[Reprinted from The Medical News, August 6, 1892.] 
GONORRHEA OF THE VESICUL/f SEMIN ALES. 
By C. S. HOFFMAN; M.D., 
OF KEYSER, W. VA. 
From a case that I have had under observation for 
the last eighteen months I have felt satisfied that there 
is a disease of the seminal vesicles which has not yet 
received the degree of attention that it should, and an 
article published in The Medical News of May 7th, 
by Dr. F. B. Robinson, of Chicago, has led me to publish 
the following case: 
In September, 1890, I was called to see Mr. L. A., 
fifty years old, married, and with whom I was well ac- 
quainted. ' He had always been very stout and hearty. 
He had never had any disease of his genito-urinary 
apparatus. I found the man suffering with a severe 
attack of gonorrhea, with epididymitis and orchitis of 
the left testicle. The gonorrhea was of about two weeks' 
standing; the orchitis and epididymitis of about three 
days' standing. The constitutional symptoms were such 
as would naturally accompany this combination of dis- 
eases. There was pouring from the urethra a copious 
muco-purulent discharge. No microscopic examination 
of the pus was made, but there could be no question 
from the history of the case, the symptoms, and dis- 
charge, that the disease was anything but a virulent 
case of neglected gonorrhea. 
The gonorrhea yielded to treatment very slowly, from 
eight to ten weeks elapsing before the discharge had 
finally ceased. The inflammation of the testicle and 2 
epididymis subsided in from seven to ten days, although 
the man at times yet complains of pain in the testicle. 
After the acuteness of the attack had somewhat sub- 
sided, another source of annoyance developed in the 
form of a heavy, aching pain located deeply in the peri- 
neum. The pain was described as a sore, heavy, aching 
feeling, especially aggravated by standing for any length 
of time. It was also increased when the rectum became 
full of feces. The patient could hardly sleep at night 
until toward morning, when he would get somewhat 
easier. He could not sit flat down on a chair, owing to 
the aggravation of the pain by the pressure. The pain 
would be very annoying for one, two, or three weeks, 
and then there would sometimes be an intermission of 
a few days of less suffering, but never entire relief. For 
the first week or two after this last trouble developed, 
micturition may have been somewhat more frequent; 
on this my notes are deficient; but after this date the 
urine was not passed oftener than natural. 
Supposing, from the symptoms, that inflammation of 
the prostate gland had developed, I employed appropri- 
ate treatment for some time without any improvement. 
On making a careful examination with my finger in the 
rectum, I found the prostate gland perfectly normal in size 
and not painful to pressure; but just back of it I could, on 
each side of the base of the bladder, clearly distinguish 
two bodies, longer than wide, which corresponded in 
location with the seminal vesicles, and which were ex- 
quisitely sensitive to touch. With a sound in the blad- 
der and my finger in the rectum, I could positively 
locate them. Moving the sound in other directions in 
the bladder and pressing against it with my finger in the 
rectum would occasion no suffering, even when I would 
press the prostate gland between the two; but as soon 
as I would catch the seminal vesicles between the sound 
and my fingers, the patient would give indications of in- 
tense pain. Notwithstanding all that I could do in the way 3 
of treatment, the man made but very little improvement. 
He was, however, able to keep at work as a carpenter, 
though with much suffering, and he would occasionally 
have to stop for a day or two and lie down. In the 
spring of 1891, I advised him to consult a celebrated 
professor of surgery in one of our best medical schools 
for examination and treatment. He returned, saying 
that the professor made three examinations, and told 
him the disease was an inflammation of the base of the 
bladder, and for the cure of it prescribed salol and oleo- 
resin of cubebs in capsules three times a day. 
From this treatment the man derived no benefit, 
although he gave it a thorough trial. I have made 
repeated examinations with my finger and sound as 
described, and have always found the prostate gland of 
normal size and not painful; while reaching further back 
and pressing on the seminal vesicles, the pain was very 
acute, and especially so on the right side. I could never 
detect any fluctuation. To touch, the vesicles appeared 
swollen and harder than it appeared to me they should 
be in health. At present, this man is not entirely well, 
but for the past four or five months he has been gradu- 
ally improving, and now rarely complains of his dis- 
ease unless his work requires him to stand much for 
several days. That this disease was not a disease ot 
the bladder is evident by the absence of trouble in mic- 
turition, which was neither frequent nor painful; nor 
has there been tenderness on pressing the bladder above 
the pubes, or with the sound in the bladder, except when 
counter-pressure was made over the vesiculee seminales. 
The prostate gland could not have been the seat of 
the trouble, else it would have been either enlarged or 
painful on pressure. 
That the seminal vesicles were the seat of the disease 
is evident from the location, from the sensation and the 
pain elicited on pressure, and that the inflammation in 
them was caused by the gonorrhea seems clear from the 4 
history of the case. Dr. Robinson says it follows ure- 
thritis and generally exists with epididymitis. In this 
case it followed the urethritis, but did not develop until 
the epididymitis began to improve. 
I find no mention made of any disease of the seminal 
vesicles in four of the five standard text-books on sur- 
gery in my library. Wyeth's Surgery, second edition, 
only mentions " that the inflammatory process may ex- 
tend to the seminal ducts.'' In Bumstead & Taylor's 
work on Venereal Diseases, fifth edition, a short article 
is given to " Gonorrheal Inflammation of the Vesiculae 
Seminales," in which the authors rely chiefly upon the 
statements of others for a description of the disease. In 
the course of this article it is said : " Inflammation of the 
vesiculae seminales can rarely be diagnosticated with ab- 
solute certainty during life; ' ' while I feel from the history 
of this case, as I have here related it, that with care it is 
possible to arrive at a correct diagnosis. 
From a careful study of this case I have been im- 
pressed with the conviction, and especially since read- 
ing the article of Dr. Robinson, that gonorrhea of the 
vesiculae seminales is probably of more frequent occur- 
rence than it is recognized to be. The affection is 
probably often diagnosticated and treated as a disease 
of the prostate gland or base of the bladder.