A MIRROR OF HOSPITAL PRACTICE. CALICUT CIVIL HOSPITAL. CASES OF ELEPHANTIASIS SCROTI. Removed by Surgeon C. Lloyd, m.d., m.c., q.tt.i., &c., U. M.'s Indian
Army.
Muitmalen Aji Moplah, Mussulman, aged 27 years, was admitted into the Calicut Civil Hospital, Malabar, August 12th 1873, with a scrotal tumour of enormous dimensions, reaching to within three inches of the ground as the man stood erect, fifteen years in growth. Patient's statement.?The tumour commenced in the scrotum, noticeable at first by a slight thickening of its coats, afterwards increasing to an enormous size and involving the penis ; this increase of size, of late years, has been attended with periodical attacks of slight fever variable in its duration, usually appearing every month, and attendant on an appreciable increase in bulk of the affected part. Within the last two or three months there have been no febrile attacks. Is able to walk about with difficulty owing to the extreme weight he has to carry, which however he keeps supported to a considerable extent by the arrangement of his dress. Has performed three pilgrimages to Mecca to the shrine of the prophet, the last being only a few years since. Elephantiasis of both legs co-exists, but in one to a very slight degree. Patient's general health is good ; heart in a perfectly healthy condition. Description of Tumour.?The shape of the tumour is somewhat oval, pediculated at its upper end where it grows from the pubes, extending down (in the erect posture) to a level with the ankles, and concealing laterally much of the lower extremities. Surface is quite smooth; about the centre is an opening which leads up to the penis. Dimensions of Tumour are :?Around the neck at narrowest part, 14? inches circumference, transverse measurement 44 inches, vertical measurement 54 inches. 21s?.-? I removed the growth with the assistance of August Dr. Pout, H. M. 43rd L. I., several dressers giving good aid. tumour the elevrited by means of ropes for an hour Having kept some of the venous blood to drain allow to previously, away, the patient was put under chloroform, a soft twisted rope (about the thickness of a window sash line) provided with handles, having previously been passed round the neck of the and running through a steel ring acting as a tourniquet, was then tightened by assistants, effectually controlling the haemorr-
tumour^
hage.
The tumour was then lowered to a level with the man's body, and the operation proceeded with. into director a inserted the sinus leading to the Having urethra, a long deep vertical incision was made down to the and the with an amputating kuife, organ, which lay penis several inches deep from the surface, was exposed ; the knife was then introduced into the sinus on the director, and the hypertrophied prepuce silt up, disclosing the glans penis. Having removed the greatly thickened prepuce, the deeply lying penis was rapidly dissected out, and reflected on to the abdomen. A long deep incision was then made over the left testis along the direction of the cord, and the gland with a quantity of fluid was found contained in the thickened tunica vaginalis, which was detached from the testis and that organ dissected out and held upon the abdomen. The right testis was reached by a similar parallel incision, and, with the cord, dissected out and reflected ; a transverse incision then connected the two, and a few sweeps of the knife separated the growth. Ligatures were then applied to every bleeding point, betwen 30 and 40 having to be used. No subsequent htemorrhage took place. The penis and testes were covered with a weak solution of carbolic oil on lint: this formed the only application. The testes which reached, with their elongated cords, nearly to the knees were supported on a pillow and, with the penis, completely excluded from the air by the dressings. The weight of the tumour was found to be nearly 65R)s. including a quantity of fluid resembling serum drawn off. About seven weeks after the operation the patient was able to get up and walk about; the testes are now quite retracted to their normal length, and covered over with a sort of skin. Case II.?Sheik Hyath, Mussulman, aged 26, admitted September 13th into Calicut Civil Hospital with elephantiasis scroti of ten years duration. For two years past patient has not been able to stand, owing to the weight and dragging of the tumour, which has commenced, to ulcerate at its base, exuding a slight
watery discharge. At the patient's request
I determined to operate, though in the best health and had a slight cough ; still life was a burden to him on account of this huge growth, which would only tend to weaken him if allowed to remain. Accordingly, as in the other case, with Dr. Pout's assistance the tumour was successfully removed on the 18th September, about thirty ligatures having to be applied. The steps of this operation were similar to the preceding one, but one (the right) testicle having been found to be diseased was removed, and the vessels of the cord tied. The weight of this tumour proved to be 16ffis. The case did exceedingly well; complete recovery, and retraction of the remaining testicle rapidly taking place. he
was
not
Remabks.?This form of growth is occasionally seen in the United Kingdom. The largest tumour successfully removed in that counry was operated on by Mr. Liston in Edinburgh, both testes and penis having been removed. An interesting
of one weighing nearly 30 pounds is published from the pen of Dr. Diblin in the Transactions of the Medico Chirurgical Society for 1863; the man however died soon after the case
operation. Dr. Fayrer of the Calcutta Hospital in his Surgery in India" records a number of cases operated, aud with, on the entire, fair results.
work " Clinical in which he has
Army.
Muitmalen Aji Moplah, Mussulman, aged 27 years, was admitted into the Calicut Civil Hospital, Malabar, August 12th 1873, with a scrotal tumour of enormous dimensions, reaching to within three inches of the ground as the man stood erect, fifteen years in growth. Patient's statement.?The tumour commenced in the scrotum, noticeable at first by a slight thickening of its coats, afterwards increasing to an enormous size and involving the penis ; this increase of size, of late years, has been attended with periodical attacks of slight fever variable in its duration, usually appearing every month, and attendant on an appreciable increase in bulk of the affected part. Within the last two or three months there have been no febrile attacks. Is able to walk about with difficulty owing to the extreme weight he has to carry, which however he keeps supported to a considerable extent by the arrangement of his dress. Has performed three pilgrimages to Mecca to the shrine of the prophet, the last being only a few years since. Elephantiasis of both legs co-exists, but in one to a very slight degree. Patient's general health is good ; heart in a perfectly healthy condition. Description of Tumour.?The shape of the tumour is somewhat oval, pediculated at its upper end where it grows from the pubes, extending down (in the erect posture) to a level with the ankles, and concealing laterally much of the lower extremities. Surface is quite smooth; about the centre is an opening which leads up to the penis. Dimensions of Tumour are :?Around the neck at narrowest part, 14? inches circumference, transverse measurement 44 inches, vertical measurement 54 inches. 21s?.-? I removed the growth with the assistance of August Dr. Pout, H. M. 43rd L. I., several dressers giving good aid. tumour the elevrited by means of ropes for an hour Having kept some of the venous blood to drain allow to previously, away, the patient was put under chloroform, a soft twisted rope (about the thickness of a window sash line) provided with handles, having previously been passed round the neck of the and running through a steel ring acting as a tourniquet, was then tightened by assistants, effectually controlling the haemorr-
tumour^
hage.
The tumour was then lowered to a level with the man's body, and the operation proceeded with. into director a inserted the sinus leading to the Having urethra, a long deep vertical incision was made down to the and the with an amputating kuife, organ, which lay penis several inches deep from the surface, was exposed ; the knife was then introduced into the sinus on the director, and the hypertrophied prepuce silt up, disclosing the glans penis. Having removed the greatly thickened prepuce, the deeply lying penis was rapidly dissected out, and reflected on to the abdomen. A long deep incision was then made over the left testis along the direction of the cord, and the gland with a quantity of fluid was found contained in the thickened tunica vaginalis, which was detached from the testis and that organ dissected out and held upon the abdomen. The right testis was reached by a similar parallel incision, and, with the cord, dissected out and reflected ; a transverse incision then connected the two, and a few sweeps of the knife separated the growth. Ligatures were then applied to every bleeding point, betwen 30 and 40 having to be used. No subsequent htemorrhage took place. The penis and testes were covered with a weak solution of carbolic oil on lint: this formed the only application. The testes which reached, with their elongated cords, nearly to the knees were supported on a pillow and, with the penis, completely excluded from the air by the dressings. The weight of the tumour was found to be nearly 65R)s. including a quantity of fluid resembling serum drawn off. About seven weeks after the operation the patient was able to get up and walk about; the testes are now quite retracted to their normal length, and covered over with a sort of skin. Case II.?Sheik Hyath, Mussulman, aged 26, admitted September 13th into Calicut Civil Hospital with elephantiasis scroti of ten years duration. For two years past patient has not been able to stand, owing to the weight and dragging of the tumour, which has commenced, to ulcerate at its base, exuding a slight
watery discharge. At the patient's request
I determined to operate, though in the best health and had a slight cough ; still life was a burden to him on account of this huge growth, which would only tend to weaken him if allowed to remain. Accordingly, as in the other case, with Dr. Pout's assistance the tumour was successfully removed on the 18th September, about thirty ligatures having to be applied. The steps of this operation were similar to the preceding one, but one (the right) testicle having been found to be diseased was removed, and the vessels of the cord tied. The weight of this tumour proved to be 16ffis. The case did exceedingly well; complete recovery, and retraction of the remaining testicle rapidly taking place. he
was
not
Remabks.?This form of growth is occasionally seen in the United Kingdom. The largest tumour successfully removed in that counry was operated on by Mr. Liston in Edinburgh, both testes and penis having been removed. An interesting
of one weighing nearly 30 pounds is published from the pen of Dr. Diblin in the Transactions of the Medico Chirurgical Society for 1863; the man however died soon after the case
operation. Dr. Fayrer of the Calcutta Hospital in his Surgery in India" records a number of cases operated, aud with, on the entire, fair results.
work " Clinical in which he has
