It is a common belief that wasting of the testicle is liable to be induced by the long continued use of iodine. I have not met with any instance of it, and there are few cases in which the evidence is such as to render it at all clear that the decay of the gland was really occasioned by the remedy. M. Cullerier has published the case of a young man who took from twenty-five to thirty drops of the tinc ture of iodine for a period of three months for the cure of an obstinate gonorrhma. This was followed by a state of impotency and partial wasting of the testicles, which lasted a twelvemonth, and the organs never regained their former size and vigour. M. Cullerier mentions another case of temporary loss of virile power occurring from the use of the iodine of iron.§ I feel convinced, however, that if iodine produces wasting of the testicle at all, it does so so rarely, that the liability cannot be regarded as any objection to the free and long-continued use of this valuable remedy. Atrophy of the testicle has been remarked in elephantiasis of the Greeks, a disease in which tubercles are developed in various parts of the skin. Dr. Adams, in an account of the cases of that disease observed in Maderia, states that all those who were attacked with it before the age of puberty never acquired the distinguishing marks of that change in the constitution, and their testicles diminished in size, and that in those affected later in life the testicles became atrophied, and they lost the power of pro creation.* Mr. Peacock also noticed a wasting of the testicles in several cases of elephan tiasis in the Leper Hospital of Colombo, in Ceylon.± A similar condition of these glands was remarked in a case of this disease, so rare in this country, narrated by Mr. Law rence t, and also in another case at the London Hospital, which I recorded many years ago.§ In a confirmed case however of this disease, in a boy aged thirteen, who was under my care in the year 1849, there was no diminution in the size of these glands. Wasting of the testicles is liable to occur after injuries of the head.
Some years ago I saw a man who had met with an injury of this description, which had been followed by wasting of the testicles, and the development of tumours on each side of the chest, resembling mammm. He was about fifty-nine years of age, a married man, and the father of several children. He had belonged to the legion in the Queen of Spain's service. About two years and a half previously, in an at tempt to jump over a trench, be fell backwards and injured the posterior part of his head. Whilst on the ground he received a bayonet wound on the side, and a sabre cut on the fore head. He recovered from these injuries and returned to England. Since the accident he had completely lost his virility. He had no desire for sexual connection ; his penis had dwindled in size ; his right testicle had gradu ally wasted, and was no larger than a horse bean, and the left gland was also a good deal diminished in bulk. The skull at the occiput seemed somewhat flattened. Baron Larrey records the case of a man who was wounded in the back of the neck by a musket ball which grazed the inferior occipital protuber ance. He recovered from the injury, but the testicles were reduced to a state of atrophy, and the penis shrunk and remained inactive. He also relates the case of a man of strong constitution and vigorous passions who re ceived a sabre wound which cut off all the convex projecting part of the occipital bone, and exposed the Jura mater. The patient lost the senses of sight and hearing on the right side, and his testicles sensibly diminished, and in fifteen days were reduced, especially the left, to the size of a beam!' Lallemand had under his care a man thirty years of age, who, in the expedition to Algiers had received a sabre wound at the nape of the neck. His
testicles were wasted, and venereal desire as well as erections had entirely ceased.lf We cannot doubt that in these cases the loss of sexual desire, and the wasting of the testicles were the direct results of the injury to the brain, and they go far to prove the essential dependence of the functions of these glands upon the cerebral organ. The physiologist cannot fail to notice the rapidity with which the atrophy is stated in some of the cases to have succeeded the injury and the extent to which it proceeded. The withering of the testicles, was, indeed, so remarkable, that it can only be attributed to the sudden and complete extinction of the sexual instinct resident in the brain, and (if I may so express myself) to the immediate impression on the system of the future uselessness of these organs. In old age and in lingering diseases the decay of the testicles is extremely slow and gradual, and is never carried to the extent observed in cases of injury to the brain. In fact, men have survived the power or desire of performing the sexual act many years without the testicles being materially reduced in size. We have seen, too, that in the lower animals the testicles have been rendered use less by interrupting the vasa deferentia, with out any such striking effect being produced on the glands as occurred in these cases of cerebral injury.
Inflammation of the tunica vaginalis, or acute hydrocele. — The inflammatory changes of the tunica vaginalis resemble those of the other serous membranes. M. Roux injected a hydrocele in a middle-aged man : inflamma tion was developed, but on the fourth day, gangrenous erysipelas attacked the scrotum, and caused the patient's death on the tenth day after the operation. On examining the tunica vaginalis, he found that it contained a large quantity of whitish serum, in the midst of which floated flakes of albumen ; other flakes of the same kind formed a thick coating over the testicle and internal surface of the membranous pouch. The serous membrane beneath appeared slightly thickened, and of a deep red colour. The epididymis and the lower part of the cord were swollen, and con stituted the more solid part of the tumour produced by the inflammation. The body of the testicle was not increased in bulk, and it retained its natural consistence.* In the mu seum of the College of Surgeons, there is a beautifully injected preparation of hydrocele, showing the effects of inflammation after the application of the caustic. It is represented in the annexed wood-cut, which exhibits the sac with part of it cut away to show the swollen state of the epididymis, and the aperture made by the caustic (1) ; the tunica vaginalis is coated with flocculi of lymph. The sac of an inguinal hernia is seen above the hydrocele. The sound state of the body of the testicle, though surrounded by an in flamed serous tunic, whilst the epididymis partakes in the disease, has been accounted for by Gendrin. He says, when the sub serous cellular tissue, which always partici pates in the inflammation of a serous mem brane penetrates into the interior of an organ, it becomes a ready means of communicating the inflammatory action ; but when the tiguous organ or subjacent part is of a dif In the different disorders of the gland this membrane usually becomes inflamed at some period or other, and adhesions between its opposed surfaces are scarcely less common than those of the pleura. In examining the testicles of twenty-four adults, I found ad hesions of greater or less extent in one or both glands in as many as nine instances.