Two cases of varicocele with undeveloped testicle : with remarks on the nature of varicocele ; and, A case of antiseptic osteotomy of the tibia in which rapidly fatal carbolic intoxication occurred / by A. Pearce Gould.

  • Gould, Sir Alfred Pearce, 1852-1922.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of varicocele with undeveloped testicle : with remarks on the nature of varicocele ; and, A case of antiseptic osteotomy of the tibia in which rapidly fatal carbolic intoxication occurred / by A. Pearce Gould. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    much a priori reason to lead us to expect such a result that it is easier to receive than to reject such evidence as we have. That a had varicocele may induce sterility, the cases carefully investigated by Curling and Gosselin surely prove. Cases are on record where the radical cure of the varicocele lias been followed by a growth of the so-called wasted testis,* (Curling, Barwell).f Thirteen months ago I operated on a man with varicocele, who was suffering from a good deal of pain in the part, with a sense of ‘ emptiness of the belly ’ after copulation, and the left testicle was slightly smaller than the right. He has lost all pain, is ‘ much stronger ’ sexually, and his left testicle is firm and plump, and if any- thing, larger than the right organ. J The much greater frequency of varicocele on the left than the right side has been variously attributed to the greater length of the left spermatic vein, to its passing beneath the sigmoid flexure, and to its mode of entrance into the renal vein. An examination of these explanations makes it appear probable that there is some other factor present. The difference in length of the two veins is slight, and does not exceed that between the two iliac veins, which has not led to a similar disproportion in the occurrence of varicosity in the veins of the lower extremities. The influence of a loaded sigmoid flexure has never been demonstrated. In only a small proportion of cases of varicocele can any history of chronic constipation he elicited, and the proportion is not greater than in men of the same age and class who are not suffering from varicocele; and on the other hand, I do not think that varicocele has ever been found to be a frequent concomitant of constipation. I recently operated on a gentleman who assured me that his varicocele always troubled him most when his bowels were confined. This is far from proving that the constipation caused the varicocele. The difference in the mode of ending of the two sper- matic veins is more generally held to account for the fact we are discussing. The left spermatic vein most frequently enters the renal vein at right angles, and in all the cases I have yet examined, where this has been the case, the open- ing has been guarded by a single or double valve, which I demonstrated to be capable of completely preventing the * Mr. Curling’s work on 1 Diseases of the Testis.’ t After the reading of this paper Mr. Bryant mentioned a very excellent example {vide Lancet, Dec. 1880). f This patient was shown at the Meeting.