JESSOKE DISPENSARY. ELEPHANTIASIS OF SCROTUM AND PENIS?AMPUTATION.

By Sub-Assistant Surgeon Unnoda Churn Kastagbee. Gobind Chandba Bhatacharjia, a Hindoo Brahmin of Jessore, aged 30 years, in pretty good health, was admitted into the Jessore Dispensary with the above complaint on the 20th July 1873. He had been suffering with it for the last 3 years. Does not recollect to have heard of the complaint being hereditary in his family, either on the father's or the mother's side. Patient suffered with a kind of fortnightly fever, which came on with shiverings generally, witliiu 5 days of the new or the full moon, and lasted for 10 or 12 hours each time The attack was attended with some tenderness, and followed after every paroxysm with some perceptible and permanent

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THE INDIAN MEDICAL GAZETTE.

enlargement or hypertrophy of the scrotum and skin of the penis, which alarmed him. 21 st.?I removed the tumour this morning under chloroform ; the penis and both the testicles were preserved. The amputated tumour weighed 2ft>s., and the hypertrophied skin consisted of the elastic and white fibrous tissue, with a large quantity of albuminous substance in a semi-fluid state infiltrated into the cellular tissue. Ten arteries were ligatured, and a few were also twisted, and the parts were dressed with carbolic oil and lint, and supported by a suspensory bandage. A laudanum draught was given internally to soothe the pain. Six hours after the operation, two of the twisted arteries commenced to bleed, and they were again ligatured. 22ncl July.?Had fever at night: pulse 120; heat 103?. Ordered aconite mixture every two hours. 24th July.?Intermission only this morning : quinine pill (4 grs.) three times a day : rum 4drs. morning and evening. 29th.?Ulcer cleaning out. Basilicon dressing. Continue rum and quinine. 31s?.?Strong attack of fever last night, attended with delirium, and pain on the left side of the chest; sore angry-looking. Aconite mixture every 2 hours j caustic lotion to be applied to the sore. 3rd August.?Fever only left this morning. Eepeat quinine and rum twice daily. Basilicon dressing. 5th August.?Sore healthy and granulating ; a small bit of skin snipped out from the inside of thigh, cut into five smaller bit3 and engrafted on the sore. Strapped and bandaged. 7th.?The grafts have sloughed, and have been washed out with the discharges. 10th.?The sore rapidly contracting and cicatrizing from the margin of the wound. Patient out of all danger. Remakes.?1. In Hindu medical works a fever is recognized, called Shattajjioar or Hat Shercijjivar, which attacks certain individuals generally during the full or the new moon from a peculiar taint or local defective condition of the scrotum, or the lower extremities, which become swollen and tender at every attack of the fever, which again partakes of the character of malaria in having three prolonged but distinct stages of the single paroxysm. In some the local swelling and tenderness disappear within three or four days after the fever has left; in others, the swelling continues permanently, and increases more and more with every succeeding attack, and this developes to what is known by the term elephantiasis. I share in the belief, which Hindus have, of the exciting cause of the disease being the local taint or weakness, and its predisposing cause being the influence of the sun and the moon disturbing the fluids of the body as the tides, and determining the periodic attack. I was myself subject to the first kind of the fever for nearly 15 years, and so was my father ; and I have therefore the strongest reason for believing in the existence of the influence of the planet during the full and the new moon in producing the attack. 2nd.?Referring to the engrafting of the skin from the thigh on the granulating surface, I am not aware if this expedient lias been tried in Bengal. Considering the length of time (sometimes 3 or 4 months) taken for the complete cicatrization of the extensive sore, and the risk to life from suppuration and pyaemia, even 3 or 4 weeks (Dr. Fayrer's cases) after the operation, it is very desirable that surgeons should endeavour to discover some plan for expediting the cicatrization.* 3rd.?The last point I wish to notice in this case is the remarkable effect of aconite in steadily subduing the very high fever, which on one occasion was so great that I thought it would carry off the patient.

* Skin engrafting in cases of amputated scrotal tumours lias, we believe, been practiced on a large scale in the Medical College Hospital, Calcutta,

and with excellent effect.?Eds., /. M. G,

I

[February 2,

1874.

Elephantiasis of Scrotum and Penis-Amputation.

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