The diseases of the male organs of generation / by W. H. A. Jacobson ... With eighty-eight illustrations.

  • W. H. A. Jacobson
Date:
1893
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Licence: Public Domain Mark

Credit: The diseases of the male organs of generation / by W. H. A. Jacobson ... With eighty-eight illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    test—i.e., during life by operation, e.g., tapping, or after death by dissection—its existence has been explained by some well-known pathological condition. Thus, it has been found to be an encysted hydrocele,* an omental hernia,t a fibrous tumour of the cord or tunica vaginalis.l In the verification of these conditions, the absence of testicular sensation,§ and the facts that no cord can be traced to them, and that they are not congenital, are the best guides. However closely a body in the scrotum may seem, in size, shape, and sensi- tiveness, to correspond to an additional testis, it must not be accepted as one unless operation or an autopsy allow an oppor- tunity of complete investigation,]| including the use of the micro- scope. In some a bifurcation of the vas deferens has been appa- rently made out.lF This is probably fallacious. It is noteworthy that Mr. Curling, in his examination of a patient supposed to have is made of the vasa deferentia, and we have, of course, no microscopical examina- tion. As is so frequent in the descriptions of these cases by the old writers, the subject of this abnormality is said to have been valde libidinosus. * This, from its rounded outline, and its close connection with the testis, may be mistaken for a small additional testis. Some years ago a man presented himself at my out-patients at Guy's Hospital as the man with three testicles. The third testicle was here an encysted hydrocele, and disappeared on tapping. ■f Even Morgagni was deceived by a piece of omentum which had descended into the scrotum wrapped up in its proper sacculus of peritonaeum, and had the candour to allow it. (Seats and Causes of Diseases, vol. ii., Dis. of the Belly, P- S45-) t In the Museum of St. Thomas's Hospital is a specimen showing that the body supposed during life to have been a third testicle is really a fibrous tumour attached to the tunica vaginalis. § Not even this is decisive. Thus, I have twice had patients with encysted hydroceles who, owing to the intimate connection of the hydrocele with the testis, spoke of testicular sensation being present in the swelling. II Thus, in the cases of supernumerary testicle recorded in the Lancet, 1865, vol. ii. pp. 448, 473, 501, there is no proof beyond that of external examination. So, too, with the three cases of polyorchismus recorded Lond. Med. Record, 1884, p. 170 and Oct. 1881. They appear to have been met with in Bulgarian and Russian soldiers. In the first, it was thought that two testes, one lying above the other, were present in the right half of the scrotum. In the second, two testes were made out in the left scrotum, each appearing to have an epididymis and cord. In the course of a gonorrhoea the patient had left epididymitis, which only attacked the lower of the two testes. The patient stated that the upper left testicle descended when he was eight. In the third case, four testes are said to have been present in a normally developed scrotum. ^ Thus, in a case of Dr. F. Hewett's, in which two testes were thought to be pre- sent on the left side, it is stated that the vessels, &c. of the two glands on the left side united to form a single spermatic cord above the smaller gland, in which, on manipulation with the fingers, two of its constituents, of firmer feel and structure than the rest, could be isolated, being most probably the deferent ducts of the glands.