As there are some doubts regarding the form of the incisions in the ancient methods of performing lithotomy, we will now give the words of some of the Arabian translators. Stephanus Antiochensis, the translator of Haly Abbas, has the following words: “Inter testes anumque finde et non in mediâ viâ sed in sinistri lateris parte ab intestinis, sitque perallela fissura, et ab exterioribus larga, ab interioribus non.” The translator of Albucasis expresses himself thus: “Finde in eo quod est inter anum et testiculos et non in medio, ad latus natis sinistræ: fiat sectio transversa.” The following are the words of Avicenna’s translator: “Cave ne scindas super commissuram quum sit malum, commissura enim secundum veritatem est locus mortalis. Amplius fac super ipsum (lapidem?) scissuram tendentem ad transversum, studendo ut cadat scissura in collo vesicæ.” The translator of Rhases expresses himself in the following terms: “Scinde super lapidem cum instrumento camadan; et scissura debet fieri transversa, et sit exterior caro larga et in interiori vesicæ stricta.”
Yet notwithstanding all this we are inclined to think that the incision was oblique and not transverse; for our author, whom they all follow, directs us to make the incision oblique (λοξὸς), and it is further clear that a transverse one would not answer the purpose so well. No dependence can be put in the accuracy of these barbarous translations. The language of Stephanus Antiochensis is particularly obscure. Casiri justly characterizes the translations of the Arabian authors as being “perversiones potius quam versiones.” (Bibl. Hisp. Arab, i, 266.)
The ancient operation, with scarcely any alterations, is described by the earlier modern writers on surgery. See Brunus (Chirurg. Magna. ii, 17); and Guido de Cauliaco (Chir. vi, 2.) They direct us to introduce a finger into the rectum and push the stone outwards; then to make an incision down upon it on the left side of the raphe. Brunus recommends a longitudinal incision.
It appears that the ancient operation of lithotomy is still practised with great success by the native doctors of Hindostan. See ‘Transactions of the Medical and Physical Society of Calcutta,’ vol. iv. An interesting case in point, related in the ‘Medical Gazette’ for Feb. 7, 1845, forms a valuable commentary on the Celsian description of lithotomy. In the year 1827 Mr. Madden the traveller saw it performed in Tyre by an old pilot on a boy of thirteen years of age. The case did well.
SECT. LXI.—ON THE PARTS ABOUT THE TESTICLES.
As contributing to the understanding of the operations on herniæ, we shall premise a description of the parts about the testicles. The testicle itself is a glandular and friable substance, formed for the production of semen. The substances called parastatæ and cremasteres, are processes from the membrane of the spinal marrow, descending along with the arterial vessels in the testicles, by which the semen is injected into the pudendum; the spermatic vessels are veins from the vena cava passing to the testicles in a convoluted manner, and by them the testicles are nourished. The tunica vaginalis (erythroides or elytroides?) is of a nervous nature; at the convex and anterior part not adhering, but at the concave and posterior parts united to the testicle, deriving its origin from the peritoneal coat. This part, where it is united to the testicle, they call the posterior adhesion. The darti are membranes connecting the external skin to the tunica vaginalis, being united to it at the part where it is united behind to the testicle. But that wrinkled skin which forms an external covering to the testicles is called the scrotum.
Commentary. Celsus gives a similar description of the parts connected with the testicles. The testicles themselves, he says, consist of medullary matter and possess no sensibility of their own, but experience violent pains and inflammations from the membrane which surrounds them. They hang from the groins by nerves called cremasters by the Greeks, with each of which descend two veins and arteries. These are covered by a thin nervous white coat, without blood, called elytroides by the Greeks. (This must be the tunica vaginalis of modern anatomists.) Above it is a stronger tunic which adheres strongly to the inner at its lower part, and is called dartos by the Greeks. (This appears to be the cremaster muscle of modern anatomists.) The veins, arteries, and nerves are surrounded by many small membranes. (By these he seems to have meant the fasciæ from the aponeurosis of the external oblique muscle.) All these parts are covered by an external investment called the scrotum. (vii, 18.)
Ruffus Ephesius says that the scrotum is a loose substance in which the testicles are placed, being in particular fleshy externally; that it consists of two tunics, the external being corrugated and called dartos, and the internal being called erythroides (elytroides?). The dartos and scrotum connect the testicles to the parts above, but the erythroides (vaginalis?) is united to and surrounds the testicle itself. (De Corporis Humani partium appellationibus, ii.)
Oribasius describes the cremasters as being two muscles which descend from the groins and surround the tunica vaginalis. (Anatomica ex Galeno.) (This is very similar to Cloquet’s description of them.)
Theophilus’s description unfortunately has come down to us very incomplete. (De Fabricâ Hominis, v, ad finem.)