A SCARLET FEVER EPIDEMIC IN AN AGRICULTURAL SCHOOL
Authors: H. S. DIEHL
Journal: JAMA (1922)

the epididymis and explained this by stating that the fact "that the lower pole of the epididymis should be the commonest site is only to be expected if the tuber¬ culous infection is a descending one."This view may be discarded in the light of more recent observations and histopathologic research.Keyes 21 states that testicular tuberculosis is never an isolated lesion.In a recent article, Young 22 says, "These statistics show conclusively the absence of iso¬ lated testicular tuberculosis and the rarity of testicular involvement when the epididymides are extensively involved."Further in the article he states that "it is probably erroneous to suppose that primary tubercu¬ losis of the epididymis often occurs.It probably seldom occurs through blood stream infections, as is so often asserted.The seminal vesicles are not only the primary focus from which the epididymides are involved, but from which also the prostate, bladder and the kidneys in many cases are involved."He is undoubtedly correct in many of the conclusions expressed in his article, especially in showing that tuberculosis of the adult testis or epididymis is often but a part of the pathologic change present.In the statement that blood stream infection is rare, I cannot concur; nor can I in the view that the testis and epididymis seldom represent the primary focus of the disease.It is undoubtedly true that the seminal vesi¬ cles present the most frequent site of primary foci in the seminal tract ; but when it is borne in mind that the earliest microscopic evidence discloses the primary focus to be multicentric in 60 per cent, of the cases and that the frequency of earliest foci in the semi¬ nal vesicles, epididymides and testes are represented by the figures seven, five and three, respectively, it is apparent that the testis and epididymis together are more frequently the site of the primary focus than the seminal vesicle.CONCLUSIONS 1. Tuberculosis of the testis may be primary and even solitary as far as the genito-urinary tract is involved.2. The infection when primary in the testis is hema- togenic and first involves the blood vessel walls, later breaking into the lumen of the tubules.3. Infection via the mucous surfaces is possible in the chronic type of the disease but hot the only method of dissemination.4. Acute hematogenous tuberculosis of the testis involves the entire gland, owing probably to the rich anastomoses of the peculiar blood supply of the organ.5. Tuberculosis of the male genital tract is more often primarily multicentric than single.6. Tuberculosis may affect the testis on one side and the epididymis or seminal vesicle on the opposite side.7. Tuberculosis of the testis is usually, in the adult, secondarily involved by extension from the epididymis.In children the reverse is true.8. Surgical removal of a tuberculous testis is indi¬ cated in acute infections of the gland if there is no evidence of other tuberculous foci.The disease may be localized there.9. Unilateral radical removal of the seminal tract is not indicated because involvement of contralateral organs is not infrequent in the disease, while corre¬ sponding organs may be free.21.