Passage of the Testicle into the Perineum. Mr. Hunter first observed that the testicle in changing its situation does not always pre serve a proper course towards the scrotum, there being instances of its taking another direction and passing into the perineum. How this is brought about, he remarks, it is difficult to say : it may possibly be occasioned by something unusual in the construction of the scrotum, or more probably, by a peculiarity in that of the perineum itself. For it is not easy to imagine how the testicle could make its way to the parts about the perineum, if these were in a perfectly natural state. He met with two instances of this imperfection. Many years ago a little boy, one of whose testicles had thus deviated from its proper course was brought to the London Hospital. The gland was lodged in the perineum at the root of the scrotum. M. Ricord met with this singular anomaly in two instances. M. Vidal (de Cassis) observed it in two brothers : their father was exempt from it. The testicle abnormally placed was smaller than the other.t. The irregularity is exceedingly rare, and the above cases are all with which I am acquainted.
Passage of the Testicle through the Crural Ring.—M. Vidal relates the case of a man, one of whose testicles, instead of passing out of the abdomen at the inguinal canal, made its exit at the crural ring. The organ was mounted upon the abdomen like a crural hernia. A portion of intestine traversed the inguinal canal, forming a rupture on that side. § I know of only one other instance of this anomaly, which is reported by Eckardt. In this case, the testicle passed out at first through the inguinal canal, but having been returned by the patient into the abdomen, it subsequently escaped at the femoral ring.% Inversion of the Testicle.— It sometimes happens that the position of the testicle in the scrotum is reversed, so that the free sur face presents posteriorly, and the epididymis is attached to the anterior part of the gland, instead of to the posterior., The first case that I met with was that of a man who had a swelling of the right testicle, which puzzled his medical attendant. On examination 1 found this to be the epididymis thickened from chronic inflammation. I was able clearly to trace the vas deferens proceeding to it along the front of the scrotum. The body of the testicle was unaffected, and its posterior edge was quite smooth and regular. The disposition of the left testicle was normal. On visiting the Hopital de Midi in Paris, in April, 1849, M. Ricord showed me a case of epididymitis on the left side, in which the gland was thus inverted. He informed me that he had often met with this arrangement. I have since had two patients under my care, one of whose tes ticles was thus inverted. One was a lad in the London Hospital affected with epididymitis. The other was a gentleman who consulted me for chronic orchitis confined to the body of the testicle. The epididymis being unaffected, the inversion was less perceptible than in the three preceding cases. M. Maissonneuve, in a thesis published in Paris in 1835, I believe first called attention to this irregular disposition, which he states that he had met with many times upon the dead body, and upon the living, and he mentions what I remarked myself in the four cases just noticed, that the inversion was confined to one side. Surgeons should bear in mind the liability to:this dis position of the gland in making their diagnosis of the diseases affecting it.
Atrophy of the testicles, like other organs formed for the exercise of tem porary functions, do not arrive at a perfect state of development until a certain period of life, after which their activity ceases, and they become gradually and imperceptibly diminished. Thus we find that in early life they are small in proportion to the size of the body as compared with their condition at puberty, and that as old age advances and the generative functions cease to be called into action, they undergo a diminution in size, their vessels grow less, the seminiferous tubes become small and contracted, and partially ob literated. In the lower animals these changes are far more remarkable than in man, for as the functions of the testicle are exerted only at stated periods of the year, as the rutting or copulating season advances these organs rapidly increase in bulk, and in its decline undergo a proportionate degree of wasting.
i In man, it sometimes happens that the tes tides do not acquire their proper size at the usual period, their development being from some cause or other arrested ; and also, after the organs have arrived at their full and perfect growth, that occasionally one or both suffer a premature decay. Under the head then of Atrophy of the Testicle I shall consider : 1. Arrest of Development; and 2. Wasting.
Arrest of Development. — If the congenital lesions to which the testicle is liable had not been previously treated of, the cases of ab sence of the organ already described, might be correctly referred to the present head, as the deficiency in these cases was no doubt the result of an arrest in the early development of the organ. But the cases that I am now about to consider are those in which the sub sequent evolution which the testicles undergo at puberty is delayed beyond the usual period, or never takes place at all. Mr. Wilson relates a curious instance of his having been consulted by a gentleman, twenty-six years of age, on the propriety of entering the marriage state, whose penis and testicles very little ex ceeded in size those of a boy of eight years of age. He had never felt the desire for sexual intercourse until he became acquainted with his intended wife ; since that period he had experienced repeated erections, attended with nocturnal emissions. He married, be came the father of a family ; and these parts, which at six and twenty years of age were so much smaller than usual, at twenty-eight had increased nearly to the usual size of those of an adult man.* Mr. Wilson mentions this singular case, as it will admit of questions whether the parts alluded to became properly formed as to size, and possessed of the power of secretion, in consequence of being, although so late in life, influenced by the passions excited by attachment to a particular female ; or whether the enlargement and proper action of the parts beginning, occasioned such passion first to exist. He thinks the probability in favour of the former supposition, in which opinion I certainly concur. Lallemand men tions having seen a man about thirty years of age, extremely fat, and without a beard or hair on the pubes, whose penis and testicle ap peared to belong to a child of from seven to eight years : he had never experienced erec tions or venereal desires.t A young man died in the London Hospital of disease of the heart. He was seventeen years and nine months old : the body measured five feet five inches in height, and was plump and well formed. There was no appearance of beard, or whiskers, or of hair on the pubes. The penis and testicles were very small, not larger than they are usually found in boys of three or four years of age. The testicles were about equal in size, and one of them weighed only two scruples and one grain. Both organs were normal in structure, appearing like the glands in early life, when the tubular structure is very indistinctly developed. No sperma tozoa could be detected. These were clearly instances of arrest of development of the tes ticles. As these organs are chiefly excited to action by an operation of the mind, it is easy to understand that they may sometimes re main undeveloped owing to defective organi sation of the brain, an absence of sexual desires being invariably remarked in these cases. Cases of wasting of the testicles after injuries of the head, and the frequent absence of the venereal appetite in cretins and idiots, tend to strengthen this opinion. The follow ing are marked examples of defective develop ment of the sexual organs, accompanied with imperfection of the brain. An idiot, aged nineteen, subject to epileptic fits, died of typhus fever in the Hackney union. The youth was of short stature, and the form of the body was not indicative of either sex, but the contour was rounded as in the female. There was no appearance of hair about the face or pubes. The abdomen and other parts were covered with a thick layer of fat. The penis and scrotum were remarkably small, not larger than they are usually found in a child two or three years of age. Both testicles were in the scrotum, but they were of very diminutive size ; the right weighed less than a drachm, and the left not more than twenty three grains. The right gland had descended a very little way below the abdominal ring. The glandular structure and epididymis of both testicles were indistinct, and the visa deferentia also extremely small. Nothing re markable was observed in the structure of the brain. Mr. Hovel!, the surgeon of the union, also showed me another inmate of the same workhouse, a lad aged nineteen, and of weak mind, whose penis and testicles did not exceed in size those of a boy seven or eight years of age, and who had only a few scattered hairs on the pubes. In the museum at Fort Pitt, Chatham, are preserved two undeveloped testicles about the size of those of a child six months old, but healthy in structure, which were taken from a lunatic 58 years of age. His penis was small and he had never experienced any inclination for sexual inter course.