Anatomy, descriptive and surgical / Edited by T. Pickering Pick and Robert Howden.

  • Gray, Henry, 1827-1861.
Date:
1901
Catalogue details

Licence: Public Domain Mark

Credit: Anatomy, descriptive and surgical / Edited by T. Pickering Pick and Robert Howden. 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.

    1204/1252 (page 1212)
    develops, the lower end of the gubernaculum is carried with the skin to which it is attached to the bottom of this pouch. The fold of peritoneum, constituting the processus vaginalis, projects itself downward into the inguinal canal, and emerges at the external abdominal ring, pushing before it a part of the internal oblique muscle and the aponeurosis of the external oblique, which form, respectively, the cremaster muscle and the external spermatic fascia. It forms a gradually elon- gating depression or cul-de-sac, which eventually reaches the bottom of the scrotum, and into this the testicle is drawn by the growth of the body of the foetus, for the gubernaculum does not grow commensurately with the growth of other parts, and therefore the testicle, being attached by the gubernaculum to the bottom of the scrotum, is prevented from rising as the bottom grows, and is drawn first into the inguinal canal and eventually into the scrotum. It seems certain also that the gubernacular cord becomes shortened as development proceeds, and this assists in causing the testicle to reach the bottom of the scrotum. By the eighth month the testicle has reached the scrotum, preceded by the lengthened pouch of peritoneum, the processus vaginalis, which communicates by its upper extremity with the peri- toneal cavity. Just before birth the upper part of the pouch usually becomes closed, and this obliteration extends gradually downward to within a short distance of the testis. The process of peritoneum surrounding the testis, which is now entirely cut off from the general peritoneal cavity, constitutes the tunica vaginalis} In the female there is also a gubernaculum, which effects a considerable change in the position of the ovary, though not so extensive a change as that of the testicle in the male. The gubernaculum in the female, as it lies on either side in contact with the fundus of the uterus formed by the union of the Miillerian ducts, con- tracts adhesions to this organ, and thus the ovary is prevented from descending below this level. The remains of the gubernaculum—that is to say, the part below the attachment of the cord to the uterus to its termination in the labia majora—ultimately forms the round ligament of the uterus. A pouch of peritoneum accompanies it along the inguinal canal, analogous to the processus vaginalis in the male; it is called the canal of Nuclc. In rare cases the gubernaculuru may fail to contract adhesions to the uterus, and then the ovary descends through the inguinal canal into the labia majora, extending down the canal of Nuck, and under these circumstances resembles in position the testicles in the male. Surgical Anatomy.—Abnormalities in the formation and in the descent of the testicle may occur. The testicle may fail to be developed ; or the testicle may he fully develo])ed, and the vas deferens may be undeveloped in whole or part; or, again, both testicle and vas deferens may be fully developed, but the duct may not become connected to the gland. The testicle may fail in its descent^ or it may descend into some abnormal position. Thus it may be retained in the position where it was primarily developed, below the kidney ; or it may descend to the internal abdominal ring, but fail to pass through this opening ; it may be retained in the inguinal canal, which is perhaps the most common position ; or it may pass through the external abdom- inal ring and remain just outside it, failing to pass to the bottom of the scrotum. On the other hand, it may get into some abnormal position: it may pass the scrotum and reach the peri- neum, or it may fail to enter the inguinal canal, and may find its way through the femoral ring into the crural canal, and present itself on the thigh at the saphenous opening. There is still a third class of cases of abnormality of the testicle : where the organ has descended in due course into the scrotum, but is malplaced. The most common form of this is where the testicle is inverted; that is to say, the organ is rotated so that the epididymis is connected to the front of the scrotum, and the body, surrounded by the tunica vaginalis, is directed backward. In these cases the vas deferens is to be felt in the front of the cord. The condition is of importance in connection with hydrocele and haematocele, and the position of the testicle should always be carefully ascertained before performing any operation for these affections. Again, more rarely, the testicle may be reversed. _ This is a condition in which the top of the testicle, indicated by the globus major of the epididymis, is at the bottom of the scrotum, and the vas deferens comes off from the summit of the organ. Cases sometimes occur, generally in the young adult, in which the spermatic cord becomes twisted. In consequence of this the circulation through it is partially or completely arrested,; if the latter, the testicle becomes gangrenous; if the former, it may undergo atrophy. The external organs of generation (Fig. 780), like the internal, pass through 1 The obliteration of the process of peritoneum which accompanies the cord, and is hence called the funicular process, is often incomplete. See section on Inguinal Hernia.