Wasting. — In investigating the alterations in the nutritive condition of the testicle, it is very desirable to fix, if possible, some standard by which they may be estimated. The size of the gland is neither uniform nor conveniently appreciated. Its weight, likewise, varies so much in different persons and in the same in dividual at different periods, according as it has lately exercised its functions or remained inactive, and as it is full of semen or empty, that it is scarcely possible to determine on any accurate standard of this kind. (See p. 976.) I should consider the testicle of an adult weighing less than three drachms as in a state of atrophy. A testicle in an advaced state of wasting, not arising from disease of the gland, usually preserves its shape, but feels soft, having lost its elasticity and firm ness. Its texture is pale and exhibits few blood-vessels, the tubuli and septa dividing the lobes are indistinct, and the former cannot be so readily drawn out into shreds as before. The epididymis does not usually waste so soon nor in the same degree as the body of the testicle. It sometimes however, loses its characteristic appearance, and I have even found it reduced to a few fibrous threads. The fluid pressed out of the wasted testicle and epididymis is entirely destitute of sper matic granules and spermatozoa. In many instances adipose tissue is deposited behind the tunica vaginalis, and encroaches on the epididymis and posterior part of the testicle. Fatty matter is also found in the glandular sub stance of atrophied testicles, as in one taken from a man aged forty-six, who died of dropy consequent on disease of the kidneys, which was wasted to one fifth its natural size. In ad dition to the presence of adipose tissue be neath the visceral portion of the tunica vagin alis, I recognised a quantity of yellow matter irregularly disposed amongst the wasted tu buli. This matter on examination in the mi croscope, proved to be oil globules, and readily dissolved on the application of ether. The structures composing the spermatic cord un dergo a corresponding diminution ; the cre master muscle disappears, the nerves shrink, and the vessels are reduced in size and num ber. The vas deferens, though small, can ge nerally be injected with mercury as far as the commencement of the epididymis. A testicle, atrophied from disease, is not only of dimin ished size and weight, but is altered in shape, being uneven and irregular, and sometimes of an elongated form. The surfaces of the tunica vaginalis are adherent and its cavity is partly or entirely obliterated. There is no, or very little, trace of the proper glandular structure, the organ being converted into fibrous tissue of a firm texture. It loses its peculiar sensi bility to pressure, but is sometimes the seat of morbid sensibility.
All those causes which produce decay in other parts likewise occasion wasting of the testicle. Thus an impeded circulation, pressure, want of exercise, and loss of nervous influence, have been noticed as causes of atrophy of this gland. To these must be added certain causes which specially affect the testicle. The following case, related by Mr. Wardrop, is a good example of atrophy from defective nutrition. A person, both of whose testicles were completely absorbed, nothing being felt in the scrotum but a loose vaginal coat, died of an aneurism of the aorta, formed at the origin of the spermatic arteries, both of which were obliterated.* A ligature on the spermatic artery is sufficient to cause a total decay of the testicle, which induced the celebrated Harvey- to propose its ap plication for the removal of a certain form of sarcocele ; a suggestion, the credit of which has been improperly assumed in recent years by C. J. Maunoir, of Geneva. The influ ence of pressure in causing partial atrophy of the testicle, is somtimes remarked in old cases of hydrocele and hcematocele, in which the gland has been long subjected to com pression from the retained fluid.
It has been said that the testicles waste in those persons who strictly adhere to their monastic vows, but I am not aware that there is sufficient authority for this remark. In persons who marry, after many years of ab• stinence from sexual intercourse, the testicles undergo a certain degree of enlargement. It is a great error to suppose that sexual connec tion in earlylife is essential for the preservation of these organs. In cases of enlargement of the prostate the ejaculatory canals sometimes become completely obstructed. Under these circumstances, the semen secreted under ex citement having no means of escape, encum bers the testicles for a time, but afterwards becomes absorbed, and it is said that atrophy of' these glands sometimes follows ; but I have never observed any instance of wasting of the organs from this cause. As examples of atrophy of the testicles from loss of nervous in fluence, may be adduced cases of paraplegia, in which these organs have been known to waste. Portal mentions the case of a robust man, aged thirty-five, who was attacked with painter's colic, attended with great debility of the lower extremities. The testicles dimin ished considerably ; and although he after wards recovered from the paralysis of his limbs, these glands always remained wasted ; and the man was incapable of the act of gene ration.* In the xxth volume of the "Medical and Physical Journal," there is an account of a case of recovery after fracture, with partial dislocation of the first and second lumbar vertebrm, followed by paraplegia, in which, three years afterwards, the testicles were found entirely obliterated. It has been stated that the testicles sometimes waste from in juries, or from compression of the spine at the origin of the spermatic nerves. In a man who had received a blow on the lum bar region, the testicles gradually wasted asvay.1 The most common cause of atrophy of the the testicle is the disturbance in its organisa tion consequent upon inflammation. As the inflammatory process ceases, the enlarged gland not only becomes reduced to its original size, but it sometimes slowly but steadily diminishes, till at length very little vestige of it remains Mr. Hunter has related three cases in which the testicle decayed in this way. I have met with several instances of atrophy arising from this cause, and there are few surgeons of experience who have not witnessed cases of the kind. Wasting of the testicle has been observed to occur after an attack of orchitis in mumps, arising as it is supposed from the translation of inflamma tion from the parotid to the testicle. Two cases of cynanche parotidea in the adult, in which atrophy took place in the gland chiefly affected, are related by Dr. R. Hamilton.* I have witnessed one case, in which the patient attributed the loss of the gland to an attack of mumps in his infancy. Wasting is more liable to occur after inflammation of the body of the gland than after consecutive inflamma tion in which the epididymis is the part chiefly affected. One or both testicles have been found to waste in persons who have indulged too much in sexual intercourse or been addicted to onanism. Baron Larrey met with several cases of atrophy from excessive venery and abuse of strong drinks amongst the soldiers of the Imperial Guard.-1- Sir B. Brodie has recorded two cases in which wasting was occasioned by over-excitement ; in one from onanism, in the other from sexual intercourse4 I have also witnessed an instance of total atrophy of the left testicle in a person addicted to excessive masturbation. In this case, and probably in the others just quoted, the wasting was preceded by an attack of inflammation induced by inordinate excitement.