spermatic cords. Lungs enlargement of spleen or liver. of the
A MIRROR OF HOSPITAL PRACTICE.
MEDICAL COLLEGE HOSPITAL. AN ENORMOUS OP
THE
ELEPHANTOID
SCROTUM;
TUMOUR
SUCCESSFULLY
BEMOVED.
[Under
the
care
of Surgeon-Major
tridge, F.R.C.S. Reported hj Gopal Chunder Chatekjee, Lattoo Paul,
S. B. Par-
Assistant-Surgeon House Surgeon.~\
Hindoo male aged 55 years, resident of Burrabazar, by occupation a shop-keeper, was admitted into Dr Partridge's ward, with a large scrotal tumour, on 10! h November 1879. History.? The patient noticed enlargement of the left testicle while he was 13 years old ; it was quite pain'ess then. After a year he also noticed slight enlargement a
of the other testicle, but he cannot state when the thickening of his scrotum commenced. Within these two years his scrotum assumed the size of a child's head, and continued so till the 45ih year of his age. During the last nine years the tumour has been growing, and for the last three years the enlargement has been very rapid. With the enlargement of the scrotum the patient has
been getting fever off and on, but the attacks have exhibited no periodicity. He has enjoyed fair health throughout his lifo, except occasional disturbance from fever. He had soft chancre about thirty years back, and also suppurative bubo; denies having had any pain in the joints, sorethroat, skin disease or any other indication of constitutional syphilis. He took no mercury for the venereal complaint. About thirteen years back he had gonorrhoea, from which he suffered off and on with orchitis and inflammation of the spermatic cords; urethral discharge ceased about He is not in the habit of seven or eight years back. taking any spirits, wines, or U3ing any intoxicating dru.'. Condition on admission.?-The patient is fairly nourished; his scrotum is enormously enlarged. The penis is embedded in the substance of the scrotum ; it can hardly be distinguished. The tumour is wide, its vertical and transverse diameters are almost equal; the antero-posterior diameter is rather smaller than the other two ; the mass is therefore somewhat flattened laterally. When the patient stands up the tumour comes down to within 6 inches from the ground. He cannot stand erect; keeps his knees somewhat flexed and everted to make room for the tumour. He can manage to lift up the scrotum and stand : can walk about half a mile with difficulty. The consistency of the tumour is rather hard : skin over it is somewhat cedematous, rough, and in places ulcerated. There is a distinct furrow, more or less semi-circular, about the middle of the tumour anteriorly indicating the orifice of the elongated prepuce: has a few superficial sores on the scrotum which were caused by rat bites ! The testicles cannot be felt. The root of the tumour or its .attachment to the pubis i* rather broad. Sensation of the integument is not acute. No fulness in.the inguinal canals: W hernia can. bo> felt i has a dragging pain, in the course _
and heart sound : no Micturation free; the urine runs down by the side of the tumour : makes water about five or six times a day : urine normal in quantity,and does not contain albumen or sugar. Power of digestion fair : bowels move regularly : no purulent discharge from the urethral passage. His weight (with the tumour) is lbs. 276. A drawing of the tumour was made and deposited in tlio Medical College Museum. Operation.?The patient was kept quiet in bed for four days after admission, and then he was operated on, on the 14th November 1879. He was placed on the operating table, and the tumour was kept raised for about half an hour before the operation; an elastic bandage was then wound round the tumour, but not very tightly, as it was considered undesirable to embarrass the circulation by driving an excess of blood into the vessels. Chloroform was administered, and a leather belt was applied round the waist of the patient. After this a strong India rubber cord was wound round the root or neck of the tumour and made fast to the waist belt by tapes so as to draw it well beyond the hypertrophied scrotum. The tumour was thus partially emptied of blood by the elevation and elastic bandage, and cut off from the circulation by the rubber cord The elastic bandage was then removed. A long director was introduced into the elongated prepuce, and by a long incision the penis was exposed ; the organ was tiien dissected out of the hypertrophied scrotum and held out of the way by an assistant. After this, two lateral incisions were made on each side of the scrotum, and were carried deep into the substance of the tumour to extricate the testicles. The patient lost no arterial blood ; across and bled : a few large venous sinuses were cut controlled were these by bull-dog forceps. The whole mass was finally removed by a few bold The incisions. operation up to this point was completed in seven minutes. Thus, the penis and both the testicles were saved. The spermatic cords were unusually long and thick ; the cremaster muscles were greatly developed. There were about 4 or 5 ounces of straw coloured serum in the eight tunica vaginalis ; openings The arteries enwere made into both tunic? vaginales. tering into the tumour were not very numerous, but some of them were very large, and a few were quite as largo 64 catgut ligatures were used to tie the as the radial bleeding vessels. The patient lost only about 5 or 6 the operation. The testicles ounces of blood during were then placed in proper position, the edges of the wound were kept everted by means of stitches, and the whole wound was washed with hot water and dressed with boracic dressings. The weight of the tumour after operation was 111 lbs. (exclusive of the serum and blood which escaped from it). Progress.?The patient suffered from shock for about 7 hours, and he then began to rally ; the temperature was QS'S3 F. ten minutes after operation and in the evening at 5 r. M. it rose to 100? F.; his pU]se was pretty full (108), an I respirations 25 in a minute. There was nobleeding from the wound except slight oozing, which was not even sufficient to soak the dressings. Severe dragging pain was complained of at night, when the patient lie was unablo was very thirsty and somewhat restless. to pass water for the first three days after operation, when his bladder was relieved by gum-elastic catheter. On the morning of the 16th November 1879, the third day of operation, his temperature came down to the normal, and continued so up to- the 9th December, with slight rise in On the 10th of December he had a the evening. vigor followed by a rise of temperature in the evening to 105?, it then became normal three days after, and ever since he has been free from febrile disturbance. His bowels began to be irritable on the fourth day ot' operation^ and continued so off and on until the loth of December ; since that date they have been quiet and his appetite fair. The woun l was very large, an 1 remained sloughy for .
January 1,
1880.]
A MIRROR OP HOSPITAL PRACTICE.
about a fortnight, during which period his testicles contracted a good deal and became firmly adherent to each other and to the surface of the wound. The patient is still in the Hospital in the fair way towards recovery ; he has escaped all the dangers which may arise from the excision of such a large tumour, and his wound is cicatrizing with the testicles and penis in good position. Ever since the operation the wound has been washed with carbolic lotion and dressed with boracic acid ointment.
15
A MIRROR OF HOSPITAL PRACTICE.
MEDICAL COLLEGE HOSPITAL. AN ENORMOUS OP
THE
ELEPHANTOID
SCROTUM;
TUMOUR
SUCCESSFULLY
BEMOVED.
[Under
the
care
of Surgeon-Major
tridge, F.R.C.S. Reported hj Gopal Chunder Chatekjee, Lattoo Paul,
S. B. Par-
Assistant-Surgeon House Surgeon.~\
Hindoo male aged 55 years, resident of Burrabazar, by occupation a shop-keeper, was admitted into Dr Partridge's ward, with a large scrotal tumour, on 10! h November 1879. History.? The patient noticed enlargement of the left testicle while he was 13 years old ; it was quite pain'ess then. After a year he also noticed slight enlargement a
of the other testicle, but he cannot state when the thickening of his scrotum commenced. Within these two years his scrotum assumed the size of a child's head, and continued so till the 45ih year of his age. During the last nine years the tumour has been growing, and for the last three years the enlargement has been very rapid. With the enlargement of the scrotum the patient has
been getting fever off and on, but the attacks have exhibited no periodicity. He has enjoyed fair health throughout his lifo, except occasional disturbance from fever. He had soft chancre about thirty years back, and also suppurative bubo; denies having had any pain in the joints, sorethroat, skin disease or any other indication of constitutional syphilis. He took no mercury for the venereal complaint. About thirteen years back he had gonorrhoea, from which he suffered off and on with orchitis and inflammation of the spermatic cords; urethral discharge ceased about He is not in the habit of seven or eight years back. taking any spirits, wines, or U3ing any intoxicating dru.'. Condition on admission.?-The patient is fairly nourished; his scrotum is enormously enlarged. The penis is embedded in the substance of the scrotum ; it can hardly be distinguished. The tumour is wide, its vertical and transverse diameters are almost equal; the antero-posterior diameter is rather smaller than the other two ; the mass is therefore somewhat flattened laterally. When the patient stands up the tumour comes down to within 6 inches from the ground. He cannot stand erect; keeps his knees somewhat flexed and everted to make room for the tumour. He can manage to lift up the scrotum and stand : can walk about half a mile with difficulty. The consistency of the tumour is rather hard : skin over it is somewhat cedematous, rough, and in places ulcerated. There is a distinct furrow, more or less semi-circular, about the middle of the tumour anteriorly indicating the orifice of the elongated prepuce: has a few superficial sores on the scrotum which were caused by rat bites ! The testicles cannot be felt. The root of the tumour or its .attachment to the pubis i* rather broad. Sensation of the integument is not acute. No fulness in.the inguinal canals: W hernia can. bo> felt i has a dragging pain, in the course _
and heart sound : no Micturation free; the urine runs down by the side of the tumour : makes water about five or six times a day : urine normal in quantity,and does not contain albumen or sugar. Power of digestion fair : bowels move regularly : no purulent discharge from the urethral passage. His weight (with the tumour) is lbs. 276. A drawing of the tumour was made and deposited in tlio Medical College Museum. Operation.?The patient was kept quiet in bed for four days after admission, and then he was operated on, on the 14th November 1879. He was placed on the operating table, and the tumour was kept raised for about half an hour before the operation; an elastic bandage was then wound round the tumour, but not very tightly, as it was considered undesirable to embarrass the circulation by driving an excess of blood into the vessels. Chloroform was administered, and a leather belt was applied round the waist of the patient. After this a strong India rubber cord was wound round the root or neck of the tumour and made fast to the waist belt by tapes so as to draw it well beyond the hypertrophied scrotum. The tumour was thus partially emptied of blood by the elevation and elastic bandage, and cut off from the circulation by the rubber cord The elastic bandage was then removed. A long director was introduced into the elongated prepuce, and by a long incision the penis was exposed ; the organ was tiien dissected out of the hypertrophied scrotum and held out of the way by an assistant. After this, two lateral incisions were made on each side of the scrotum, and were carried deep into the substance of the tumour to extricate the testicles. The patient lost no arterial blood ; across and bled : a few large venous sinuses were cut controlled were these by bull-dog forceps. The whole mass was finally removed by a few bold The incisions. operation up to this point was completed in seven minutes. Thus, the penis and both the testicles were saved. The spermatic cords were unusually long and thick ; the cremaster muscles were greatly developed. There were about 4 or 5 ounces of straw coloured serum in the eight tunica vaginalis ; openings The arteries enwere made into both tunic? vaginales. tering into the tumour were not very numerous, but some of them were very large, and a few were quite as largo 64 catgut ligatures were used to tie the as the radial bleeding vessels. The patient lost only about 5 or 6 the operation. The testicles ounces of blood during were then placed in proper position, the edges of the wound were kept everted by means of stitches, and the whole wound was washed with hot water and dressed with boracic dressings. The weight of the tumour after operation was 111 lbs. (exclusive of the serum and blood which escaped from it). Progress.?The patient suffered from shock for about 7 hours, and he then began to rally ; the temperature was QS'S3 F. ten minutes after operation and in the evening at 5 r. M. it rose to 100? F.; his pU]se was pretty full (108), an I respirations 25 in a minute. There was nobleeding from the wound except slight oozing, which was not even sufficient to soak the dressings. Severe dragging pain was complained of at night, when the patient lie was unablo was very thirsty and somewhat restless. to pass water for the first three days after operation, when his bladder was relieved by gum-elastic catheter. On the morning of the 16th November 1879, the third day of operation, his temperature came down to the normal, and continued so up to- the 9th December, with slight rise in On the 10th of December he had a the evening. vigor followed by a rise of temperature in the evening to 105?, it then became normal three days after, and ever since he has been free from febrile disturbance. His bowels began to be irritable on the fourth day ot' operation^ and continued so off and on until the loth of December ; since that date they have been quiet and his appetite fair. The woun l was very large, an 1 remained sloughy for .
January 1,
1880.]
A MIRROR OP HOSPITAL PRACTICE.
about a fortnight, during which period his testicles contracted a good deal and became firmly adherent to each other and to the surface of the wound. The patient is still in the Hospital in the fair way towards recovery ; he has escaped all the dangers which may arise from the excision of such a large tumour, and his wound is cicatrizing with the testicles and penis in good position. Ever since the operation the wound has been washed with carbolic lotion and dressed with boracic acid ointment.
15
