Almost to the ground

scrotumAn article from an 1831 edition of the London Medical Gazette begins unpromisingly: 

Enlargement of the testes, scrotal tumors, and hydrocele, are common diseases to which the inhabitants of Tahiti, and other islands in the Southern Pacific, are subject; nor are they confined to the natives alone, as Europeans, after a long residence, are equally liable to those affections.

Although there were several cases of scrotal enlargement on many of the islands I visited in the southern ocean, that which I subjoin is the only one, extraordinary from its magnitude, which came under my observation. 

Am I alone in detecting a note of regret?

The question may arise—to what are we to attribute the disease? To this it will be difficult to find a satisfactory answer: whether it ought to be attributed to climate, diet, a licentious mode of life, or the idiosyncrasy of the individuals, it is at present impossible to determine. It is supposed by some to depend upon their food, or some peculiarity in the water: a residence in low situations: a long and continued use of the water contained in the unripe cocoa-nuts (which is so much used as a beverage among the natives of these islands), and peculiarity of climate, are equally assigned as the causes of its production; while, among the different hypotheses, it is difficult to form a correct opinion.

Enthusiasts for the modish coconut water, take note.

During a visit to the island of Tahiti, in October 1829, the subject of the enormous tumor of which a rough sketch is annexed, came under my notice.

You don’t really want to see the sketch do you?  Oh, go on then:

scrotal tumour
Blimey

He is named Victorio Pantoha, and is a native of Mexico, but had resided for upwards of twenty-eight years in the island of Tahiti.  He was about fifty years of age.  The first commencement of the tumor that he observed was about nine or ten years ago, in the form of a swelling on each side of the groin, which gradually increased in size, descended, and – he says – united and formed one mass, entirely covering the penis.  The tumor has been gradually increasing from that time, and has now attained the enormous dimension shewn in the above cut.

Blimey.

It was at some parts smooth, at others had a wrinkled appearance, excepting at the lower part of its right side, which was tuberculated and livid: the general colour, however, was a dirty yellow.  The tumor was very callous to the touch, except at the upper part about the pubes and a few inches below. The spermatic cord was not affected. The penis was not visible, nor were the testicles to be discovered, though he remarked to me that he felt one sometimes on the right side, which seemed to be of the natural size; but I could not feel it, after an accurate examination. He describes the tumor as still gradually increasing in size; it must soon, therefore, touch the ground, as it nearly does so at present.

Oh my word.  Not an achievement of which one would be proud.

During the time that I was making the accompanying drawing, I was obliged often to stop, that he might sit down, on account of the uneasiness and pain in the loins which the standing posture occasioned.

To be quite honest, Dr Bennett, none of your readers are hugely surprised.

His countenance has an anxious appearance…

There are, I would suggest, good reasons for that.

The weight of the tumor, so far as it could be ascertained, was about 96 lbs., and the size, by careful measurement, was found to be as follows :

The length, from the crest of the pubes to the base of the tumor, 2 feet 5 inches. Circumference of the upper part, just below the pubes, 21 inches; of the centre, 4 feet; of the largest part, just below the urethra, 4 feet 8 inches.

Indeed an object of impressive proportions.

On my arrival in England, which has just taken place, I was informed of an operation having been very lately performed at Guy’s Hospital, in a somewhat similar case, the subject of which was a native of China. The operation terminated unsuccessfully, and I shall make no comments upon it.

This is probably – in all seriousness – just as well.  Such large tumours typically have a well-developed and complex blood supply, and even today removing one can be a ferociously complicated task.  Surgeons will only embark on such a procedure once they have some idea of the structures they will encounter inside the tumour, and whether there are any major blood vessels which cannot safely be divided.   In 1832, without any of the sophisticated imaging technology we have today, they hadn’t a hope of success.  And this was without anaesthesia!  The poor patient.

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