Lining the inside of each compartment of the scrotum is a thin serous membrane, the tunica vaginalis, which also forms an investment for the testicles. The testicles are two oval glands, lying obliquely in the scrotum, whose function it is to secrete the essential male reproductive elements, or spermatozoa, and some of the fluid elements of the semen. Lying upon the outer border of the testicles, close to their convex surfaces, are the two crescent-shaped epididymides, each epididymis being described anatomically as having a head (globus major), a body (corpus), and tail (globus minor). In order to study these structures more carefully it is necessary to make a section through them with a sharp knife, when their anatomical organization can be seen in detail. Upon cutting open a testicle it is seen to be of a drab color, and, if it be dissected out in a basin of water, one can unravel a great number of thread like filaments, each of which has an average length of two and a half feet; these filaments are the seminiferous or semen bearing tubes, each testicle being computed to contain upward of eight hundred of them.
Each testicle is subdivided by numerous septa, or partitions, into upward of two hundred and fifty to four hundred compartments, each division containing one or more of the convoluted seminiferous tubules. The seminiferous tubules, approximately eight hundred in number, unite before leaving the testicle into about twenty ducts of larger size, the vasa recta, to form the straight tubules which carry the testicular secretions to the epididymis. They emerge from the testicle at its upper part, piercing the tunica vaginalis which covers it, and unite together to form the head, globus major, of the epididymis. The head of the epididymis is thus seen to be firmly connected with the upper part of the testicle by these efferent ducts. In the head of the epididymis the tubules are still numerous and much convoluted, or twisted and curved upon themselves, but at the upper part of its body they unite to form a single tube of larger calibre, approximately twenty feet in length, which by its convolutions forms the body and globus minor.
The single tube, no longer convoluted, then continues under a new name, the vas deferens. The vas deferens (vide Fig. XII.) is a tube, eighteen to twenty four inches in length, which begins at the lower part of the globus minor and passes upward along the inner side of the testicle, forming a part of the spermatic cord; it then enters the abdominal cavity at the internal abdominal ring, arches over the bladder and descends to its base, where it becomes sacculated, and finally unites at the base of the prostate gland with the duct of the vesicula seminalis to form the ejaculatory duct, which opens on the floor of the posterior urethra. The vesiculce seminales are two membranous pouches, situated on the base of the bladder, which serve as reservoirs for storing the semen each vesicle of a calibre about that of a goose quill, and from four to six inches in length, though from their convoluted character they appear shorter.
Each seminal vesicle terminates in a duct which unites with the vas deferens on either side to form a duct of larger size, which then receives the name of the ejacidatory duct. The ejaculatory ducts, one on either side, are each about three quarters of an inch in length, and pierce the prostate gland to open by two valve like slits into the posterior part of the urethra at the sides of veru montanum. With this short consideration of the anatomical features of the seminiferous glands and ducts we are now in a better position to proceed to the complications of epididymitis and orchitis.
The essential elements of the semen are formed in the testicles and conveyed thence by a system of intricately coiled tubes of small calibre to the posterior part of the urethra, so that it is not difficult to understand the manner in which the gonorrhceal process travels backward from the urethra in the reverse direction.
Gonorrhceal inflammation, due to the invasion of gono-cocci, seems to have a special predilection for the tubules in the head of the epididymis; then, next in frequency, it invades the testicle itself; and next the larger sac like dilatations of the vesiculce seminales. The gonococci undoubtedly pass down these tubes by contiguity, infecting as they travel along; but the effects are most usually to be seen only in the epididymis, though if the base of the bladder were more accessible it would probably be found that the seminal vesicles were first affected. The inflammation which is set up by the proliferation of the gonococci in the mucous membranes of the seminal passages has a tendency here also to pass into a chronic stage and to produce an abundant growth of scar like tissue, which will, almost without fail, leave permanent deleterious results wherever it is localized.
Inflammation of the epididymis or testicle, or of both, is more frequent among that class of patients who from necessity or policy cannot rest from their ordinary occupations, or among those who have received too active and harsh treatment in the acute stage of gonorrhoea, or who persist in venery and alcoholic excesses. According to Bergh and Tournier, it would seem to occur once in every eighth or ninth case of gonorrhoea in private practice, while Finger believes that it occurs in 29.9 per cent of hospital cases, and Lydston says that it should not occur oftener than once in twenty cases, provided that the patient has skilful treatment and maintains sexual hygiene and rest. Both sides are affected with equal frequency, though it is rare to find the right and left epididymes involved at the same time.