DOI: 10.7925/drs1.ucdlib_280054
title: Suppuration in the tunica vaginalis

description: Watercolour medical illustration depicting suppuration in the tunica vaginalis. It has the alternative reference numbers 1663 and P5 on the front. The artist's name is in the bottom right corner 'J. Connolly fec.t'. Includes stamp of Bristol Boards papermakers in top right corner. The Richmond Hospital Museum reference is A.a.44. The entry for this in P263/1 pg. 5 reads 'Suppuration in the tunica vaginalis. J. Dunne aet 46. Mr Hamilton'. The typed note on the back begins 'Chronic inflammation of the testicle; Suppuration of the tunica vaginalis'.
description: Scope and content: The full typed note on the back reads 'Chronic inflammation of the testicle; Suppuration of the tunica vaginalis. Mr Hamilton, in bringing before the society a case of disease of the testicle, observed that the operation of castration was usually employed where the disease was of a malignant character, and was consequently most unsatisfactory, inasmuch as the disease very generally returned. Still the surgeon felt it to be his duty to remove the testicle in such cases, as the only chance, though a slight one, of freeing the patient from a malady almost inevitably fatal. They were also, however, called on to undertake the operation when the disease was not malignant, but of an incurable character – for instance, in strumours diseases of the testicle, in cystic disease, of which he had formerly exhibited a specimen, and in some cases of chronic inflammation, which had ended in disorganization of the gland. In chronic inflammation, with enlargement and induration, it might appear that the removal of the testicle was not of urgent necessity. It will be found, however, that an enlarged testicle is a serious inconvenience; it is very subject to injury, and by its weight drags on the nerves of the chord, and causes pain in the back, preventing the sufferer in some cases from following his usual avocations. For example, Mr H. removed a testicle from a groom, who was prevented by it from earning a livelihood. The case he was about to exhibit was one of this class. The man was admitted into hospital with disease of the left testicle, the tumour being of the size of a small coca-nut. It was red and oedematous, and there was adhesion between the tunica vaginalis and the enlarged testicle. It appeared to be a case of abscess of the testicle itself, which was making its way towards the surface. The man was an engine boiler worker, and about three years ago received a blow on the testicle from a piece of flying iron. Acute inflammation was rapidly set up, and then it subsided into the chronic state, but there had been evidently great enlargements of the testicle, and though it continued large, it was not painful, and the man was able to attend to his work. Two months before his admission into hospital he was struck a second time with a piece of iron on the diseased testicle. Acute inflammation was at once excited, and when he was admitted, there was an open abscess, giving exit to a profuse discharge of matter, and the man seemed to suffer a good deal. Having allowed the violence of the inflammation to subside, he examined the testicle more carefully, and found that both it and the chord were enlarged and hard. Its removal was recommended, and the man willingly assented to the performance of the operation. In ordinary cases of castration the operation was one of the most simple in surgery, but in the present case it was not quite so easy, owing to the existence of adhesions, which rendered rather more than the usual amount of dissection requisite. The testicle was not so much diseased as he anticipated, and the abscess was not in it, but in the tunica vaginalis. In a portion of the epididymis there was a collection of pus. The testicle was not enlarged to any great extent. The surface of the tunica vaginalis was considerably diseased, and presented a granular appearance corresponding to the surface of the testicle. There was a quantity of hard, semi-cartilaginous lymph. At the first glance the testicle would seem to be but little diseased, but it was his belief that it was extensively affected, and presented that appearance peculiar to chronic inflammation of the testicle under certain circumstances. Sir Benjamin Brodie states that in chronic inflammation of the testicle, the usual pathological condition is that of yellow tubercle in the substance of the gland, but this was not the only form. Mr H. believed that chronic inflammation effected other changes, such as were observed in this testicle and that of the groom which he had already exhibited to the society, and of which he now presented a drawing by Mr Connolly. The testicle is enlarged, the tunica albuginea from an eighth to a quarter of an inch in thickness, the substance of the testicle of a dull yellow colour, contrasting strongly with the pinkish-grey of the healthy gland, the tubuli being found in the microscope larger than natural, and not containing spermatozoa, but only seminal vesicles. April 16 1864'.
description: Numbering/sequence: Original reference number: 1663.