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derived from two sources, viz. : (a) from the third, the fourth, and sometimes the
second sacral nerves : these fibres, which are known as the pelvic splarichnics
(Gaskell), consist almost entirely of fine medullated nerves, and pass from the sacral
spinal nerves directly to the pelvic plexus without going through the gangliated cord
of the sympathetic ; (b) from the hypogastric plexus of the sympathetic : these fibres
are nearly ail non-medullated. They arise from the upper lumbar nerves, and reach
the hypogastric plexus through the aortic plexus and the inferior mesenteric ganglion.
Both sets unite in the pelvic plexus, which contains numerous ganglia, and the fibres
which go from the plexus to the bladder are mainly, if not entirely, non-medullated.
According to v. Zeissl, the pelvic splanchnics supply only the longitudinal fibres of
the bladder, but Griffiths found that stimulation of the peripheral cut ends of these
nerves produced contraction of the entire muscular coat on the same side. These



216 THE URINARY ORGANS.

nerves also contain sensory fibres from the bladder. Stimulation of the peripheral
cut ends of the hypogastric fibres causes feeble contraction of the corresponding half
of the bladder (Langley), and if the bladder be previously contracted it causes rapid
relaxation (Griffiths). The hypogastric plexus also contains sensory fibres, which
probably reach the spinal cord through the twelfth dorsal and first and second
lumbar nerves.

RECENT LITERATURE OF THE URINARY OR&ANS.

Adami, J. Q-., and Day. J. Ii., Two cases of complete double ureter, Montreal Mecl. Journal,
1893-94.

Aschoff, Ii., Eln Beitrag zur normal, u. pathol. Anatomic der Echleimhaut do- Harmcege,
U.SAO., Virch. Arch. f. path. Anat., Bd. cxxxviii., 1894.

Earth, P., Rccherches tsur (a structure de I'uretere humain, These, Nancy, 1894.
Berkeley, Henry J., The intrinsic nerves of the kidney, Bull. Johns Hopkins Hospital, v. iv.
Bianchi-Mariotti, G. B., Ricerche sull 'histologia normale delV uretere, Atti e rendic. ace. med.
chirurg. Perugia, v. ix., 1893.

Birmingham, A., Peculiar horse-shoe kidney, Trans, of the Eoy. Acad. of Med. in Ireland,
]894. Simple unilateral (sly moid) kidney, Trans, of the Hoy. Acad. of Med. in Ireland, vol. viii.,
1890.

Bradford, J. Hose, The innervation of the renal blood-vessels, Proceed, of the Roy. Soc.,
vol. xlv., and Journal of Physiol., vol. x., 1889.

Brown, Macdonald, Variations in the position and development of the kidneys, Journ. of
Anat. and Physiol., vol. xxviii., 1894.

Brunn, A. v., Ueber drilsendhnliche Bildungen in der Schleimhaut des Nierenbeckens des
Ureters und der Harnblase beim Menschen, Arch. f. mikrosk. Anat., Bd. xli., 1893.

Cabot, A. T., Observations upon the anatomy and surgery of the ureter, The American Journal of
the Medical Sciences, 1892.

Cuccati, Giov., Nuove osservazioni intorno al distribuimento e alia terminazione dclle fibre
nervei nella vescica urinaria in alcuni anjibi, rettili e mammiftri, Memorie della r. accademia delle
scienze dell' istituto di Bologna, 1889.

Cunning-ham, D. J., The form of the spleen and of the kidneys, Journal Anat. and Phys., vol.
xxix., 1895.

Disse. J., Beitraye zur Kenntniss der Spaltrdiime des Menschen, iv. Der Blascnspaltraum bei
Kindernund sein Verhdltniss zum Cavum Eetzii, Arch. f. Anat.. Supplement, 1889 ; Untertuchungen
iiber die Laye der menschlichen Harnblase und ihre Vcrdnderungen, im Laufc des Wachstums,
Anatom. Hefte, 1891 ; Ueber die Veranderungen der Epithelien in der Niere bei der Harnsekretion,
Anatom. Hefte, ii. , and Verhandl der Anat. Gesellsch., 1892.

Disselhorst, R., Der Harnleiter der Wirbcltiere, Anat. Hefte, Bd. iv., 1894.
Dogiel, A. S., Zur Frage ilber das Epithel. der Harnblase, Archiv f. mikroskop. Anat.,
Bd. xxxv., 1890.

Dwig-ht, T., Case of absence of the riglit kidney. Jour. Anat. and Phys., vol. xxix., 1894.
v. Fischer-Benzon, L., Beitrag zur Anatomic und CEtiologie der beweylichen Nitre, Kiel,
1887.

ilesch. M., Bcmcrkungen uber die Beziehungen des Bauchfcllszur vordcren Wand der Harnblase,
Anat. Anzeiger, 1888.

Golgi, C., Roncl. d. r. accad. d. Lincei, t. v.

Golubew, "W. S., Ucber die Blutyefasse in der Niere der Sdugetiere und des Menschen, Internat.
Monatsschr. f. Anat. u. Physiol., Bd. x., 1893.

Griffiths, Joseph, Observations on the urinary bladder and urethra, The Journ. of Anat. and
Physiol., vol. xxv., 1891.

Gruber, W., Hautigcr Isthmus einer Hufeisenniere, Vircli. Arch. f. path. Anat., Bd., ciii.
Halasz, Heinrich, Niere mit doppeltem Ureter, Anat. Anzeiger, Bd. ix., 1894.
Hamburger, 0., Ueber die. Entwickclung der Sdugetiernicre, Archiv f. Anat. u. Physiol.,
1890, Anatom. Abt., Supplement- Band.

Hedinger, Heinrich, Ucber den Bau der Malpighi schen Gefdssknduel der Niere, Breslau,
Inaug. Dissert., 1888.

Hepburn, D., Floating kidney, Jour. Anat. and Phys., vol. xix., 1885.
Holl, M. , Zur Topographic des ive'Michen Harnlcitcrs, Wien. med. Wochensch., 1882.
James, Ernest W., Congenital absence of right kidney and suprarenal capsule, Brit. Med.
Journal. 1893, vol. ii., p. 579.

Kostjurin, S. D., Das glatte Muskclgcwebe der Nieren und seine Bedeutung als Harnleiter,
Aichiv f. experimentelle Pathologic und Pharmakologie, Bd. xxv., 1888.

Howden, R. , Case of misplaced kidney with undesccndcd testicle and rudimentary vas deferens
on the same side, Jour. Anat. and Phys., vol. xxi, 1887.

Kruse, A., Demonstration von Fallen abnormer Lage und Gestalt der Nieren, Deut. med.
Wochensch., 1890.

Kruse, Walther, Ein Beitrag zur Ilistoloyic der gewundcnen Harnkandlchen, Virchow's Archiv
f. pith. Anat., Bd. cix., 1887.

Lindner, Ueber die Wandcrnicre der Frauen', Berlin, 1 888.



RECENT LITERATURE OF THE URINARY ORGANS. 2 17

Little, John Fletcher, The depth of the cortex of the kidney, Proceed, of the Anatora. Soc. of
Gt. Britain, Journ. of Anat. and Physiol., 1888.

Mackey, E., Solitary kidney in a child, Brit. Med. Jour., 1887, vol. ii., p. 62JL

M'Gee, Report upon the distance of the lower end of the kidney from the crest of the ilium,
Trans, of the Roy. Acad. of Med. in Ireland, vol. ix., 1891.

Mahon, R. B., Abnormal arrangement of the kidney and its vessels, Jour. Anat. and Phys. .
vol. xxiii., 1889.

Menzies, W. 3?., Two cases of single kidney, Jour. Anat. and Phys., vol. xxi., 1887.

Manca, &., Rapport cntre les poids des reins et le poids et la superficie du corps chez les chiens,
Arch. ital. de biol., t. xxi. 1894 (abstract of a paper in Atti d. R. Accad. d. sc. d. Torino).

Noel, J., Absence congenitale du rein et de I'uretere du cote' droit chcz une fcmme de 62 ans, Bull.
soc. anat., Paris, 1892.

Newman, D., On malposition of the kidneys, Glasgow Med. Journ., 1883.

Nussbaum, M. , Zur Kenntnis der Nierenorgane, Archiv f. mikroskop. Anatomic, Band xxvii.

Pilliet, Sphincter interne dc la vessie, Bull. soc. anat., Paris, 1892.

Richmond, W. Stephenson, Abnormal ureters, Jour. Anat. and Phys., vol. xix., 1884.

Rothstein, T., Zur Kenntnis des Nierenepithels, Biol. Foren. Forhandl., Stockholm, 1891.

Russel, J. C., Note on a peculiar shaped kidney, Jour. Anat. and Phys., vol. xix., 1885.

Spencer, H. R., The distance of the lower maryin of the kidney from the iliac crest in the infant
at birth, Jour. Anat. and Phys., vol. xxvi.

Steig-er, R., Beitrage zur Histologie der Niercn, Yirchow's Archiv f. path. Anat., Bd. civ.

Symington, J., n the position of the empty and distended bladder in the male child, Edin. Med.
Journ., April 1885 ; The topographical anatomy of the child (position of bladder), 1887.

Takahasi, S., Beitrage zur Kenntnis der Lage der fotalen und kindlichen Harnblase, Archiv f.
Anat. u. Physiol., Anatom. Abt., Jahrg. 1888.

Thompson, W. H., Horse-shoe kidney, The Dublin Journal of Med. Sci., August, 1889.

Thomson, A., Second annual report of the Committee of Collective Investigation of the
Anatomical Society of Great Britain arid Ireland for the year 1890 91, Distance of the lower margin
rf the kidney from the iliac crest, Jour. Anat. and Phys., vol. xxvi.

Tweedy, H. C., Case of single unilateral kidney , Jour. Anat. and Phys., vol. xxviii., 1894.

Waldeyer, Ueber die sogenannte Ureter scheide, Verhand. der Anat. Gesellsch., Anat. Anzeiger,
1892.

Zuckerkandl, E., Ueber den Fixationsapparat der Nieren, Wien. med. Jahrbuch, 1883.



BEPEODUCTIVE ORGANS.

BY E. A. SCHAFER .AND J. SYMINGTON.

I. IN THE MALE SEX.

UNDER this head are included 1, the testes with their ducts and coverings ;
and, 2, the urethra, with certain accessory parts, such as the prostate and Cowper's
glands. The urethra in the male is at once the outlet for the urine from the
bladder and the products of secretion from the sexual glands. Extending from the
neck of the bladder to the extremity of the penis, it is surrounded in its first part
by the prostate gland, and there receives the excretory ducts of the testes and
vesiculae seminales ; its second part passes through the triangular ligament of the
perineum ; and its third and longest part passes along the perineum and penis.,
surrounded by the corpus spongiosum.

THE TESTES AND THEIR ACCESSORY STRUCTURES.

The testes or testicles, the two glandular organs which produce the spermatozoa,
are situated in the pouch of integument termed the scrotum, each being suspended
by its own spermatic cord.

The spermatic cord. The parts which form this cord are the excretory duct
of the testis, named the vas deferens, the spermatic artery and veins, lymphatics,
nerves, and connecting areolar tissue. Besides this last the cord has several
coverings in common with the testis. The structures mentioned come together to
form the cord at the internal or deep abdominal ring, arid, extending through the
abdominal wall obliquely downwards and towards the middle line, escape at the
superficial or external abdominal ring, whence the cord descends over the front of
the pubis into the scrotum.

The inguinal canal. By the term inguinal canal is understood the space
occupied by the spermatic cord as it passes through the abdominal wall. It extends
from the deep to the superficial abdominal ring, and is about an inch and a half in
length. In the upper part of this course the cord has the fascia transversalis behind
it, and is covered in front by the lower fibres of the internal oblique and transversalis
muscles ; lower down it lies in front of the conjoined tendon of these muscles, the
fibres of which have arched inwards over it, and its cremasteric covering is in contact
anteriorly with the aponeurosis of the external oblique muscle. The inguinal canal
is therefore said to be bounded posteriorly by the fascia transversalis above and the
conjoined tendon below, and anteriorly by fibres of the transversalis and internal
oblique muscles above, and the aponeurosis of the external oblique muscle below ;
while its floor is formed by the curving backwards of Poupart's ligament, and its
roof by the apposition of the layers of the abdominal wall and the arched fibres of
the internal oblique and transversalis muscles.

As it enters the inguinal canal, the cord receives a covering from the infundibuli-
form fascia, a thin layer continuous with the fascia transversalis, and prolonged
down from the margin of the deep abdominal ring ; within the canal it receives a
covering from the cremaster muscle and its layer of fascia ; and as it emerges from
the canal there is added superficially to this, the intercolumnar fascia prolonged
from the margin of the superficial abdominal ring.



THE SCROTUM AND SPERMATIC CORD. 219

The scrotum. The scrotum forms a purse-like investment for the testes and
part of the spermatic cords. Its condition is liable to some variation according to
che state of the health and other circumstances ; thus it is short and corrugated in
robust persons and under the effects of cold, but becomes loose and pendulous in
persons of weak constitution, and under the relaxing influence of heat. A superficial
division into two lateral halves is marked by a slight median ridge, named the
rap/ie, extending forwards to the under side of the penis, and backwards along the
perineum to the margin of the anus.

The coverings of the cord and testis in the scrotum may be enumerated from
without inwards as follows, viz., the slcin, superficial fascia, and dartos tissue, the
inter columnar fascia, the cremaster muscle and. fascia, and the infundibuliform fascia,
which is united to the cord by a layer of loose areolar tissue ; lastly, the special
serous membrane of the testis named the tunica vaginalis, which forms a close
sac, of which one part lines the scrotum and the other closely envelopes the
testis.

1. The skin of the scrotum is very thin, and is of a darker colour than that of
the body generally ; it is commonly thrown into rugas or folds, which are more or
less distinct according to the circumstances already mentioned. It is furnished
with sebaceous follicles, the secretion from which has a peculiar odour, and it is
covered over with thinly scattered curled and flattened hairs, the bulbs of which
may be seen or felt through the skin when the scrotum is stretched. The superficial
blood-vessels are also readily distinguished through this thin integument.

2. Immediately beneath the skin of the scrotum there is found a thin layer of a
peculiar loose reddish-brown tissue, endowed with contractility, and named the
dartos tunic. This subcutaneous layer is continuous with the superficial fascia of
the groin, perineum, and inner side of the thighs, but assumes a different structure,
and is entirely free from fat. The dartoid tissue, which is more abundant on the
fore part of the scrotum than behind, forms two distinct sacs, for the corresponding
testes, united together along the middle line so as to establish a median partition
named the septum scroti, which is adherent below to the deep surface of the raphe,
and reaches upwards to the root of the penis. The dartos is very vascular, and
owes its contractile properties to the presence of a considerable amount of unstriped
muscular tissue (Kolliker).

3. The intercolumnar or spermatic fascia, a very thin and transparent but
relatively firm layer derived from the tendon of the external oblique muscle of the
abdomen, is attached above to the margins of the external ring, and is prolonged
downwards upon the cord and testis. It lies at first beneath the superficial fascia,
and lower down beneath the dartos, and it is intimately connected with the layer
next mentioned.

4. The cremasteric layer is composed of scattered bundles of striped muscular
fibres, connected together into a continuous covering by intermediate areolar
membrane. The red muscular portion, which is continuous with the lower border
of the internal oblique muscle of the abdomen, constitutes the cremaster muscle, and
the entire covering is named the cremasteric fascia. By the action of the cremaster
the cord is shortened and the testicle is raised towards the abdomen.

5. The infundibuliform fascia, continuous above with the fascia transversalis
and situated immediately beneath the cremasteric fascia, invests the cord completely,
and is connected below with the posterior part of the testicle and the outer surface
of its serous tunic. On forcing air beneath the infundibuliform fascia, a quantity
of loose and delicate areolar tissue is seen to connect its deep surface with the vas
deferens and spermatic blood-vessels, and to form lamellae between them. This
areolar tissue is continuous above with the subserous areolar tissue found beneath
the peritoneum on the anterior wall of the abdomen ; below, it is lost upon the back



20 MALE REPRODUCTIVE ORGANS.

of the testicle. Together with the inftmdibuliform fascia, it forms the fascia propria
of Astley Cooper.

Lying amongst this loose areolar tissue, in front of the upper end of the cord, there is often
seen a fibrous band, which is connected above with the pouch of peritoneum found opposite
the upper end of the inguinal canal. Mid which passes downwards for a variable distance
along the spermatic cord. Occasionally it may be followed as a fine cord, as far as the upper
end of the tunica vaginalis ; sometimes no trace of it can be detected. It is the vestige of a
tubular process of the peritoneum, which in the foetus connects the tunica vaginalis with the
general peritoneal membrane. The testicle is placed within the abdomen during the greater
part of foetal life ; but at a period considerably prior to its escape from the abdominal cavity,
a pouch of peritoneum already extends down into the scrotum. Into this pouch, or p-roi-exxu*
vaginalis puritana-i, the testicle projects from behind, supported by a duplicature of the serous
membrane, named the mtsorchium. Sooner or later after the gland has descended into the
scrotum, the upper part or neck of this pouch becomes contracted and finally obliterated, from
the internal abdominal ring down nearly to the testicle, leaving no trace but the indistinct
fibrous cord already described, while the lower part remains as a closed serous sac surrounding
the testicle, and which is thence named the tunica vaginalis.

In the female foetus an analogous pouch of peritoneum descends for a short distance along
the round ligament of the uterus, and has received the appellation of the canal of Nucli. Of
this traces may almost always be seen in the adult.

The neck of the processus vaginalis sometimes becomes closed at intervals only, leaving a
series of sacculi along the front of the cord ; or a long pouch may continue open at the upper
end, leading from the abdominal cavity into the inguinal canal. In other instances, the
peritoneal process remains altogether pervious, and the cavity of the tunica vaginalis is thus
made continuous with that of the peritoneum. In such a case of congenital defect, a portion
of intestine or omentum may descend from the abdomen into the inguinal canal and scrotum,
and constitute what is named a congenital hernia. Lastly, one or both testes may remain
permanently within the abdomen, or their descent may be delayed till after puberty, when it
may occasion serious disturbance. Retention of the testes in the abdomen (cryptorchismus)
is, in many instances, the accompaniment of arrested development of the glandular structure ;
it is. however, a peculiarity which may be present without impotence.

In a few mammals, as the elephant, the testes remain permanently within the abdomen ;
in a much larger number, as the rodentia, they only descend at each period of rut. The
complete closure of the tunica vaginalis is peculiar to man, and may be considered as connected
with his adaptation to the erect posture.

6. The tunica vaginalis. This tunic forms a shut sac, of which the opposite
free surfaces are in contact with each other. Like the serous membranes in general,
of which it presents one of the simplest forms, it may be described as consisting of
a visceral and a parietal portion. The visceral portion, tunica vaginalis testis, closely
invests the greater part of the body of the testis, as well as the epididymis, between
which parts it is depressed in the form of a pouch (digital fossa), and lines their
contiguous surfaces, and it adheres intimately to the proper fibrous tunic of the
gland. Along the posterior border of the gland, where the vessels and ducts enter
or pass out, the serous coat, having been reflected, is wanting. This portion of the
serous covering frequently presents yillous prolongations on the borders of the
epididymis and upper end of the testis ; these processes, sometimes of considerable
length, are covered in some places with cylindrical, in others with layers of flat
epithelium.

The parietal or scrotal portion of the tunica vaginalis is more extensive than
that which covers the body of the testis ; it reaches upwards, sometimes for a
considerable distance, upon the spermatic cord, extending somewhat higher on the
inner than on the outer side. It also reaches downwards below the testicle, which,
therefore, appears to be suspended at the back of the serous sac, when this latter is
distended with fluid ; a fold, or so-called ligament, being left projecting at the lower
end of the epididymis (fig. 235, /).

Vessels and nerves of the scrotum and spermatic cord. The arteries
are derived from several sources. The two external pudic arteries, branches of
the femoral, reach the front and sides of the scrotum, supplying the integument and



THE TESTICLES.



221



dartos ; the superficial perinea! branch of the internal pudic artery is distributed to
the back part of the scrotum ; and, lastly, more deeply seated than either of these
is a branch given from the epigastric artery, named cremasferic,~v;'5ick. is chiefly
distributed to the cremaster muscle, but also supplies small branches to the other
coverings of the cord, and by its ultimate divisions anastomoses with the other
vessels. The artery of the vas deferens, a long slender vessel derived from the
superior or inferior vesical, accompanies the tube in its whole length. The veins
accompany the arteries. The veins of the cord form the spermatic or pampiniform
plexus elsewhere described. The lymphatics of the scrotum pass into the inguinal
lymphatic glands.

The nerves also proceed from various sources. The ilio-inguinal, a branch
of the lumbar plexus issuing by the external abdominal ring, supplies the integu-
ments of the scrotum ; this nerve is joined also by a filament from the ilio-
hypogastrit branch of the same plexus : sometimes two separate cutaneous nerves
come forward through the external ring. The two superficial perineal branches of
the pudic nerve accompany the artery of the same name and supply the inferior and
posterior parts of the scrotum. The inferior pudendal, a branch of the small sciatic
nerve, joins with the perineal nerves, and with them is distributed to the sides and
lower part of the scrotum. Lastly, the genital branch of the yenito-crural nerve,
reaching the spermatic cord at the internal abdominal ring, passes with it through
the inguinal canal, and supplies the fibres of the cremaster muscle, besides sending
a few filaments to the other deep coverings of the cord arid testicle.



THE TESTICLES.

The testicles, the principal reproductive glands (8l8vpos, bp\is), are suspended
obliquely in the scrotum by means of the cord and membranes already described ;

Fig. 235. THE LEFT TUNICA VAGINALIS OPENED, SHOWING

THE TESTIS, EPIDIDYMIS, &C., FKOM THE OUTER SIDE.

(Allen Thomson. )

p, p, cut edges of the parietal layer of the tunica vagi-
nalis drawn aside ; t, body of the testis ; e, e', epididymis ;
f, a fold of the tunica vaginalis passing from the body of the
testis to the side. In the upper part of the figure the tunica
vaginalis has been dissected off at the place of its reflection
on the cord to show v d, the vas deferens, and g, the organ
of Griraldes ; G,the three small nodules of this organ enlarged
about ten times, and showing the remains of tubular struc-
ture within them ; h, hydatid of Morgagni, or appendix of
the testicle.

they are usually placed at unequal heights, that
of the left side being lower than the other.
They are of an ovoid form, but are slightly
compressed laterally, so that they have two
somewhat flattened sides or faces, an upper and
a lower end, an anterior and a posterior border.
They are about an inch and a half (37 mm.)
long, an inch and a quarter (28 mm.) wide from
back to front, and nearly an inch (24 mm.)
thick from side to side. The weight of each
varies from three-quarters of an ounce to an
ounce (15 to 24*5 grammes, W. Krause).

The front and sides of the testis, together

with the upper and the lower ends, are free, smooth, and closely invested by the
tunica vaginalis. The posterior border is attached to the spermatic cord, and it is




222 MALE REPRODUCTIVE ORGANS.

here that the vessels and nerves enter or pass out. When the testis is suspended in
its usual position, its upper end is directed obliquely forwards and outwards, as well
as upwards, whilst the lower, which is rather smaller, has the opposite direction.
It follows from this that the posterior or attached border is turned upwards and
inwards, and the outer flattened face slightly backwards.

Attached to the posterior border of the gland, and resting also on the neighbour-
ing portion of its outer face, is a long narrow body, the epididymis, which forms part
of the excretory apparatus of the testicle, and is principally composed of the
convolutions of a long tortuous canal or efferent duct, to be presently described. Its
upper extremity, larger than the lower, projects forwards on the upper end of the



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