Encysted hamatocele of the spermatic cord results from the effusion of blood into the cyst of a hydrocele of this part. But it is an affection only known to me from preparations. In the Museum of St. Bartholomew's Hos pital there is a specimen of the kind. The cyst is empty : but it is described to have contained blood, and its walls are deeply stained with the colour of partially decom posed blood. Its lining membrane is wrinkled and coarsely granular, and the tissues around it are thickened, brawny, and adherent toge ther. In the Hunterian Museum there is a specimen (No. 2460.) of old encysted hmma tocele of the spermatic cord. A good-sized cyst, lined by a membrane, polished and a little wrinkled, is filled with a soft, tawny looking granular matter, resembling the altered coagulum of blood observed in ordinary hmmatocele after long maceration in spirit. The tissues around the cyst are thickened and indurated, just like those around an old hmmatocele of the testicle. There is a hernial sac immediately above it, and a hydrocele below, with the sac open for some distance up the cord as far as the cyst of the hmma tocele. The latter does not communicate either with the tunica vaginalis, or the hernial sac. In the Musee Dupuytren at Paris, I also saw a preparation of this affection, which occurred in the practice of the late M. Blan din.
Orchitis. — Inflammation of the testicle occurs in two forms, acute and chronic ; and it may commence either in the body or secre ting part of the organ, or in the epididymis. Inflammation beginning in the body of the testicle may be idiopathic, or may be excited by external violence : the disease is at first confined to the interior of the organ, the epididymis and tunica vaginalis being affected only secondarily, and sometimes entirely es caping. Orchitis is far more frequently a consecutive affection than a primary, the in flammation being transmitted from the urethra along the vas deferens. In this latter form of orchitis, which is familiarly known by the term hernia hunzoralis, the epididymis is first attacked, and the tunica vaginalis generally participates in the disease.
Acute Orchiti.r. — F ew pathologists have examined a testicle in a state of acute inflam mation, and I am unacquainted with any au thentic account of the alterations in structure from inflammation originating in the body of the gland. I have twice had the opportunity of examining a testicle affected with acute se condary orchitis ; and the following description of the pathological appearances is drawn up from these investigations, and from the ac count of the dissection of two testicles affected with gonorrhoeal inflammation recorded by M. Gaussail.# The tunica vaginalis is more or less distended with lymph or albuminous matter, infiltrated with reddish serum, which form loose adhesions between the opposed surfaces of the membrane ; these adhesions are so slight as easily to admit of being broken down with the finger. The membrane is in jected with a multitude of minute red vessels which ramify in various directions and form a compact network. At a later period red ves
vels may be traced proceeding from the free surface of the tunica vaginalis to the false membranes forming the adhesions. The vo lume of the testicle appears very little if at all increased, the great bulk of the tumour being occasioned by the swollen epididymis and effusion into the serous sac. When cut into, the gland appears somewhat darker than natural, from a congested state of its vessels. The epididymis, particularly the lower part, is enlarged to twice and sometimes thrice its natural size, and feels thick, firm, and in durated. This enlargement is produced by the effusion of a brownish deposit in the areolar tissue between the convolutions of the duct. The coats of the vas deferens are thickened, and the vessels ramifying near them injected, sometimes along the whole extent of the duct. Albuminous deposit is found in the areolar tissue around the tortuous part of the vas deferens and tail of the epididymis, which frequently forms the bulk of the swelling ob served in these cases. Owing to the epidi dymis being the part chiefly and most con stantly affected in consecutive orchitis, some of the modern French writers have denomin ated the disease epididymitis.
In treating of the acute inflammatory changes in the tunica vaginalis, I particularly remarked that the inflammatory action was very liable to extend to the substance of the epidi dymis, but not to the body of the testicle, and I noticed the pathological law enunciated by Gendrin, by which the circumstance was ac counted for. We find, too, that inflammation of the epididymis is much more readily pro pagated to the tunica vaginalis than inflam mation originating in the glandular structure of the testicle. When inflammation com mences in the body of the gland, the enlarge ment takes place slowly, and is seldom con siderable until the disease has existed for some length of time, which is easily explained by the unyielding texture of the tunica albu ginea, and the circumstance of the tunica vaginalis remaining unaffected. Suppuration occasionally takes place in this form of orchitis, whereas in consecutive inflammation the form ation of pus in the substance of the gland is of rather rare occurrence. I do not mean, however, to assert, that the glandular struc ture of the testicle never suffers in consecutive orchitis, for I believe that it does so in some instances ; but, according to my observations, and I have paid some attention to the sub ject, it very commonly escapes, the inflamma tion not extending further than to the epidi dymis. When inflammation terminates in suppuration, the matter is so slow in making its way externally, owing to the density, thick ness, and low organisation of the tunica al buginea, that it generally burrows in vari ous directions, producing numerous sinuses throughout the gland, and disorganising its delicate structure. The matter sometimes be comes encysted, forming a separate abscess.