Epididymis

“ If the period of sexual excitement extends over fifteen to thirty minutes, the whole duct system from the epididymis to the ampulla becomes gorged with the secreted testicular product. This [57] secretion consists of active motile spermatozoa, of spermatic granules and of mucus. The latter is secreted by the ducts of the epididymis and the vas deferens, the testicle itself furnishing only spermatozoa, spermatic granules and a small amount of liquid, just sufficient in quantity to float the spermatozoa out of the testes into the ducts. ”

“ In the bull, infection of some part of the genitals, during some period of life, is very constant, however, whether or not it is productive of observable changes in his breeding efficiency. The finding of the fine connective tissue strands and tufts on the serous surface of the tail of the epididymis of practically all bulls examined, both sterile and fertile, indicates past or present infection of the scrotal sac. The vesicles and tail of the epididymis are, as stated previously, the most commonly invaded tissues of the tract. The testes are less frequently involved. ”

“ In some instances, however, it increases with great rapidity, and gives rise to severe local disorder, with more or less constitutional derangement. One of the most serious and unpleasant effects of this disease is atrophy of the testicle and epididymis, produced by the pressure of the enlarged veins; it may exist in various degrees, from the slightest softness and diminution of volume to almost entire wasting of the organ, and occasionally, though rarely, affects both sides simultaneously. ”

“ The operator, grasping the testicle, carefully draws out the spermatic cord, and with a pointed bistoury makes a transverse incision, above the tail of the epididymis, through the posterior septum of the cord, involving what we know as the white muscle of Bouley, the efferent canal, and the small testicular artery. ”

“ Seeligmann conducted a pathologico-anatomical investigation which led him to conclude that in cases of gonorrhoeal epididymitis, in addition to the inflammation of the epididymis, phlebitis and periphlebitis of the plexus pampiniformis occurs, and also lymphangitis of the extensive system of lymphatic vessels which pass through 536the spermatic cord from the testicle; the changes left in the blood and lymphatic vessels by the inflammation, result in the testicle being for the future imperfectly nourished, and often therefore lead to impairment of the functions of this organ ”

“ When the Tubuli come out from the body of the testicle, they run along the back of it and form a net work of vessels called Rete Testis; it is supposed that by the net work the semen is conveyed from the testicle. The continuations of this Rete Testis have been denominated Vasa Deferentia, which, ending in a number of Vascular Cones, constitute what is called the [17] Epididymis. The Vasa Deferentia, after forming three conical convolutions, unite and form larger tubes, which ultimately end in one large excretory duct, called the Vas Deferens. ”

“ In the male, tubular connections are established between the testes and the middle part of the primitive kidney (mesonephros) . These connections are the vasa efferentia (v.e.) , and the mesonephros is now equivalent to the epididymis of the rabbit. The Wolffian duct is the urogenital duct of the adult, and the Mullerian duct is entirely absorbed, or remains, more or less, in exceptional cases.
In the female, the Mullerian duct increases greatly in length-- so that at sexual maturity its white coils appear thicker and longer than the intestine-- and becomes the oviduct ”

“ If a young man keeps his mind pure and avoids{349} all habits that excite the sexual organs, practically all the sexual life formed by the testes will be absorbed. Whenever he maintains a high state of passion for several minutes, several hundred of the latent sperm cells in the epididymis will take on active life and be sent over to the ampullæ, and emissions under this condition would contain many sperm cells. This is why the unnatural emission is injurious. Owing largely to our artificial methods of living, when a boy is eighteen, the seminal vessels secrete more than can be absorbed. ”

“ Effusion takes place into the cavity of the tunica vaginalis, and thereby the tumescence is still more increased, this tunic from its great dilatibility readily accommodating itself to the accumulation of fluid within. Sometimes the effusion is bloody, more generally serous, and not unfrequently composed of serum more or less tinged with blood. The epididymis remains enlarged longer than any other part, often during the remainder of life. Sickness, vomiting, and violent fever, attend the progress of the swelling. ”

“ If there is any one of the various modes of operating in which the standing position is allowable, this, in our opinion, is the one, the steps of the process being so few and so short, and admitting such simplicity and rapidity. These consist in making a free opening in the bag, reaching with a single stroke of the knife into the vaginal cavity; grasping the testicle and pulling it gently downwards; and cutting the cord right across, from the front backwards, above the epididymis, the cord returning of itself into the vaginal sac—the division being made, of course, on both sides. ”

“ The entire mixture is then propelled, and ejaculation produced by strong muscular contractions of the entire urethra. As was stated before, the semen is the product of the testicles, the excretory ducts, and the accessory sexual glands. The testes furnish the essential germinal elements, the sperms, and some of the fluid content. Then is added the product of the epididymis, vas, and ampulla, which stimulates the spermatozoa to active motility, nourishes the organisms, and adds somewhat to the fluid bulk of the secretion. ”

“ If he has practiced the habit only in a very limited way, so that he is not suffering from any bad consequences, postponement of marriage is not necessary.
What should a young man do when he discovers that he has varicocele?—The approach of this disease is first noticed by a dilation of the cord leading to the epididymis of the left testis. When the veins become full of impure blood and feel like a handful of tangled earthworms and the left gland becomes painfully tender and begins to become much reduced in size, then the individual has a real case of varicocele. ”

“ In the later stages, only a few dividing spermatogonia appear among the debris of the other unrecognizable cells of the tubule. In the epididymis which itself is 42normal, when the testis is showing degeneration, very few spermatozoa appear, in the later stages none. Many spermatids are present in various stages, and some spermatocytes. Animals in the hyper-thymic condition appear to be sterile. ”

“ Syphilis of the testicles has been studied by Henoch,198 Cornil,199 Parrot,200 Hutinel,201 North,202 Bryant,203 and others. It is found to consist of a true interstitial orchitis, very closely resembling that seen in the syphilitic testicles of adults. Hutinel's investigations, based on ten cases, showed the testicles slightly enlarged and harder than normal, the scrotum pendent, the epididymis normal, the tension of the tunica vaginalis and tunica albuginea slight. ”

“ Anteriorly it opens into the body cavity. It is also called the Mullerian duct, and in the great majority of vertebrata it becomes the oviduct, uniting with its fellow, in the case of the dog-fish, ventral to the oesophagus. In the male it usually disappears; the uterus masculinus of the rabbit is still very generally regarded as a vestige of it. Kolliker has shown, however, that this interpretation is improbable. Ms. is the mesonephros, some or all of which becomes the epididymis in the male of types possessing that organ, and is connected with G. by the vasa efferentia. ”

“ The natural seminal secretion, semen, or sperma, after its production in the testicle, is carried out thru a long seminal duct, which, when unraveled, measures 21about twenty feet long, but in a natural condition is twisted and folded on itself many hundred times, forming a bundle-like swelling in the back of the testicle—epididymis. ”

“ Man of 44, lean, weak, wrinkled, incapable of physical work by reason of easy fatigue. Libido failing for years and almost extinct, testicular pains, and double-sided hydrocele. With local anesthesia the typical Winkelmann operation was performed. On both sides there was ligature of the vas deferens300 between the testicle and the epididymis. The cure took a week and the patient was soon discharged. ”

“ The epoöphoron or parovarium is a collection of short tubes which radiate from the upper border of the ovary when the broad ligament is pulled out as in fig. 6. It is best seen in very young children and represents the vasa efferentia in the male. Near the ovary the tubes are closed, but nearer the Fallopian tube they open into another tube which is nearly at right angles to them, and which runs toward the uterus, though in the human subject it is generally lost before reaching that organ. It is known as the duct of Gärtner, and is the homologue of the male epididymis and vas deferens. ”

“ As each genital gland enlarges it remains attached to the rest of the intermediate cell mass by a constricted fold of the coelomic membrane, known as the mesorchium in the male, and the mesovarium in the female. Lying dorsal to the genital ridge in the intermediate cell mass is the mesonephros, consisting of numerous tubules which open into the Wolffian duct. This at first is an important excretory organ, but during development becomes used for other purposes. In the male, as has been shown, it may form the rete testis, and certainly forms the vasa efferentia and globus major of the epididymis ”

“ Keyes on account of frequent urination, incontinence, and a swollen testicle. There was no family history of tuberculosis, and his previous history was that given above. A twenty-four hour specimen of urine gave the following analysis: Amount 2070 cc., sp. gr., 1014, acid, urea 1.2%, a trace of albumin, no sugar, white blood cells, red blood cells, but no tubercle bacilli. On physical examination it was found that he had a lump in the left lobe of his prostate and also in the tail of his right epididymis. ”

“ The main danger of Epididymitis is just in this very possibility, that the spermatic duct may be partially or completely obstructed and blocked permanently by the inflammation, in consequence of which no spermatozoa can go out from the testicle of this side, and if 90Epididymitis occurs on both sides, which happens often, then obliteration of the spermatic ducts is complete; in other words, the man can never have children—he becomes sterile. ”

“ Sex has no influence on the liability that tends to being attacked, the proportion between the sexes being about equal. As to age, he finds the greatest proportion to be between three and ten years, but he has often treated those of either sex even at the age of fourteen and up to seventeen years. It is absolutely necessary to examine the external genitals and the urine of those affected by this disease, as phlegmasiæ of the vagina, of the vestibule or urethra in girls, or the practice of onanism, or lithiasis, cystitis, or pyelitis may be the cause of the disease. ”

“ The testes, epididymes, vesicles, prostate, and other parts, each contribute their essential part to the semen, abnormalities of any one of which, as a rule, result in interferences with reproduction. If the vesicles are involved, we must bear in mind just what is the part played by their secretion, and what is the probable result if their essential elements are not added to the semen. In like manner, we must consider the prostate, whose secretion stimulates the vitality of the sperms, and adds fluid bulk to the semen. ”

“ Secretions, urine and semen accumulate and decompose in a phimosed prepuce, cause irritation and lead to masturbation. All cases of phimosis should be operated upon in infancy, by complete or partial circumcision.
In women, the number of diseases which prevent conception is much greater than in man. The ovary may undergo cystic degeneration or become the seat of a tumor; but affections of the uterus and vagina cause more sterility than ovarian affections. This results chiefly from catarrh and inflammation which destroy the spermatozoa before they can reach the egg during its descent. ”

“ Whenever sexual orgasm occurs in the male, after puberty, without ejaculation, the condition known as aspermatism may be said to exist, and may be considered as a symptom of disease. This may be partial or complete. I have known a number of individuals who failed to ejaculate semen at the time of sexual orgasm, and the semen would pass away in jets some time after the penis had become flaccid. These cases exist where there is no sign of organic stricture of the urethra, or any other organic trouble within the prostate gland or ejaculatory ducts. ”

“ A man was spoken of in both France and Germany a who passed for many years as a female. He had a cleft scrotum and hypospadias, which caused the deception. Sleeping with another servant for three years, he constantly had sexual congress with her during this period, and finally impregnated her. It was supposed in this case that the posterior wall of the vagina supplied the deficiency of the lower boundary of the urethra, forming a complete channel for the semen to proceed through. ”

“ Where the genital organs exist, but are malformed, or pathologically altered, their virility may be nullified.
The most frequent malformation is in the urethra, which sometimes opens in the perinœum—the part marked a in the annexed cut; at others, on the dorsum of the penis, and not unfrequently under its surface: so long, however, as the orifice opens in that portion of the penis which enters the vagina, so that the emissio seminis may be therein deposited, impregnation may and will take place; and even in cases where artificial means have been employed to convey the fluid. ”