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CHAP. VIII.

Hypertrophy of the Scrotum; different Causes of. — Elephantiasis endemic in Bengal and Lower Egypt; probable Causes of. - Example of Malarious Fever. · True Elephantiasis of the Scrotum.- Hypertrophy from Hydrocele; from Syphilis; Condition of the Organs involved; Mode of operating; Mismanagement by the Native Doctors; Number of Operations for Six Years previous to April, 1845; in the Mesmeric Trance, for Eight Months.-First Case.-Some Cause for the late Increase of Cases.—Operations in the Mesmeric Trance.

THIS disease is so common in Bengal, and attains such a magnitude, that it deserves a chapter to itself, in which it will be seen that if Mesmerism cannot prevent it, it is very effectual in assisting its removal. These singular, and often prodigious tumours are generally called " elephantiasis of the scrotum;" but, correctly speaking, this is a misnomer, many of them not having their origin in the constitutional affection called elephantiasis, but arising from local irritation and debility of the parts, caused by syphilitic sores, or simple hydrocele; and the appearance of the tumours and aspect of the patients are often characteristic of their respective exciting causes.

In Fig. VI.* will be seen an excellent specimen of the true constitutional elephantiasis, in which the disease is accompanied with periodic fever, and general cachexy to such a degree as to inake it unsafe to remove the local excrescence, as in the individual, whose portrait this is. The disease, in this shape, is endemic in Bengal almost exclusively, it being rarely seen in upper India, and appears to have its origin in a hot, moist, malarious, relaxing climate, in which the poor are ill-fed and ill-clothed. In Egypt it is also principally confined to the delta of the Nile, which considerably resembles Bengal in climate and the condition of its people. Endemic sources of disease abound here to a dreadful extent, but chiefly originate in the ignorance, indifference, and poverty of the people; and an enlightened and benevolent government should interfere to prevent its subjects perishing in their ignorance, by enforcing stringent police regulations for the improvement of the public health, especially by attention to drainage and filling up all unnecessary pools of water. Ragged old tanks, and offensive

*For the reasons assigned in the Editor's preface, the plates transmitted from India, as portions of this work, are not published; but remain with the publishers for the inspection of the scientific reader — D. E.

pools and holes of water, form a chain along the roadside, in and near all towns and villages, and spread like a network over the country; their insulation rendering them only the more pestiferous, by making each an independent hotbed of malarious exhalations. The thing is so general, that every cottage may be said to be built over a green putrefying pool, out of which the mud to build the house had been taken, and which is reckoned a domestic convenience. Into this all the animal and vegetable débris of the houses is thrown the pigs wallow in it, the people wash their fish and rice, and bathe in it; and it is then used for cooking and drinking, as it is conveniently near, and saves the trouble of going to the nearest large tank, or the river. This accumulation of animal and vegetable matter, festering under a tropical sun, renders every hole a pest pit, and the whole population eat, drink, and breathe perpetual infection. The effects are as dreadful as might be anticipated in a debilitating climate, and among an ill-fed people, and are deeply written in the personal appearance of the natives of the country.

Ague, remittent fever, spleen, rheumatism, diarrhoea, dysentery, and cholera are inherited by the poor people along with their homes; and the

general constitutional debility is evidenced by the incredible frequency of elephantiasis, diseases of the skin, and parasitic growths on the body. Ague and spleen were endemic diseases in Scotland, fifty years ago, when every cottage had its "midden" before the door; and if northern nations suffer so much from miasmatic influences, we can readily imagine their terrible energy in Bengal, where every aid and appliance is afforded them.

I shall give an illustration of the extreme gravity of these causes of disease, from a case that lately occurred in my private practice, and which I am disposed to regard as an acute form of the disease which, in its chronic shape, gives rise to constitutional elephantiasis. On the 16th May, 1845, I was requested to visit one of the richest Hindoo families here; and on going, found eight persons, men, women, and children, labouring under different degrees of the same disease, and of which two men of the same party had died, shortly before. In the worst cases the feet were swollen, and hard as in elephantiasis, and a brick-red inflammation extended half way up the leg, and was still advancing. The others were worn out with fever, and their bodies were generally or partially dropsical. The party con

sisted of one family and its attendants: no other persons living in the same house were affected. This led me to suspect some local cause of contamination, and I requested to be allowed to view the suite of apartments occupied by this part of the family. The house is a large two-storied pile, in which, as usual, all the family connections live. I could see nothing objectionable about the rooms inhabited by my patients; but, on looking out of the back windows, I saw that the house rose right over a large, ragged, neglected tank, covered with green filth, and smelling vilely, and that this was the only part of the house so situated. I then examined below, and perceived that the water was led upon a brick platform to a passage in the lower story, to save the people from going out: numerous narrow lanes, the sides as high as the house, led from the tank to the different parts of the house, and all opened into the court around which this family exclusively lived in small illventilated rooms. In short, it was a most ingenious labyrinth, contrived for receiving and retaining all the mephitic vapours from the tank, into which were thrown all the "exuvia" of this large family, or rather clan. This year, it so happened, was peculiarly adapted for the development of malaria; all the tanks in the district