Of Medicine, in Eight Books

by Aulus Cornelius Celsus

CHAP. XVIII. A DESCRIPTION OF THE TESTICLES, AND THEIR DISEASES.

I now come to those diseases which arise in the private parts about the testicles: which, that I may the more easily explain, I shall first give a short account of the nature of the part. The testicles then have something resembling small glands[(22)]: for they do not discharge blood, and are void of all sensation; the coats, however[(23)], which contain them, are pained in wounds and inflammations. Now each of them hangs from the groin by a nerve (the vas deferens) which the Greeks call cremaster[ HK ]: and with each descends both a vein and an artery. And these are covered with a membrane, thin, nervous, not sanguineous, and white, which by the Greeks is called elytroides[ HL ]. Over that is a firmer coat, which adheres strongly in the lowest part to the interior one. The Greeks call it dartos[ HM ]. Besides, there are many small membranes, which inclose the veins and arteries, and those nerves; and betwixt the two coats in the superior part they are thin and open. Thus far then the coats and vessels are peculiar to each testicle. But there is a sinus common to both, and to all the internal part, which is also exposed to our view. The Greeks call it oscheum[ HN ]; in our language it is scrotum. And this in the lower part is slightly connected with the middle coats, above only envelopes them.

Under this then several disorders occur: which happen sometimes when these coats, which I said had their origin from the groin, are ruptured; at other times, when they are entire: for sometimes the coat, which ought to separate the intestines from the inferior parts, is either first inflamed from a distemper, and afterwards burst by the weight, or ruptured at once by some wound. Then either the omentum alone, or that and the intestine together, fall down into it by their own weight. And finding a way there, they bear down gradually from the groin upon the inferior parts, and by and by divide the nervous coats, which, for the reason I gave before, are open. The Greeks call these enterocele[ HO ] and epiplocele[ HP ]: with us an indecent, but common name for them is hernia.

Now if the omentum descends, the tumour in the scrotum is never removed either by fasting, turning the body one way or another, or placing it in any particular posture; and if the breath be kept in, it is not much increased, is unequal to the touch, and soft and slippery.

But if the intestine also descends, the tumour without any inflammation sometimes lessens, at other times increases, and it is generally free from pain, and when a person is at rest, or lies down, it sometimes entirely subsides, at other times it is so diminished, that a very small part of it remains in the scrotum; but upon vociferation, or repletion, and a violent exertion of force in bearing a great weight, it increases: by cold it is contracted, by heat dilated; and at that time the scrotum is both round and smooth to the touch, and what lies within is slippery; if it be pressed, it returns to the groin; and being let go, it rolls down again with a murmuring kind of noise, and this happens in the lesser degrees of this malady. But sometimes from the reception of excrements, the swelling is vastly enlarged, and cannot be reduced; and occasions pain at such times to the scrotum and groin, and abdomen. Sometimes too the stomach is affected, and throws up first reddish coloured bile, then green, and in some even black.

Sometimes the membranes being entire, a fluid distends this part: and there are also two species of this. For it either collects between the coats, or in the membranes, which surround the veins and arteries in that part, when they are oppressed, and have grown callous. Neither has that fluid betwixt the coats one certain seat: for sometimes it lodges between the external and middle, sometimes betwixt the middle and internal coat. The Greeks call this by the general name of hydrocele[ HQ ], of whatever species it be. Our countrymen, not being acquainted with any distinctions, include this also under the same name as the former disorders.

Now in these there are some symptoms, that belong to all, and others, that are peculiar to each particular species. The general are such as indicate the collection of a fluid; the particular, its seat. We know a fluid is contained within, if there be a tumour, that never disappears entirely, but is sometimes lessened by fasting, or a slight fever, and chiefly in children. And this is soft, if there is not a very great quantity of fluid within; but if it has greatly increased, it resists like a bottle filled, and tightly tied; the veins in the scrotum also are inflated; if we press upon it with our finger, the fluid yields, and fluctuating raises the part that is not pressed; and it appears through the scrotum, as if it were in a glass or a horn; and in itself is attended with no pain. The seat of it is thus known: If the water be betwixt the external and middle coat, when we press with two fingers, it gradually returns between them; the scrotum is somewhat lax and whitish; if it is stroked, it stretches little or nothing; the testicle can neither be seen nor felt in that part. But if it is within the middle coat, the scrotum is more stretched and raised higher, so that the penis above it is concealed under the swelling.

Besides these, when the coats are equally entire, a ramex grows there. The Greeks call it cirsocele[ HR ], when the veins swell. These being sometimes twisted, and rolled up toward the superior part, fill either the scrotum, or the middle coat, or the innermost one; sometimes they grow even within the innermost coat about the testicle itself and its nerve. Those that are in the scrotum itself are exposed to view; and those which lie upon the middle or innermost coat, as being deeper, are not indeed equally discernible, but yet are visible; besides that there is both some swelling, according to the size and capacity of the veins, and it also resists pressure more, and is unequal by reason of the varicous dilatations of the veins; and on that side where it is, the testicle is more dependent than it should be. But when this malady has grown upon the testicle itself and its nerve, the testicle hangs down much lower, and becomes less than the other, as being deprived of its nutriment.

Sometimes, though seldom, flesh grows between the coats. The Greeks call that sarcocele[ HS ].

Sometimes too the testicle itself swells from an inflammation, and also brings on fevers; and unless the inflammation has quickly ceased, the pain reaches to the groin and ilia; and these parts swell, and the nerve, by which the testicle hangs, is enlarged, and grows hard at the same time.