a. "We have already found that fibroid tissue occurs as a consequence of chronic inflammation, and its termination in induration.

b. The formation of cysts is very unusual, a fact that acquires special interest from the frequency of their occurrence in the ovaries. c. Enchondroma is equally rare.

d. An anomalous osseous substance is sometimes developed in the indurated testicle, i. e. in the fibroid tissue; and assumes the shape of round, tuberculated, or tendiniform concretions.

E. Tubercle

Tubercle not unfrequently attacks the testicle primarily, and its chief seat is the epididymis. From this point it not only spreads to the vasa deferentia, the vesiculae seminales, the prostate, and the glands that are connected with the organs of generation generally; but also to the lymphatics of the abdomen, the thorax, and even of the neck, on the one hand, or on the other to the urinary organs, in the manner previously described (p. 161). In the former case we find the glands aggregated or strung together in large, shapeless, nodulated masses, and infiltrated with cheesy tubercular matter.

Tubercle is developed in young subjects who are predisposed to tubercular affections, in consequence of excessive or unnatural gratification of the sexual desires. The pathological anatomist has been unable to demonstrate its connection with gonorrhoea, or, in other words, to prove the blennorrhoic character of the general morbid affection, as well as of tubercle itself; and we, therefore, consider the gonorrhceal theory of orchitic tubercle to be wanting in a most essential point.

The affection proves fatal, either by the universal atrophy induced by the effusion of tubercle throughout the lymphatic system, or by the supervention of more or less acute tubercular deposition in the urinary organs, in the lungs, on the peritoneum, and in the spleen.

Orchitic tubercle generally appears in the shape of rounded nodules, of the size of a millet- or hemp-seed, or a pea, which coalesce into larger masses; they scarcely ever undergo a retrograde metamorphosis, but fuse, and thus establish tubercular suppuration or phthisis orchitica. The increase in size of the testicle varies according to the number of the individual tubercles, and more still according to the size of the tubercular conglomerations. Its surface is irregular and nodulated. The tissue surrounding the tubercle and the tubercular abscess becomes cartilaginous, lardaceous, and tough.

In the same manner as elsewhere, and especially in the lungs, we find inflammation of the serous investment supervening upon tubercular affections; thus the tunica vaginalis testis is liable to attacks of inflammation, accompanied by tuberculizing exudation of various forms.

Tubercle of the testicle is of extreme interest as contrasted with the immunity from tubercle enjoyed by the ovary.

Cancer

All the varieties of cancer undoubtedly occur in the testicle, but both according to my own observations and those of others, medullary carcinoma is the most frequent. It always gives rise to very extensive degeneration, is very soft, and presents fluctuation; sometimes it perforates the tunica vaginalis and the skin, and is thus converted into an open cancerous sore.

It generally so completely takes the place of the proper orchitic tissue that no trace of the latter is left; still many cases occur in which it occupies the interstices of the hypertrophied fibro-cellular stroma of the testicle. It is peculiarly liable to a complication with renal cancer, and also with medullary growths in the cellular tissue surrounding the pelvis and the hip-joint, with medullary retro-peritoneal growths, and finally with universal cancerous cachexia.

The frequency of its occurrence in the testicle, especially as a primary affection, is of interest when contrasted with the rarity of its appearance in the ovary, and with the frequency of cysts and the allied form of areolar cancer, in the latter.

The vas deferens is generally attacked by disease extending to it from the testicle, or the vesiculae seminales; it is found to be affected by induration and thickening of its coats and ossification, which probably result from inflammation, by tubercle, and cancerous degeneration.