Spermatozoa are rarely, if ever, present in the fluid of common hydrocele. In one case, a few seemed to have escaped into the general cavity, from the rupture of a small cyst.

Diffused hydrocele of the spermatic cord is a rare affection. It consists in the enlargement of the cells of the areolar tissue, and their distension with a white or yellowish serous fluid. The inclosing fascial sheath is condensed and thickened, and at the lower part of the swelling, which is always the largest, separates it completely from the tunica vaginalis. The nature of the disease does not seem to be sufficiently ascertained. Mr. Curling classes it with simple oedema; we should be more inclined to regard it as a chronic inflammation.

Encysted hydrocele of the spermatic cord forms a tumor, of oval shape, and seldom attaining the size of a hen's egg. It is loosely attached to the vessels of the cord which pass behind it. Instead of there being only one cyst, there may be several, forming a series along the cord. This circumstance indicates their origin, from the partially obliterated process of peritoneum, which is carried down with the testicle in the formation of the tunica vaginalis. According to another view, they are simple cysts, of new production, analogous to those which constitute encysted hydrocele of the testis. It may be mentioned that simple hydrocele occurs not unfrequently together with some of the other varieties, and also with inguinal hernia.

Hæmatocele is the term applied to a tumor formed by an effusion of blood from the vessels of the testis, or of the spermatic cord. Its most

Hæmatocele: tunica vaginalis greatly thickened; testis pretty healthy.-From Mr. Curling's article.

common seat is in the tunica vaginalis, which may be so greatly distended as to exceed the size of the adult head. The blood undergoes various changes, coagula being formed, sometimes in separate masses, sometimes in firm layers, as in the walls of an aneurism. The fluid part, in old cases, is more or less thick and grumous, sometimes resembling coffee-grounds. The presence of the blood occasionally excites inflammation, leading to fibrinous and serous effusion, and, it may be, to suppuration. The effused blood sometimes putrefies, offensive gases are produced, and, unless free exit be given to the decomposed matter, fatal gangrene takes place. The tissues surrounding the tunica vaginalis are apt to become involved in the inflammation, though they are affected in a more chronic manner, and