In these cases, when the matter effused is small in quantity, after all inflammation has subsided, the more fluid particles are absorbed, and the pus remains for a considerable time in the form of an indolent concrete mass, which has been mistaken, after death, for tu bercular deposit. The pus when found in this concrete state appears at first sight very like crude tubercular deposit ; but on further examination it will be found to be contained in a distinct cyst, from which it may easily be separated, and the structure of the testicle will be perceived to be more or less altered from its healthy state; whereas in tubercular disease, the morbid deposit is in immediate contact with the tubular structure, which, though atrophied by pressure, is usually in other respects sound. Concrete pus may likewise be mistaken for the firm yellow mat ter effused in chronic inflammation. It differs from it, however, in being friable and easily broken up, and also in being enclosed in a cyst, whereas the yellow fibrinous substance is homogeneous and consistent, and almost inseparably diffused amongst and connected with the convoluted tubuli around it. The distinctive characters just described will be easily recognised on comparing the accom panying representation of concrete pus en cysted in the testicle with fig. 651.
I examined two enlarged testicles taken from a man who died suddenly. Both glands had formerly been attacked with acute inflammation, and for some months before death they had been the seat of chronic pain. In the left testicle, which was the larger of the two, from two to three drachms of thick yellow inspissated pus were contained in a distinct cyst, which occupied the centre of the gland. There was no trace of tubuli, but the remainder of the organ was composed of a fibrous tissue : the sac of the tunica vaginalis was obliterated by close ad hesions. The tunica vaginalis of the right testicle contained about half an ounce of yellowish serum and in the centre of the gland there was a small concrete abscess, but the tubular structure was apparent and very little diseased. Pus existing in this concrete or in spissated state often keeps up pain and irrita tion for a long period, and renders the testicle liable to repeated relapses of inflammation.
Suppuration occasionally takes place in the epididymis. In several cases of consecutive orchitis which have come under my care, at a late period of the disease an abscess formed in the areolar tissue around the termination of the epididymis and inflected portion of the vas deferens, and burst at the most depending part of the scrotum. In many instances, after acute orchitis has subsided, the testicle is restored to its natural condition ; in other cases, permanent changes of a serious nature are the consequence. I have observed in testicles that have been affected with inflam mation some time before, that the septa ap pear to be more distinct, and to enter more largely into the composition of the gland than is natural; that the small seminal tubes are less numerous and apparent ; and that a great part of the organ is converted into a dense white fibrous tissue, without the presence of tubuli. In these cases the fibrinous matter
effused in the areolar tissue connecting the tubuli, not having been absorbed after the cessation of inflammatory action, had occa sioned partial atrophy of the proper structure of the organ, and been converted into the dense tissue just described. Complete atrophy is one of the most serious results of acute inflammation of the testicle. I have already remarked that the disturbance in the organisa tion of the testicle consequent upon inflam mation is the most common cause of wasting. Consecutive orchitis, if not checked in the early stage, seldom subsides without leaving behind distinct traces of its existence, which never disappear entirely during the remainder of the patient's life. The epididymis fre quently remains enlarged, presenting an in durated irregular knotty swelling, seated usually at its lower part, which is occasioned by the presence of a dense hard deposit be tween the convolutions of the duct and around the inflected portion of the vas de ferens. On making a section of the epidi dymis in this state, I have often observed not only a highly thickened condition of its duct, but also, in some instances, very considerable dilatation ; so that the point of a fine probe might be introduced into the canal without difficulty, its area being increased four or five times. These effusions about the duct rarely if ever produce its obliteration, the yielding nature of the tissues preventing this injurious result. In old cases the epididymis acquires the density and consistence of cartilage, and sometimes even of bone. These changes are rarely' found without the presence of old ad hesions, obliterating partially or completely the sac of the tunica vaginalis. The coats of the vas deferens are also found for some ex tent thickened and indurated. The alterations noticed in the body of the testicle have been observed, in some instances, coexisting with those in the epididymis ; but in by far the majority of cases, the glandular structure is unimpaired. In only two cases in which the epididymis was thus diseased, have I remarked a decidedly atrophied condition of the organ. The absence of pressure, owing to the unre sisting nature of the membrane investing the epididymis, appears to prevent the oblitera tion of the duct of which it is composed, and thus accounts for atrophy occurring much more rarely after consecutive orchitis than after inflammation originating in the body of the gland, where the delicate seminal tubes are enclosed in the firm unyielding tunica albugin ea.