Note 56 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 9)

[In upwards of one hundred cases examined by Mons. Breschet of Paris, only one occurred on the right side. With this result, the experience of nearly every practitioner must coincide. Cirsocele may take place at any period of life, in the young as well as in the old; but it is most common, by far, within the first ten years after puberty, or during the period of the greatest excitement of the genital system. In twenty-seven cases observed by Mons. Landouzy, in which this subject was particularly noticed, seven occurred between the ages of nine and fifteen; seventeen between fifteen and twenty-five; three between twenty-five and thirty-five.

Cirsocele appears to be occasionally hereditary. Professor Blandin of Paris, in an able article on this disease, in the “Dict. de Medicine et Chirurgie Pratiques,” refers to three brothers with whom he was personally acquainted, who were all exempted from military duty on account of the existence of this malady: the father was similarly affected. An analogous case is mentioned in an inaugural dissertation published a few years ago at Paris.

The causes of cirsocele are, venereal excesses, masturbation, protracted exercise on foot or horseback, contusions of the scrotum, inflammation of the testicle, and mechanical obstacles to the return of the blood to the spermatic veins, whether produced by the presence of a tumour, fatty accumulations of the omentum or mesentery, or the wearing of tight and ill-constructed trusses. Of these the first two are probably the most frequent and influential. Indeed, I am persuaded, from considerable experience, that this is the case. How these causes act in developing this affection admits of ready explanation. Their tendency is not only to determine an abundant afflux of blood to, and consequent congestion in, the genital organs, but to produce more or less fatigue in the muscles of those parts, especially in the cremaster and dartos, together with a loss of nervous innervation, which diminish their power and contractile energy. The testicle being thus insufficiently sustained sinks down, by its own weight, into the scrotum, which, with the spermatic vessels, is thereby kept in a state of constant relaxation. Heat acts in a similar manner, and produces similar results. Hence cirsocele is more frequent in hot than in temperate climates, and worse in summer than in winter.—ED.]