ABNORMAL ANATOMY OF THE TESTICLE. Congenital imperfections and malformations.— Numerical excesses and defects.— Cases of su pernumerary testicles are mentioned in the writings of the old authors, and persons have been described with four or five of them, ac companied with a proportionate increase in the venereal appetite. Nearly all these cases are of a fabulous character. Such must be remarked of the case of 7revT6pxos, or man with five tes ticles, mentioned by Schaarf#, and with that of a man with four testicles alluded to by Blegny.t Blasius, an old writer not un worthy of credit, has, however, given an account of the examination of a man, thirty years of age, and otherwise well formed, who had two testicles on the right side, of the same size and shape as that on the left, which is illustrated by a small engraved figure re presenting a distinct artery from the aorta, and vein from the vena cava proceeding to each of the two testicles on the right side.$ This is the only case of supernumerary testicle recorded by the old authors, which has any semblance of authenticity. Neither Morgagni, Haller, nor Meckel met with a single exam ple, and they questioned the existence of such a condition. Two cases have recently been recorded as examples of triple testicle, but they were not verified by examination after death. One is related by Bliimener, an army surgeon, in Rust's Magazin fiir die Gesammte Heilkunde for 182I: the other by Dr. Macann, a British surgeon.§ An epi plocele, a fatty or fibrous tumour in the scrotum, or an encysted hydrocele of the cord, might readily be mistaken for an additional testicle. Morgagni mentions that he was once deceived by a portion of omentum. In the pathological collection at St. Thomas's Hos pital is preserved the testicle of the eccentric Dr. Monsey, who appeared during life to be supplied with three of these glands. The sup posed additional testicle consists of an in durated fibrous tumour attached apparently to the tunica vaginalis. • Many instances of nzonorchides, or persons having only a single testicle are also mentioned by the old authors ; but as the data are very imperfect, and as little was known respecting the transition of the testicle at the time these cases were recorded, they must be viewed with great suspicion. They were most pro bably cases in which one of the glands was either retained within the abdomen, or, from some cause had been completely atrophied. I know no satisfactory reason why a defici ency of one or both testicles should not occasionally occur without any other mal formation ; but they are anomalies of which there are few authentic examples in the annals of medical science. Mr. Paget has published the particulars of a case in which he believes one testicle was deficient at birth.* No account of the man is attached to the particulars of the dissection, and it is open to question whether the deficiency of the gland was not the result of atrophy. Dr. Fisher, of Boston t, has recorded a more satisfactory example of absence of both testicles. The de: ficiency was remarked from birth, and the sub ject of the malformation was regarded as a na tural eunuch, and died at the age of forty-five.
Mr. Thurnham has published an account of the dissection of an infant who died at the age of four months. In addition to an atrophied condition of the right kidney, and a remark able malformation of the ureters, it was found that neither of the testicles had descended. The right lay in the abdominal cavity, just above the inguinal canal. On the left side no testicle would appear to have been formed ; the spermatic vessels on this side terminated in a little mass of fat ; the vas deferens, how ever, was present, and was apparently as well developed as that of the perfect testicle.$ A case of monstrosity is related by Dr. Friese in Casper's Wochenschrift.§ The child lived only half an hour : in addition to the absence of the external genital organs, there were neither testes, vasa deferentia, nor vesiculm seminales. Cases, however, in which the whole of the genital apparatus is deficient or irregularly formed, do not come within the scope of this article. Geof•oy St. Hilaire has recorded a remarkable, and so far as I know, unique case of union of the testicles in the abdomen. II Deficiencies and imperfections of the yes deferens. — In Mr. Paget's case of supposed absence of the testicle it is stated, that the vas deferens terminated nearly opposite the external ring in a rounded cul-de-sac; and in Dr. Fisher's case of deficiency of both testicles, that the vasa deferentia, though properly formed and nearly of natural size, terminated in cul-de-sacs at the end of the cord. In the
museum of St. Bartholomew's Hospital, there is a preparation taken from a man fifty years of age, who died of strangulated hernia. A piece of intestine was strictured by a band of adhesion connected with the mesentery, and the testicle was detained in the upper open ing of the ring. On dissection of the parts, the vas deferens was found to terminate near the testicle in a cul-de-sac. The gland was very small, and its structure appeared granular like the undeveloped testicle of a youth. There was no trace of the epididymis. Mr. Hunter in dissecting a male subject found the vasa deferentia not only deficient near the testicles, but terminating below in a single irregularly formed vesicula seminalis, and having no com munication with the urethra.* There are a few other cases on record, in which the vas deferens has been defective at the extremity which joins the ejaculatory canal. Thus, Tenon, in the dissection of an infant affected with extraversion of the bladder, found that the vasa deferentia terminated separately at the bottom of the pelvis, in two white tuber cles: the scrotum, testes, and vesicuim semi nales were in a natural state. t But besides these imperfections at its two extremities, this duct has been found wanting throughout nearly its whole extent. Brugnoni mentions, that in dissecting the parts of generation in a robust man, from twenty-six to twenty-seven years of age, he found the right epididymis almost entirely absent, the only part remaining being the head, which formed nodules filled with semen. The rest of the epididymis and the vas deferens were wanting, without any mark of disease. The testicle was perfectly sound, and nearly of the same size as the left one. On examining the corresponding vesicula seminalis he found at its anterior extremity a portion of the canal of the vas deferens about an inch in length, and properly formed. The vesicula seminalis itself was flaccid and quite empty ; whilst the left was full of semen. He remarks, that although this vicious conforma tion was according to all appearances con genital, nevertheless the vesicula seminalis and ejaculatory canal had preserved their natural cavities.$ In a case related by Bosscha, the left vas deferens of a robust man terminated in a blind extremity near the testicle, the rest of the canal being wanting. There was the rudiment of a left vesicula seminalis in the form of a blindly-ending canal running tor tuously in the shape of the letter S. The left testicle was sound.* Mr. Paget has happily explained the origin of these several defects in the vas deferens, by reference to the mode of development of the special organs of generation. He observes after Miiller and Valentin, that, in the normal course of human development the proper ge nital organs are in either sex developed in two distinct pieces : namely, the part for the for mation of the generative substance, the testicle or ovary, and the part for the conveyance of that substance out of the body, the seminal duct or ovi-duct. The testicle or ovary as the case may be, (and in their earliest periods they cannot be distinguished), is formed on the inner concave side of the corpus Wolffianum, and the seminal or ovi-duct, which is originally an isolated tube closed at both extremities, passes along the outer border of that body from the level of the formative organ above to the cloaca or common sinus of the urinary, genital, and digestive systems below. The perfection of development is attained only by the conducting tube acquiring its just connec tions at once with the formative organ, and„ through the medium of the cloaca, with the exterior of the body. The sexual character is first established, when, in the male, the for mative and conducting organs become con nected by the development of intermediate tubes which constitute the epididymis ; or when in the female, a simple aperture is formed at the upper extremity of the conducting tube, and is placed closely adjacent to the formative organ. In both sexes alike, the lower ex tremities of the conducting tubes first open into the common cloaca, and subsequently, when that cavity is partitioned into bladder and rec tum, or bladder, vagina, and rectum, they ac quire in each their just connections, and become in the male the perfect vasa deferentia, and in the female the Fallopian tubes and uterus.