In 1829 a fifty-year-old labourer, John Marsh, was knocked down and run over by a cart laden with bricks. He was conveyed to Winchester County Hospital, where the doctor who examined him recorded that
his scrotum, on inspection, was found to be of most enormous size, extending two thirds downwards between the thighs, and measuring in circumference seventeen inches; its colour of a jet black, and its texture, from over distention, so exquisitely thin as to threaten immediate rupture from the slightest manipulation. The abdomen perfectly flaccid, and nearly empty.
A neat bruise across his stomach indicated the exact course the wheel had taken as it passed over him. The patient vomited incessantly, was in a cold sweat and his extremities were cold. The most obvious injury was dealt with first:
On being placed in bed, the viscera were returned to their natural situation without much difficulty, merely by elevating the hips, depressing the shoulders, and applying moderate and careful pressure with flannels moistened in hot poppy fomentation; the facility of reduction depending on the large opening through which the viscera had passed, together with the favorable and relaxed state of the patient.
He was given opium to calm his stomach, and the poppy fomentation (a flannel soaked in water in which poppy heads had been steeped, a local analgesic) applied to the scrotum and abdomen. Hot water bottles were applied to his feet. The grossly distended scrotum was causing him great pain, and was suspended so that its weight would not trouble him.
By the third day his abdomen was still exceedingly sore. Generous doses of castor oil were administered, with inevitable results. The scrotum was
somewhat reduced in size, though perfectly black.
At this point the treatment was stepped up:
Thirty leeches to be applied to the abdomen directly; tepid bath as before; blister to be placed over the belly at bedtime; and to take three spoonsful of the following mixture every four hours: Sulphate of Magnesia, water.
The physicians remained concerned about the state of his scrotum, and decreed that it should be regularly bathed in spirit lotion.
Sixth day—Has continued to improve in every respect. Quite free from pain, except when endeavouring to turn in his bed. Pulse eighty-six; skin natural; tongue moist; complains of great flatulence. The lotion has had the effect of corrugating and contracting the scrotum, which is still extremely black.
From this point his progress was rapid:
Twelfth day.—Quite convalescent; has been capable of sitting up in his bed for some hours, the precaution of applying a double truss having been previously taken. He was discharged cured in three weeks from the time of the accident.
A happy outcome? Not quite, it seems:
Since this patient has left the hospital, I am informed he is subject to occasional diarrhoea, which is extremely violent, and reduces him very considerably before it can be checked. He is compelled to wear his double truss both night and day, otherwise the viscera descend immediately into the scrotum in very large quantities.
[Source: The London Medical and Physical Journal, 1829]