File:The cyclopædia of anatomy and physiology (1849) (20200024874).jpg

Title: The cyclopædia of anatomy and physiology
Identifier: cyclopdiaofana0402todd (find matches)
Year: 1849 (1840s)
Authors: Todd, Robert Bentley, 1809-1860
Subjects: Anatomy; Physiology; Zoology
Publisher: London, Sherwood, Gilbert, and Piper
Contributing Library: MBLWHOI Library
Digitizing Sponsor: MBLWHOI Library

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1000 TESTICLE (ABNORMAL ANATOMY). Scarpa.* The disease is of the nature of simple oedema, a watery fluid being diffused throughout the areolar tissue connecting the vessels of the spermatic cord, and enclosed in a sheath, which is invested by the musculo- aponeurotic structure of the cremaster muscle. When the complaint has lasted some time, the sheath is found more or less thickened. The areolar tissue within is infiltrated with a limpid albuminous serum of a white or yel- lowish colour, which flows out in the course of the dissection. The cells infiltrated with serum are converted into large vesicles, some of which are big enough to admit the tip of the finger. These cells are larger and more delicate towards the base of the swelling, where they sometimes disappear altogether ; so that there is only one considerable cavity at the lowest and more depending part. The base of the swelling corresponds to the point at which the spermatic vessels join the testicle, and at this part a dense septum cuts off all communication with the tunica vaginalis. Jn some instances the effusion extends along the cord into the abdomen, as in a remarkable case related by Mr. Pott. In the annexed figure of this affection, (Jig. 043.), taken from Scarpa, Fig. 643.
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the envelope of the cremaster is laid open, ex- posing the pyramidal swelling enclosed in its sheath of condensed areolar tissue. The tes- * Memoria sull' Idrocele de Cordone Spermatico. Bertrandi, an Italian surgeon, in a memoir pub- lished by the French Academy of Surgery, in 1778, has given an accurate description of this affection, which, however, he did not sufficiently distinguish from the encysted hydrocele of the cord. He dis- sected on the dead body a diffused hydrocele, which contained twenty ounces of fluid. tide and tunica vaginalis are seen below it. In general anasarca the areolar tissue of the spermatic cord, as well as of the scrotum, is frequently distended with serum; but osdema of the cord alone is a very rare affection. Sir A. Cooper makes no allusion to it, and Mr. Pott, to whom we are indebted for so good and accurate a description of this species of hydrocele, probably met with a greater num- ber of cases of it than have occurred in the practice of any surgeon since his day. Encysted Hydrocele of the Spermatic Cord.— A cyst containing fluid may be developed in the loose areolar tissue of the spermatic cord. The cyst is formed of a thin transparent membrane, possessing the ordinary characters of a serous membrane, and contains generally a limpid aqueous liquid, having little or no albumen, but sometimes a straw-coloured serum similar to the fluid of simple hydrocele. It is of an oval form, and its size, though variable, seldom exceeds that of a hen's egg, and is usually smaller. It is loosely attached by areolar tissue to the vessels of the cord which are situated at its back part, but be- come separated and displaced by it. The cyst is invested by the common integuments, super- ficial fascia, musculo-aponeurotic sheath of the cremaster muscle, and fascia transversalis. It may occur either immediately above the tes- ticle, in the middle of the cord, or just below the abdominal ring, and even within the in- guinal canal. Usually there is a single cyst, but occasionally several are developed, and a chain of them has been formed along the cord. The cyst and its contents are liable to changes consequent upon inflammation. Encysted hydrocele of the cord appears to originate, in general, in a partial or imperfect oblitera- tion of the prolongation of peritoneum drawn down at the period of the transition of the testicle. I have already described the different appearances presented by the remains of this prolongation, which, it has been remarked, sometimes consists of a single cyst, or of two or more sacculi, moistened by a serous fluid. When this fluid accumulates in any quantity, an encysted hydrocele is the result. Such is obviously the mode of origin of this affection when occurring in infants, and no doubt in adults it generally originates in the same way. M. J. Cloquet has remarked that the remains of the peritoneal process accompanying the testicles in their descent were met with in male subjects of all ages, and he mentions as a singular circumstance, that they were nearly as frequently found in the old as in the young subjects.* My own dissections agree with the observations of this accurate anatomist. In the museum at the London Hospital there is a preparation showing the tunica vaginalis continued for about two inches up the cord, and, immediately above it, an encysted hydro- cele, which was taken from an adult subject. In dissecting the body of a man, aged eighteen, I found an encysted hydrocele of the cord * Description of the parts concerned in Inguinal and Femoral Hernia, tr. by McWhinnie, p. 25.

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