Syphilitic orchitis is essentially of the same nature as the chronic orchitis just described. It commonly commences in the body of the gland and rarely terminates in suppur ation, or in the production of a hernial fungus. Sir A. Cooper states that in the majority of cases the disease attacks both testicles. The eight examples recorded in his work do not, however, bear out this remark; for in only two of them does it appear that both organs were attacked. According to my observation, the disease is more commonly confined to a single gland, though it occasion ally affects both : this appears to he the opinion also of Ricord.* The appearances on dissection correspond with those observed in chronic inflammation.
Tubercular Disease.— In the deposit is met with in the crude state, form ing a yellow caseous substance similar to the tubercular matter occurring in the lymphatic glands. It is sometimes developed in a single mass ; at other times several distinct deposi tions are formed in different parts of the organ : in both cases at the expense of its glandular structure, which becomes atrophied as the disease advances. The epididymis is more frequently affected than the body of the gland. In a specimen taken from a man who died of phthisis, I found the whole of the epididymis occupied by tubercular matter, with scarcely any trace of tubuli; whilst the body of the gland, though small, was perfectly sound and unaffected. (fig. 652.) In some cases I have seen two, three, or more distinct tubercular deposits, separated by portions of healthy gland. This was the case in both testicles removed from a middle-aged man who died of phthisis. In some instances these isolated masses appeared to be con tained in cysts formed by the processes from the tunica albuginea which separate and sup port the lobules. Sometimes the separate deposits seemed to be coalescing and joining together, so as to form one continuous mass ; and I have found a single mass of tubercular matter surrounded by glandular structure ex panded into a thin layer. In other specimens the whole testicle was occupied by a homo geneous cheesy mass, without any trace re maining of the original structure of the gland. In some instances in which the disease was thus advanced, there was very little increase in the size of the testicle; it only felt heavier and harder than in the natural state. In
others, again, there was either a general uni form enlargement, or an irregular swelling at some part, commonly at the head of the epi didymis. Some of these testicles, in which the disease was not much advanced, when injected made beautiful preparations, the yellow inorganic tubercular matter contrasting in a marked degree with the vermilion hue of the intervening sound portions of the organ. On several occasions I found a small quantity of serum in the tunica vaginalis, with partial adhesions and depositions of lymph. In a further stage of the disease, the characteristic deposit becomes softened down, and converted into a yellow pultaceous substance, evidently tubercular matter mixed with pus. The ab scess extends to the scrotum ; and after it has burst and the matter has escaped externally, cavities and sinuses are left which may be said to resemble the tubercular cavities in the lungs. The course of the disease, however, in the testicle, more nearly resembles the changes which ensue in tubercle of the ab sorbent glands.
It has been a question whether the tuber cular matter is originally formed in the areolar tissue connecting the tubuli, or in the tubuli themselves. I have certainly seen this de posit in the vas deferens near the testicle, and within the ducts of the epididymis. Dr. Carswell has given a representation of a tes ticle contdining a multitude of pale yellow coloured granular bodies of various sizes, which, he says, were obviously formed by the accumulation of tuberculous matter in the tubilli seminiferi. The epididymis was as thick as the little finger, and its convoluted ducts were obviously filled with a similar deposit. I believe that tubercle may be de posited in both situations, within as well as between the tubuli. Earthy matter is some times found in the testicle, generally in the epididymis, the part most frequently the seat of tubercle. This substance is exactly si milar to the putty-looking chalky matter often observed in the lungs and bronchial glands. It is highly probable that, in these cases, the gland had at some former period been the seat of tubercular deposit, but I have not yet been ab:e to establish this point satisfactorily.
Carcinoma.— This disease occurs in the testicle under the four forms of Scirrhus, En cephaloid, Colloid, and Melanosis.