A MIRROR OF HOSPITAL PRACTICE. CASE OF ELEPHANTIASIS OF By Surgeon H. D.
SCROTUM. Cook, M.D.,
Civil Surgeon, Vellore. Abdool Rhyma Cooty, Moplah, age 40, came to me from Ponany, Malabar, on the 20 th May 1880, with the above disease, and requested its removal. For a description of the tumour, I refer the reader to the photograph taken before the operation by an amateur native photographer, and through the kindness of Mr. Whiteside, the Collector of the district, who took a great interest in the case.* the circumference of the tumour was not be well judged by the photograph. I may say that the tumour was large enough in circumference to be encircled by the fore-arms of the patient; it was most unusually hard and consequently very heavy, the lower portion especially was as hard as a stone. The man could scarcely walk any distance, and, as it can be seen by the photograph, his legs were much apart. There was no appearance of a penis ; the meatus was only visible, but by manipulation about an inch of the organ could be protruded, which was a great guide to me when dissecting out the organ. The testicles were to be felt: the right much enlarged and intensely hard, and the left slightly enlarged but not hard. The man's general health was fair. As I was examining the patient, Dr. H. Scudder of the American Mission, Ranipett Dispensary, came to see me, and he kindly volunteered his assistance, as also did Dr. Faucett of the 25th N. I. after I informed him of the case; and to him I am greatly indebted, as he was, I believe, the means of saving the man's life at a very anxious moment. The operation was performed on the 26th May 1880 after the man had been to some shrine to invoke his deity to protect him from the danger he was about to encounter. Chloroform having been administered, the Esmarch bandage was firmly bound round the tumour that lay like a mountain on the operating table, and it was with some difficulty that the bandage was applied to the unwieldy mass. Before the tubing was applied around the neck of the tumour, I dissected out the penis and laid it upwards on the abdomen, and then the tubing was firmly applied underneath the penis, each end being held by an assistant. I then proceeded to dissect out the right testicle, which was the most difficult part of the operation, as it was deeply imbedded in the hard gristle-like nature of the tissue of the tumour ; and it was firmly adherent to the surrounding tissue. The welling up of venous blood at this stage was great, but very little arterial blood was lost; a few small arteries, which were not compressed by the Esmarch tubing, spouted, and were immediately twisted. The right testicle having been got out, Dr. Scudder relieved me of the knife and proceeded to dissect out the left, which was a comparatively easy business, as it was not deeply imbedded, and had little or no adhesions. At this stage the man suddenly got collapsed, his pulse quite imperceptible and respiration suspended, and it was with a sad heart that " I exclaimed he is done for," but Dr. Faucett was not so and he immediately resorted to artificial ; hopeless respiration assisted by Dr. Scudder, and finally on Dr. Faucett withdrawing the tongue and working well on the chest, the Dr. Scudder's finger, which was the first patient bit sign of life. He revived somewhat, and I immediately with the operation, which now consisted of removproceeded ing the enormous mass as it lay divested of penis and testicles. We decided to take away the right testicle as it was diseased, I accordingly transfixed the enlarged chord with an aneurism needle, ligatured it and then removed it. I then removed the mass by making two sides flaps which were brought together, and so no raw surface was exposed. The result was all that could be desired, the flaps uniting underneath the penis. I regret a photograph was not taken after the
Unfortunately
taken, but this
can
* The photograph shows an immense pear-shaped tumour the circumthat of the patient's fundus is as large as ference of whose waist reaching down to the calf of the leg in the erect posture. The is situated is imbedded orifice below the pubes. ; the preputial penis The scrotal raphe is very prominent, and the surface uneven and tuber/. M. G. culated.?Ed.
270
THE INDIAN MEDICAL GAZETTE.
the man went away suddenly during my temporary absence from the station. The tumour when removed weighed f?4 pounds. The man had two severe attacks of secondary hoemdrrhage, which weakened him considerably, but lie is now quite well, and was discharged from hospital on the 23rd July 1880.
operation;
lie marks. If I have to perform this operation again, (which is exceedingly likely) I Would in the first place pay much greater attention to the evacuation of the blood in the tumour before removal. Secondly.?I would elevate the tumour^ by means of a rope suspended from the ceiling and let it be in that position for 12 hours. By this means the tumour would be comparatively emptied of blood, and in that position I would dissect out the penis and then apply the Esmarcli bandage. Thirdly.?I would have no flaps of skin. I would leave the testicles exposed and remove the tumour en masse. The penis would be dissected up, the testicles dissected out, and then by one sweep of the knife remove every thing; new skin would I fancy soon form. Fourthly.?I would see that my Esmarch bandage was in a good condition. In this country this appliance is very apt to get out of order, and lose its elasticity. In this case, in the middle of the operation, the tubing gave way, but fortunately only one turn of it: and before the last turn "gave" we caught hold of both ends. If all the turns had given way, the rush of blood would have been serious if not fatal.
[October 1;
1880-
SCROTUM. Cook, M.D.,
Civil Surgeon, Vellore. Abdool Rhyma Cooty, Moplah, age 40, came to me from Ponany, Malabar, on the 20 th May 1880, with the above disease, and requested its removal. For a description of the tumour, I refer the reader to the photograph taken before the operation by an amateur native photographer, and through the kindness of Mr. Whiteside, the Collector of the district, who took a great interest in the case.* the circumference of the tumour was not be well judged by the photograph. I may say that the tumour was large enough in circumference to be encircled by the fore-arms of the patient; it was most unusually hard and consequently very heavy, the lower portion especially was as hard as a stone. The man could scarcely walk any distance, and, as it can be seen by the photograph, his legs were much apart. There was no appearance of a penis ; the meatus was only visible, but by manipulation about an inch of the organ could be protruded, which was a great guide to me when dissecting out the organ. The testicles were to be felt: the right much enlarged and intensely hard, and the left slightly enlarged but not hard. The man's general health was fair. As I was examining the patient, Dr. H. Scudder of the American Mission, Ranipett Dispensary, came to see me, and he kindly volunteered his assistance, as also did Dr. Faucett of the 25th N. I. after I informed him of the case; and to him I am greatly indebted, as he was, I believe, the means of saving the man's life at a very anxious moment. The operation was performed on the 26th May 1880 after the man had been to some shrine to invoke his deity to protect him from the danger he was about to encounter. Chloroform having been administered, the Esmarch bandage was firmly bound round the tumour that lay like a mountain on the operating table, and it was with some difficulty that the bandage was applied to the unwieldy mass. Before the tubing was applied around the neck of the tumour, I dissected out the penis and laid it upwards on the abdomen, and then the tubing was firmly applied underneath the penis, each end being held by an assistant. I then proceeded to dissect out the right testicle, which was the most difficult part of the operation, as it was deeply imbedded in the hard gristle-like nature of the tissue of the tumour ; and it was firmly adherent to the surrounding tissue. The welling up of venous blood at this stage was great, but very little arterial blood was lost; a few small arteries, which were not compressed by the Esmarch tubing, spouted, and were immediately twisted. The right testicle having been got out, Dr. Scudder relieved me of the knife and proceeded to dissect out the left, which was a comparatively easy business, as it was not deeply imbedded, and had little or no adhesions. At this stage the man suddenly got collapsed, his pulse quite imperceptible and respiration suspended, and it was with a sad heart that " I exclaimed he is done for," but Dr. Faucett was not so and he immediately resorted to artificial ; hopeless respiration assisted by Dr. Scudder, and finally on Dr. Faucett withdrawing the tongue and working well on the chest, the Dr. Scudder's finger, which was the first patient bit sign of life. He revived somewhat, and I immediately with the operation, which now consisted of removproceeded ing the enormous mass as it lay divested of penis and testicles. We decided to take away the right testicle as it was diseased, I accordingly transfixed the enlarged chord with an aneurism needle, ligatured it and then removed it. I then removed the mass by making two sides flaps which were brought together, and so no raw surface was exposed. The result was all that could be desired, the flaps uniting underneath the penis. I regret a photograph was not taken after the
Unfortunately
taken, but this
can
* The photograph shows an immense pear-shaped tumour the circumthat of the patient's fundus is as large as ference of whose waist reaching down to the calf of the leg in the erect posture. The is situated is imbedded orifice below the pubes. ; the preputial penis The scrotal raphe is very prominent, and the surface uneven and tuber/. M. G. culated.?Ed.
270
THE INDIAN MEDICAL GAZETTE.
the man went away suddenly during my temporary absence from the station. The tumour when removed weighed f?4 pounds. The man had two severe attacks of secondary hoemdrrhage, which weakened him considerably, but lie is now quite well, and was discharged from hospital on the 23rd July 1880.
operation;
lie marks. If I have to perform this operation again, (which is exceedingly likely) I Would in the first place pay much greater attention to the evacuation of the blood in the tumour before removal. Secondly.?I would elevate the tumour^ by means of a rope suspended from the ceiling and let it be in that position for 12 hours. By this means the tumour would be comparatively emptied of blood, and in that position I would dissect out the penis and then apply the Esmarcli bandage. Thirdly.?I would have no flaps of skin. I would leave the testicles exposed and remove the tumour en masse. The penis would be dissected up, the testicles dissected out, and then by one sweep of the knife remove every thing; new skin would I fancy soon form. Fourthly.?I would see that my Esmarch bandage was in a good condition. In this country this appliance is very apt to get out of order, and lose its elasticity. In this case, in the middle of the operation, the tubing gave way, but fortunately only one turn of it: and before the last turn "gave" we caught hold of both ends. If all the turns had given way, the rush of blood would have been serious if not fatal.
[October 1;
1880-
