Of a hydrocele.
If there be a fluid within the membranes, an incision must be made, in boys upon the groin, unless too large a quantity of fluid forbid the operation in that place; but in men, and where-ever there is a large quantity, the scrotum must be opened. Then if the incision be made in the groin, the coats must be drawn out at that part, and the humour evacuated; if at the scrotum, and the disease be immediately below that coat, there is no more required but to evacuate the humour, and cut away any of the membranes, that happen to contain it; then it must be washed with water, and an addition either of salt, or nitre: if the disease lie within the middle or innermost coat, they must be taken entirely out of the scrotum and cut off.
CHAP. XXII. OF A RAMEX IN THE SCROTUM.
A ramex situated upon the scrotum must be cauterized with small and sharp irons run into the veins themselves, provided they burn nothing else: it is peculiarly necessary to apply the cautery where they are twisted and rolled together; afterwards meal mixed up with cold water must be laid on; and the bandage must be applied, which I recommended for the anus; on the third day lentils with honey must be put to it: after the separation of the eschars, the ulcers must be deterged with honey, embrocated with rose oil, and brought to cicatrize by dry lint. Where the veins above the middle coat swell, the groin must be cut, and the coat brought without the orifice; after which the veins are to be separated from it by the finger, or the handle of the knife, and where they adhere, tied both above and below by a thread; then they must be cut through close to the ligatures, and the testicle replaced. But if the ramex be situated upon the innermost coat, it is necessary to cut out the middle one. And then if two or three veins swell, so that some part be affected, but the greater part be from the disease, the same method must be pursued as directed above; that is, the veins being tied both at the groin and testicle, may be cut off, and the testicle reduced to its place. But if the ramex have seized upon the whole of it, the fore finger must be introduced through the wound, and put under the veins, so as to draw them out gradually and uniformly, till the one testicle be equal to the other; then fibulæ are to be put in the lips in such a manner, as to lay hold of these veins likewise. It is done thus. A needle passes through the lip from the external part, and then is directed not through the vein itself, but its membrane, and from thence is forced into the other lip. The veins ought not to be wounded, lest they discharge blood. There is always a membrane between these veins, which occasions no danger, and holds them fast enough, when taken up by the thread: and therefore two fibulæ are sufficient. After this, whatever veins have been brought out, should be returned into the groin with the broad end of the probe. The time for loosing the fibulæ is, when the inflammation is gone, and the ulcer deterged; that the cicatrix may at once bind up both the lips and the veins.
When the ramex has grown between the innermost coat, and the testicle itself and its nerve, the only cure is to cut off the whole testicle: for it does not in the least contribute to generation, and hangs down in all indecently, in some even with pain. But in this case too, an incision is to be made in the groin, and the middle coat must be drawn out and cut away; the innermost one is to be treated in the same manner; and the nerve, by which the testicle depends, to be cut off. After this, the veins and arteries must be tied by a thread at the groin, and cut off below the ligature.
CHAP. XXIII. OF A SARCOCELE.
If flesh happen to grow between the coats, it must certainly be taken out; and the most convenient way of doing it is by an incision in the scrotum.
But if the nerve be indurated, the disorder cannot be cured either by the hand or medicines. For the patients are oppressed with ardent fevers, and either green, or black vomitings, besides these a violent thirst, and roughness of the tongue; and generally about the third day, frothy bile is discharged by stool, which excoriates the parts; and food can neither be easily taken or retained; not long after, the extremities grow cold, a tumour comes on, the hands are expanded involuntarily; then comes on a cold sweat in the forehead, which is followed by death.