No author, that I know of, has described a similar disease in the female genitals, although the skin which envellopes these parts, differs but little from the skin of the genital organs of man. The periodical discharge and other resources given by nature to the female, operate, without doubt, against the formation of these excrescences. But a singular case of a woman, named Hammet Fatomi, of Cairo, furnishes me with an example of well marked sarcocele of the labia; I shall relate this case. Every author who has written on sarcocele has described it as incurable, from the ill success they have had by internal or topical remedies. All those who have proposed extirpation have been fearful, or at least have not practised it. M. Imbert Delonnes has the merit of being the first to perform this operation, in boldly extirpating the sarcocele of Delacroix*; I did not know of the success of his operation when I performed a similar one, (the case I have cited), and proposed to extirpate several other enormous sarcoceles, when the army was removed.

When the complaint is recent it may be treated with the remedies hereafter described; but in an advanced stage there is no other resource but extirpation, preceded, however, by remedies proper fo remove the cause of the disease. Among the internal remedies antimonials combined with mercurial medicines, and convenient doses of sudorifics, continued for some time, or alternated with small doses of the mineral acids, diluted in some mucilaginous fluid, produce the best effects, but particularly the sulphuric acid, lowered and applied in form of lotion to the parts, or a weak solution of muriate of mercury, or oxide of copper, or muriate of ammonia, the effects of which are increased by gentle and uniform pressure on the disease. The success of these means will be evident in the diminution of the bulk of the tumour, the retraction of the skin, and the amendment of the patient's countenance. If this be the case, the remedies should be continued until the disappearance of the disease. Incisions or caustics seem to me to be useless. I rest my opinion on the little success which the Spanish and English surgeons had in one of the cases related. It is even possible that these means, if followed by the astringent remedies I have mentioned, may produce cancerous ulceration. But after the use of these remedies differently combined, and for a sufficient time, if the sarcocele continues in the same state, I do not hesitate to pronounce the necessity of amputation, and the possibility of performing it without danger. Its necessity is marked by the

*See his Memoir,

failure

failure of all other means, and the certainty that the disease will continue to increase, and though the inconveniences are not intense, they lead with certainty to the grave.

It now only remains for me to describe how the operation is to be performed. The vessels which supply the tumour arise from the external pudic artery, and some branches of the internal pudic artery. The spermatic arteries are sent wholly to the testes, and are therefore out of the way; and the hæmorrhage which the other vessels produce is not of much importance, and the arteries are easily secured by a ligature when they are divided: The operation is long and tedious, but not highly painful. The removal of the tumour being complete, if the disease even has been complicated with elephantiasis, which I have usually seen, there is no fear that the sarcocele will be reproduced; but the remedies for elephantiasis should be continued.

There are some general precepts for this operation: the testes should be carefully avoided, and also the corpora cavernosa and spermatic cords. Two oblique incisions beginning from the prepuce, one passing down below the testis on each side of the tumour. The parts between the testicles and corpora cavernosa, must be deeply cut with a double edged knife, carefully avoiding the testes, and the portion below the line formed by these incisions should be removed. If there still remain some sarcomatous substance round the penis or testes, it should be dissected away. The corpora cavernosa and testes are to be covered by the skin which is left, and the edges may usually be approximated and confined by ligature, or by plaister and bandage. The parts discharge, retire and cicatrize without difficulty. If hæmorrhage occurs, the vessels should be secured immediately with ligature, or (if their orifices cannot be discovered) by actual cautery. The success of the operation will be improved by continuing the use of internal remedies.

CASE I.

Jacques Moline, a Copt, and cook to the convent of Capuchins, at Cairo, consulted me for a considerable tumour in the scrotum, which he had had for many years; it was of a pyramidal form, and weighed about six pounds. The right testicle corresponded with the superior part of the tumour and was sound; the penis had almost disappeared; the left testis was confounded with the fleshy mass which formed the sarcocele, and could not be felt: I still doubted if it formed part of the tumour, for he had never felt pain. This swelling was formed of a dense (coucnncuse), and in

some

some parts almost cartilaginous substance. In the middle of the irregular mass the testicle was discovered diminished in size; the wound was properly dressed. The treatment was not disturbed by any untoward accident, and on my departure for Alexandria, I left the patient advancing to his recovery.

CASE II.

Mahammet Ibrahim, about sixty years of age, was blind and affected with elephantiasis, which he had had for many years. His legs were half as large again as his thighs, and his feet were monstrous. The skin towards the superior part of the leg was smooth and marbled, and there were many varicose veins running on it. The other part was round, with thick yellow rugous incrustations, disposed like scales, separated from each other, particularly at the articulations, by deep ulcerated furrows, which discharged an ichorous fœtid fluid. The crusts were more considerable at the ancles and the heel than other parts. Deep cavities were observable between the toes, and on the sole of the foot. When pressure

was made on the parts of the limb which were most swelled, there was no pain produced, nor was any impression left by the finger; the skin and cellular membrane offered all the resistance of cartilage.

This man had lost his sight by the endemic ophthalmia; he was of dark complexion, of weak constitution, and languished out a miserable life. The tumour weighed about seventy-five pounds, it was of an oval form, and interspersed at its inferior part with furrows and incrustations, hard and resisting in some parts, and soft, but without fluctuation, in others, of a blackish brown colour. At the middle and fore part an oblong aperture, surrounded with a thick and callous border formed by the pressure, was observed. This aperture led to the urethra, which passed upwards and backwards towards the pubis. The corpora cavernosa were felt anteriorly at the neck of the tumour, and the testes on the sides, or rather towards the back part; these last seemed sound, and the spermatic chords were elongated and enlarged, and the arteries, whose pulsation was readily perceived, seemed to have enlarged their calibre; the skin of the abdomen was stretched to accommodate itself to the tumour, and the hair, of the pubis was considerably below that region, so much, indeed, that the navel was on the pubis.

This enormous mass, which was supported by a suspensory, produced no other inconvenience, than to impede by its weight the motions of progression.

CASE

CASE III.

An husbandman of Upper Egypt had a sarcocele for twelve or fifteen years, which was daily augmenting. At the time I saw him at Cairo, his tumour was enormous, and weighed near one hundred pounds; it descended nearly to his feet, separating the legs; it was of an oval form and of a brownish colour, unequal on its surface, and interspersed with incrustations; like the sarcocele of Ibrahim, the prepuce was in the middle of the anterior part, and the testicles on its sides, or towards the superior portion. After having been treated by the physicians of his country, he consulted an English physician who was travelling in Egypt; in hopes of a perfect cure, he consented to the application of an actual cautery; but the repeated use of this remedy gave him no relief, and the tumour continued in the same state. Some years after he consulted a Spanish physician, who also was journeying in Egypt, who plunged a knife deeply into the tumour, persuaded that it was hydrosarcocele, but there issued only a little blood, and the disease, so far from yielding to this operation, became worse and larger. These two operations, the patient said, were performed without his suffering much pain; and no accident or inconvenience was produced. The cicatrices were yet tender when I first saw him at Cairo, and he was disposed to submit to its extirpation, which I advised, but the same impediments, as in the former case, prevented my performing it.

CASE IV.

Hamet Fatomi, thirty years of age, wife of a labourer of Cairo, came into the civic hospital on account of two tumours, which she had had for many years. These tumours

seemed to have their origin in the external labia, for there was no vestige of these parts to be seen, nor of the nymphæ; they were nearly of the same size, were placed by the side of each other at the entrance of the vagina, and each of them resembled the head of an infant, rugous and unequal on the greatest part of their circumference, smooth on the inner part and of a violet colour; their prominent sides, or rather their base, was covered with pustulous incrustations, like the sarcocele of Ibrahim, and discharged a similar foetid ichorous fluid, they were attached by small roots to the ischium and pubis, were hard, insensible, and like scirrhus, measured about thirteen inches each in circumference, four inches in diameter, and seven inches long.

The woman, who was of a sickly constitution, had an in

cipient

cipient elephantiasis. Her lips were thick and of a lead colour, her gums pale and ulcerated, sorrowful appearance of the eyes and countenance, and disposed to melancholy; the digestive functions, however, went on well. I attributed this affection to the incipient elephantiasis, and it is remarkable that she had never menstruated regularly.

I proposed to extirpate the tumour, and began to give her remedies which I had already employed, with benefit, in elephantiasis. In six weeks her limbs and lips were less swelled, and nearly in their natural state; she had become stronger, the tumours were somewhat softer, the discharge which flowed from the ulcerated scabs had become less foetid, in short, I considered her in a fit state for the operation.

The necessity of extirpation in this case, and in the case of Ibrahim, was acknowledged in a consultation, and the operation was fixed for the next day, when the order arrived for me to repair with the army to Alexandria, and obliged me to abandon both of these cases.

To the Editors of the Medical and Physical Journal.

GENTLEMEN,

JUDGING it to be the duty of medical men to acquaint

each other with their most successful manner of treating discases, particularly those which are frequently productive of great fatality; and as I am persuaded it not only tends to the improvement of medicine as a science, but will ultimately prove to be for the good of the community at large, I submit the following observations for publication in your highly esteemed Journal.

Observing the mortality which has lately occurred at Debenham, in Suffolk, occasioned by the Scarlatina Anginosa Maligna, I was led to recall to mind the plan from which I had experienced the most favourable results.

The treatment recommended and adopted in this often alarming malady is very opposite and curious; some prac titioners enforcing a strict antiphlogistic plan, while others prescribe a tonic, invigorating, and even stimulating mode; though each of these may be useful, yet each may be carried to excess; hence both require limitations.

The practice from which I have experienced the greatest success, has been that of adopting the antiphlogistic plan at the commencement. Venesection as strongly, and no doubt deservedly, recommended by Mr. Hamilton, in my opinion, (No. 116.) Q

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