SECT. LXIV.—ON CIRSOCELE AND PNEUMATOCELE. When the vessels about the scrotum or darti are in a varicose condition, they are called simply varices, but if the nutrient vessels of the testicles be in a varicose state, the affection is named cirsocele. The symptoms of it are obvious. There is a collection attended with swelling, and somewhat curved, of a botryoidal shape, and accompanied with relaxation of the testicle. It also occasions certain inconveniences, especially in running, exercising, and walking. We may operate upon it thus. After putting the patient in a convenient posture, we must lay hold of the scrotum and push the cremaster to the under part; it is easily distinguished from the vessels, being more slender, firmer, and elastic, as being strong and firm; the patient also feels pain upon pressure, and moreover it is connected with the penis. Having secured the vessels in the scrotum by our own fingers and those of our assistant, and stretching them strongly, we press obliquely the point of a scalpel direct upon the vessels; then having transfixed the parts with hooks and dissected what lie under the skin, and having exposed the vessels, as mentioned in the operation of angiology and that for aneurism, and pushing through them a needle having a double thread, and cutting the loop of the thread, we tie the ligatures round the vessels where the varices arise and where they terminate, and make a straight incision in the intermediate space. Having evacuated the blood collected in the tumour, we apply the treatment for suppurations until the ligatures with the vessels themselves fall out of their own accord. Leonides says, that when a few of the vessels which nourish the testicles are in a varicose state this operation should be performed, but that when all are affected, the testicle should be cut out along with them, lest being deprived of its nutrient vessels it should decay. Pneumatocele being a species of aneurism, Leonides forbids us to operate upon it for fear of a hemorrhage, which cannot be restrained from taking place at the time; but, there being two kinds of it, the one occasioned by the four vessels which nourish the testicle, and the other by the arteries of the darti and scrotum being affected, the moderns refrain from meddling with the latter, but operate upon the former. We distinguish them from one another, inasmuch as that which arises from the arteries is easily made to disappear upon pressure with the fingers, whereas that from the nutrient vessels of the testicles, not at all or with much trouble. We operate upon it as for cirsocele, taking up each of the veins and securing it with a thread. * * * * *