NOTICES TO CORRESPONDENTS. Dr. Harrison of Thornbury, has deemed it necessary, in conse quence of the incredulity of Senex,' to send us the following statement, sworn before the Rev. R. Slade, Vicar of Thornbury, and Justice of the Peace for Gloucestershire. "To remove every suspicion of imposition of relating a falsehood with any intention to impose on any man or any set of men what-i soever, I declare upon oath on the Evangelists of Almighty God that the case related to me by my son T. E. Harrison, late surgeon of his Majesty's ship Halifax, in your useful Medical Journal for January, 1811, (P. 31.) on the fatal effects of Cherries, I believe to be true, and can safely declare that I know it to be so." We have copied this affidavit, because Dr. Harrison seems hurt that his former account should have been disputed; but we cannot sanction appeals to magistrates on such occasions; scarcely a nos. trum is advertised without a case sworn before a justice or a cler. gyman; and this distinction between regulars and quacks is in our opinion a wholesome one. Dr. Harrison has also related some fatal instances of copious bleeding in fever; and one of boiling water being poured on the breast, and afterwards "live wood embers out of the fire" being laid upon it, to raise a blister. As they are not stated with sufficient minuteness, we suppose the Doctor did not intend them for insertion. We have been favoured with communications from I. F. R. from Senex, from Messrs. Eagland and Cullen; and from Dr. Ireland, Printed by E. Hemsted, Great New Street, Fetter Lane. THE Medical and Physical Journal. VOL. XXV.] APRIL, 1811. [NO. 146. Printed for R. PHILLIPS, by E. Hemsted, Great New Street, Fetter Lane, London. For the Medical and Physical Journal. On the Sarcocele of Egypt, from MONS. LARREY's Relation Chirurgicale de l'Armé de l'Orient.* THE word Sarcocele is derived from the Greek (sæpe xnλn), Fabricius ab Aquapendente, Fabricius Hildanus, Lanfranc, Fallopius, André de Lacroix, and others, have described this disease under the name of caro adnata ad testem. Since these authors, whose observations seem to relate to the sarcocele of warm climates, modern surgeons have confounded it with diseases of the testis, such as swelling, inflammation, scirrhus, hydrocele and hydrosarcocele. The etymology of the word sarcocele, and the signification which antient authors seem to attach to it, proves that this denomination * We are indebted to a valuable correspondent for this translation, from the only copy of M. Larrey's work yet in England, of an interesting history of a most extraordinary disease. Under the term sarcocele a disease is here described differing essentially from the affection, which in this country has been designated by that appellation. The sarcocele of Europe is a disease of the body of the testicle, liable to become seriously active from external accident, from irritating applications, and from incisions made into it when mistaken for hydrocele. But we are assured in this memoir, that the sarcocele of Egypt and other hot climates, is a carneous mass enormous in size, possessing little sensibility, having no other connection with the testicle than being in its neighbourhood; bearing the potential and even the actual cautery, and suffering setons to be passed through it, with impunity and occurring also in the female. The sarcocele of Europe is an organic disease of the testes; (Vid. Jour. for March, p. 276) the sarcocele of Egypt is a disease of the scrotum and capsule of the testes in the male, and of the common teguments and cellular substance of the labia pudendi of the female, connected with elephantiasis, and being, possibly, one form of that disease. ED. (No. 146.) P belongs belongs exclusively to that disease which distends beyond measure the teguments external to the testicle, particularly the scrotum and dartos; and gives to these parts an extraor dinary volume or size. The great number of individuals I have seen attacked with this complaint in Egypt confirms me in this opinion, and induces me to trace the causes, symptoms, progress, and effects, and to point out the means of relief, which are in the power of art. My researches into the nature of sarcocele induce me to believe that it is confined to warm climates, at least, that it is very rarely met with in cold regions, for the great number of examples which we meet with in Europe are the produce of Asia or Africa. The scrotal tumour of the minister, Charles Delacroix, is perhaps a single instance of sarcocele well marked which has taken place in our climates, and the volume of this tumour was small, in comparison of the cases of sarcocele related in the German Ephemeris for 1692, in Dionis's Chirurgical works, the Bibliotheque de Medicine, tome Ix, and of those which I have seen. with astonishment. in Egypt, some of which weighed at least fifty pounds. I shall relate some of those cases which are most worthy of remark. By sarcocele, properly so called, I mean that tumour which is formed in the scrotum, and is a fleshy mass, broad at its inferior extremity, and attached to the pubis by a peduncle or neck more or less extensive. Externally it is rugous and irregular, separated by furrows or cavities, corresponding with the mucous cryptæ, or the roots of the hairs; yellow scaly incrustations are usually found on its surface, more particularly if the sarcocele be of long duration. When these crusts fall off, there are underneath several smal! ulcers, which discharge an ichorous fluid. The tumour is indolent and harder at some parts than at others; it may be felt and pressed upon in any direction without exciting the smallest pain. The patient is no otherwise incommoded by it than by its weight, and the impediment it proves to walking, which compels him to have it suspended. The urine flows over the tumour without excoriating it. In the great number of sarcoceles which I have seen, I have remarked that the testicles and spermatic chord were in a sound and natural state, and situated on the sides of the tu mour; but the vessels of the testis were usually augmented in size (varicose). If the testicle should participate in the dis easc, it will be accompanied by the symptoms proper to such affection. It does not, however, seem to me, that the testis is capable of so great an augmentation of size with whatever disease disease it may be affected; for the patient would sink if the morbid alteration were in the testicle, before the sarcocele has arrived even to its second stage. The alteration of the testicle, in such cases, is the original disease, and to be regarded as distinct from sarcocele, and treated according to its particular character. It is not my design to describe the affections proper to the testis, I am only to relate what I have observed of the sarcocele of Egypt. Labourers, but particularly those whose occupation requires their sitting, as weavers, embroiderers, taylors, are most subject to it; many circumstances seem to contribute to produce the disease. Among the internal causes may be enumerated, depraved humours, inveterate syphylis, which has for one of its symptoms in this country, pustules and pruritus of the scrotum, which is, however, much disre garded by the Egyptians. This singular virus, produced also perhaps by vicious humours, is, probably, the cause of another disease not less distressing, elephantiasis. I have remarked that all those who are affected with sarcoce have symptoms, more or less apparent, of elephantiasis. The subject of a case at the end of this memoir is a striking example. All these causes produce their effects on the cellular membrane and skin of the scrotum, as being most disposed to the attacks of psoric and similar complaints; its laxity, its innumerable mucous cryptæ, and the little sensibility it is endued with, predispose it to tumefaction; the vessels first are surcharged, become weakened in their tone, the scrotum enlarges, and at the same time acquires a density like that of the placenta. The testicle preserves its form and health, but soon ceases to be distinguished, except at the posterior part of the tumour, which continues to increase in every direction, but particularly downwards. downwards. The cellular membrane thickens as well as the envellopes of the testicle; and the skin also augments in density and size. The integument which covers the pubis, the inguina, the penis, and the nates, contributes gradually to form the enormous tumour which is produced; thus the skin covered with hair, which protects the pubis, descends considerably below that region. The extremity of the prepuce presents itself in the form of a sort of navel on the anterior surface of the tumour. The urine flows down from the aperture without being projected. The external surface of this fleshy mass becomes rugous and scaly; it retains but little warmth, and the superficial veins are considerably enlarged. Sarcocele may increase to almost any size; a case related in the German Ephemeris weighed more than two hundred weight. The case of a Fellah (agricultor) of Upper P2 Egypt, Egypt, which I shall hereafter relate, was considered to weigh one hundred pounds. I have seen in different parts of Egypt ten or twelve different cases. If these tumours are dissected they seem composed of a dense (couenneuse) substance, with little vascularity and harder in some parts than in others; these have but little sensibility, and when cut do not give much pain. This I was able to remark on extirpating a commencing sarcocele in a cook of the Capuchin convent, at Cairo. At the School of Medicine at Paris, there is a model of a sarcocele, which was not extirpated, but the dissection after death confirms this description. The testicles were sound, and the tumour was formed by their membranes, then preternaturally distended. An old man, at Cairo, consulted me for an enormous sarcocele which he had had for twenty years, the size of which obliged him to keep his bed. Anxiety to be relieved had impelled him to consult the physicians of his country, who had exhausted their efforts in vain. Cautery, caustics, incisions, and discutients, had been employed. The last person he consulted pierced the tumour through its centre with a large needle and ligature; he suffered but little pain, which proved that the testicles did not participate in this disease. This seton, which was moved daily, produced an abundant flow of serous foetid matter; (he was also affected with elephantiasis.) The continued discharge of the seton produced but little diminution of the tumour; and as no more was to be expected from it than other means which had been employed, I proposed the extirpation; and when I was about to perform it an order to go to Alexandria, which the English had threatened to attack, compelled me to leave this unfortunate old man to his fate. To the causes I have adduced may be added, bad diet, intemperance, too frequent venery, the immoderate use of warm baths, to which all classes of Egyptians are addicted; living in damp and marshy places, the effects of climate, mode of dress, or injuries of the scrotum, may also contribute to the formation of the disease. Sarcocele has been hitherto considered to belong exclusively to man; the term is limited to the disease in the genital organs. But we may consider the fleshy tumours which take place in other parts, particularly in the face, where the skin is liable, as well as the scrotum, to be affected by venereal and other diseases, as so many sarcomatous tumours of the he same nature and depending on the same causes. The examples of such tumours are sufficiently numerous. There are also local causes which determine their formation in one part rather than others, such as falls, mechanical injuries of the skin, or the application of chemical corrosives. No |