In the slight degree and chronic state in which we most frequently meet with this affection, no injurious effect is produced on the testicle ; but when highly or rapidly de veloped, the dilatation of the veins interferes so much with the nutrition of the gland as to occasion wasting. A partial atrophy of the gland, coexisting with varicocele has come under my notice in more than twenty instances ; indeed, in nearly all cases in which there was a decided dilatation of the spermatic veins on one side only, the testicle of that side was the smaller of the two. In a man, aged fifty-six, with a varicocele on the left side, the testicle was so reduced that it scarcely exceeded the usual size of the organ in an infant. Some years ago, a tall sailor was under my care on account of a varicose ulcer on the left leg, who had a large varicocele on the left side, and a testicle so wasted, that it could scarcely be felt through the tunica vaginalis, which was loosely distended with fluid. The period of puberty is the time at which varicocele most cemmonly occurs. I have met with very few cases before that age.
Adipose tumours. — The spermatic cord may be the seat of abnormal depositions of fat. They occur at different parts, as high up as the inguinal canal, and as low down as the epididymis. In examining the testicles of a young man who died of pleurisy, I found a quantity of fat along the cord, and around the epididymis, and some also beneath the tunics vaginalis covering the posterior part of the testicle. In another case I met with small isolated masses of fat, coupled with a small encysted hydrocele of the cord. When de
veloped in considerable abundance this de posit sometimes forms a tumour either in the groin or in the scrotum. A tumour of this kind in the scrotum has been mistaken for ()mental hernia. I once dissected a lobulated fatty tumour, surrounded by the thickened sheath of the spermatic cord, on the body of a man upwards of eighty yetis of age, which was very similar in appearance to a portion of omentum contained in a hernial sac. A mass of fat, however, in the cord may form a more defined and distinct swelling. Such a tumour is preserved in the Museum of the College of Surgeons. (No. 2461.) It is em bedded about an inch above the testicle, in the tissues of the spermatic cord and loosely connected with them. Its shape is oval ; it measures four inches in length, and consists of numerous lobes of soft fat, closely held together by their thin fibro-cellular par titions. An interesting case of large fatty tumour in the scrotum, originating in the spermatic cord, was seen by several surgeons, in 1844, much difficulty having been ex perienced in making out the nature of the swelling. The tumour, together with the testicle, was excised by Mr. Lawrence.* Another of the same character, but of smaller size, subsequently formed in the remains of the cord in the groin, and was excised by me in May, 1.849. Collections of fat in the scrotum have been known from the time of Galen by the term steatocele. I suspect that they all originated from the spermatic cord.