Surgical diseases and injuries of the genito-urinary organs.

  • Thomson-Walker, John, Sir, 1871-1937.
Date:
[1914]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical diseases and injuries of the genito-urinary organs. 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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    size it separates the testicle and epididymis, and the vasa efierentia may be stretched over it. The wall consists of fibrous tissue lined with columnar or some- times flattened epithelium. The fluid is alkaline, opalescent, and milky, and when the glass containing it is swung round the cir- culating fluid gives a remarkable drift-cloud or shimmering appear- ance, similar to that seen in the urine in bacilluria. The milkiness is due to spermatozoa, which are actively motile under the micro- scope. The spermatozoa are present at each tapping. Rarely, the fluid is colourless and no spermatozoa are present. Pathology.—There are two views in regard to the pathology of these cysts : (1) Retention cyst.—Communication between the cyst and a seminal tubule has been proved by the injection of mercury into the vas deferens and the discovery of globules in the cyst. The opening into the duct will usually admit a fine bristle. According to some authorities, these cysts are due to rupture of one of the vasa efferentia. (2) The second view is that the cysts take origin in fcetal relics : {a) The organ of Giraldes (Wolffian body), so that they are analogous to the parovarian cysts in the female, (b) The hydatid of Morgagni; this is the remains of the duct of Miiller, and is the analogue of the Fallopian tube in the female : it normally forms a small pedun- culated cyst between the upper pole of the testis and the globus major, (c) The vas aberrans ; this has origin in the tubules of the Wolffian body, and forms a diverticulum of the commence- ment of the vas deferens. The position of this body is against the view that it gives origin to the cysts. Encysted hydrocele of the testis is very rare, and forms a single cyst situated beneath the tunica albuginea. Symptoms.—Small cysts are usually found accidentally as rounded, firm, elastic swellings of the globus major, or connected with the epididymis above and with the outer side of the testicle. In a patient who consulted me there was sudden moderately severe pain in the testicle, followed by the appearance of a small, tense, tender cyst of the globus major. Usually, however, small cysts give rise to no pain or inconvenience. Larger cysts approximate the testicle in size. There is an oval elastic swelling situated imme- diately above the testicle and inseparably connected with it, but marked ofi from it by a groove which can be seen on inspecting the scrotum. The upper pole may be larger than the lower, and the cyst resembles an inverted pear. The cyst grows slowly, and never reaches the size of a large vaginal hydrocele. It is usually unilateral, and on the right side, but may be bilateral. When a