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In 1932, Engle 1 described the experimental production of descent of the testicle in immature monkeys by the injection of hormones of the anterior pituitary gland or substances obtained from pregnancy urine. Since maldescent of the testicle is a condition for which the physician is not infrequently consulted, it was felt that this observation might open up a new approach to the study and treatment of this developmental defect. INCIDENCE The incidence 2 of undescended testicle in army recruits is reported as varying from two to five per thousand applicants. Maldescent apparently occurs more frequently on the right side, since the descent of the left testicle normally precedes that of the right. The condition of maldescent is bilateral in about 25 per cent of the cases. SURGICAL TREATMENT Bevan 3 advises that an operation for undescended testicle be performed in the first or second year of life. He does not

A TERATOMA in the undescended testis of an infant is of such rarity that a search of the American literature published during the past ten years fails to show a reported case. I have no knowledge of any other reports. The following case report is rendered for that reason and with the hope that it may be of interest to those dealing with patients of similar age and sex, for teratoma is another lesion to be considered in the differential diagnosis of an intra-abdominal mass in an infant. Teratomas are neoplasms arising from totipotential cells that produce many types of tissue. They are most frequently found in the gonads but occur at times in the neck and mediastinum. They may become malignant. One can postulate that the presence of a tumor in an undescended testis indicates that its size may have prevented descent of the embryonic organ. This migration takes

Whether the undescended testicle is more liable to become the seat of malignant change than the scrotal testicle and whether, of undescended testicles, the inguinal is more likely to be affected than the abdominal are two questions which have not been satisfactorily answered. In 1927 Wangensteen wrote, "No greater diversity of opinion probably exists concerning anything in medicine than the question of malignancy in the undescended testis." In 1936 Hinman said, "Whether tumor is relatively more frequent with inguinal than with abdominal retention is uncertain." From the data recorded in the literature it can now be stated unequivocally that the undescended testicle is more liable to malignant change than the normally placed testicle and that the abdominal testicle is more liable to malignant change than the inguinal. There are at least six main reasons why these truths have so long remained obscure: 1. The medical profession has neglected the science

At the Columbus meeting of the American Medical Association I read, before the Section on Surgery and Anatomy, a paper entitled "Operation for Undescended Testicle and Congenital Inguinal Hernia," published inThe Journalof the A. M. A., Sept. 23, 1899. Since that time I have had the opportunity of operating on a further series of cases, representing practically all the varieties of this malformation and have made some improvements, made necessary by difficulties occasionally met, which make operative reduction of the misplaced testicle possible in almost all cases; and places, I believe, the operation in a position where it should be accepted as a standard surgical procedure. A further reason for again presenting this subject is the fact that a number of my colleagues have informed me that they have had difficulty in understanding and in carrying out the operation which I recommended, and I have felt that a series of plates illustrating the various

The diagnosis of inguinal hernia is usually a simple matter even in a small infant. The parents' history of a bulge in the groin on straining, observation of such a mass, and palpation of the distended sac make the diagnosis relatively easy. The detection of an empty sac or patent processus vaginalis on the opposite side requires more experience and diagnostic acumen. It was this problem of the contralateral side which led to the review of 1,000 cases from the surgical service of the Children's Hospital, Louisville. Material and Procedure This series covers a 5-year period and includes staff patients operated upon by house officers under our supervision, and the private patients of both of us. These were all consecutive patients with hernia, except that those with undescended testicle were excluded. The Figure shows the distribution of the patients by age. The policy of the service has been to advise

Although more than thirty years have passed since Schuller 1 described his operation for bringing the undescended testicle into the scrotum, and although in this time many other observers have reported series of cases and personal experiences, many surgeons still doubt the practicability of the operation and in dealing with this condition advise excision of the undescended testicle as the operation of choice. Rawling 2 is the most prominent advocate of excision as the operation of choice, his conclusions being based on a study of the results of 120 cases. Opposed to Rawling we have on the other hand numerous reports, including those of Brocha, Bevan and Coley. The important questions to be decided regarding this operation are, first: Is the non-descended testicle worth saving? Second, Is it technically possible to bring such a testicle into the scrotum in a manner that will preserve its vitality? With these points in

SEX DEVELOPMENT The observations of Marro and others1have indicated the frequent occurrence of developmental defects of the reproductive apparatus and the physical characteristics of sex in idiots, cretins, epileptic persons, criminals, and persons with mental disease beginning at puberty. In male patients, varicocele, undescended testicle, hernia, hypospadias, unusually large and small testicles, deficiency of pubic hair and beard, and disturbance in skeletal growth, were reported to be more frequent than in controls. These observations were made before there was much evidence to indicate that certain endocrine glands are in some way essential to the normal development and functional activity of the reproductive apparatus. More recently Emerson has reported the frequency of a type of imperfect physical development called "status lymphaticus" in alcoholic patients2and in patients with dementia praecox.3He found this type in 22 per cent. of 1,000 alcoholic and drug cases in the alcoholic

Because conflicting reports have appeared in the literature, particularly since the introduction of endocrine therapy, confusion still exists concerning the reasons for nondescent of the testis and the optimum treatment for this condition. A recent issue of an American medical journal, for instance, contained two papers on the use of gonadotropic substance in the treatment of cryptorchidism, one1reporting successful response to this treatment in 19 per cent of the cases and the other2stating that in 72 per cent of the patients treated the testes descended into the scrotum after injections of the substance. Two other papers, both written by pediatricians in Chicago, have been published within the last four months, one3reporting successful results in 29 per cent and the other4in 72 per cent of a series of boys with cryptorchidism treated with extracts of the urine of pregnant women. In both series

The infrequency of congenital perineal testicle is best shown by the report of Gregan (Montpellier, 1913), who collected records of eighty-three cases up to the year 1913, but did not state what proportion of these were congenital, since this type is by far the more uncommon. The literature dating from this time contains reports of three cases of perineal testicle, two of which were of the traumatic variety (Bevan, A. D.: The Surgical Treatment of Undescended Testicle,The Journal, Sept. 19, 1903, p. 718. Mulligan, R. A.:Proc. Roy. Soc. Med., London, 1912-1913, vi. Simpson, J. S.:Med. and Surg. Rep., Episc. Hosp., Philadelphia, 1914, ii). I wish to report another case of the rarer type: the congenital form of perineal testicle. The patient, a boy of 12, had complained for the past six months of pain in the perineal region when in the sitting posture, especially when suddenly arising

When the final chapter is written on the subject of cryptorchidism, it will be divided in our opinion into two distinct chapters. One will have to do with the embryology, histology and physiology of undescended testicle, and the second with the anatomy, technic of operation and end results. In the former the name of Dr. Carl Moore1of the University of Chicago will stand out prominently, while in the latter the names of Bevan,2Torek,3Meyer,4Cabot,5Cunningham, Keyes, Wangensteen,6Eccles and others will be noted. Bevan was a pioneer in this work and deserves particular attention, because he has continued to perfect his orginal operation so that at the present time his technic is more generally accepted than any other. To date there have been more than forty different operations described in the literature. That is the best evidence that no one technic

As such cases as the following must be of extreme rarity, and as they shed a great amount of light on the phenomena of earlier and normal descent, and at the same time perhaps instruct us somewhat as to the manner in which we should deal with cases of undescended testicle; cases where the majority of opinion has been in favor of the complete removal of the organ when it interferes with the comfort of the patient, is caught in the inguinal rings, or complicates a hernia, I have deemed this instance one worthy of consideration. Not long ago I operated for strangulated hernia complicated with undescended testicle, and after closing the hernial sac and rings, drew the testicle, which was enclosed in the sac, into the scrotum and fastened it there with the tunica by means of stitches. This procedure necessitated the invagination in part of the scrotum. The

History. —J. T., aged 17, had had an undescended testicle in the lower end of the right inguinal canal since a baby without producing any symptoms. On July 13, while walking along a railroad track he stumbled and fell forward. In attempting to catch himself he felt something give way in the right inguinal region, but after resting for a few minutes, during which time he vomited once, he was able to walk to his home half a mile away. During the next two hours he vomited several times and had a great deal of pain in the region of the undescended testicle which had increased to twice its normal size. When seen three hours after the injury a diagnosis of strangulated hernia was made and an unsuccessful attempt made to reduce it under anesthesia. Immediate operation was then performed.