A THREE MONTHS’ 
SURGICAL SERVICE 
AT 
BAY VIEW HOSPITAL, 
Baltimore, ettd. 
W. B. PLATT, F. R. C. S. (Eng.) 
[Reprint from the Transactions of the Medical and Chirurgical Faculty of the 
State of Maryland.] 
BALTIMORE: 
Press of Thomas & Evans, 
Baltimore Street and Post Office Ave., 
1885. Ueprinted from Tue TkansactioNb of the Medical and Chieuegical Faculty of tiiK 
State of Makyland, 1885.] 
THREE MONTHS’ SURGICAL SERVICE AT BAY VIEW 
HOSPITAL. 
W. B Platt, F. R. C. S. (Eng.) 
Bay View Hospital has seen a great change for the better in the first 
year that the patients have had systematic medical and surgical care. 
This is due in great part to the visiting medical staff who have 
directed the attention of the Trustees and Superintendent to matters 
of hygienic and medical importance, with the usual result of an 
immediate improvement. 
The Trustees and Superintendent deserve great credit for the desire 
they have shown to improve the condition of the patients as soon as 
the way was pointed out. 
The resident physician Dr. W. J. Jones, also deserves all praise 
for his faithful care and good management of the patients. 
The hospital is much cleaner than ever before. The walls and 
floors are regularly scrubbed. The ordinary food is of good quality 
and quantity. The building is well heated, and the beds in general 
reasonably clean and comfortable. There are however still some 
urgent needs, which we hope may before long, be remedied. These 
are— 
ist. The great necessity of good nursing. 
2nd. Prohibition of smoking and chewing in the wards where sick 
patients are confined to bed. 
3rd. The abolition of the “pool” and substitution of separate baths. 
4th. Some accessible and suitable place for patients suffering with 
erysipelas, scarlatina, diphtheria, etc. The cold and distant “ pest- 
house ” is altogether unfit. 
5th. The total isolation, in separate wards, of patients suffering 
from active forms of syphilis. A set of knives, forks, spoons, and 
towels, should be provided, different from those used by other patients. 
It is a great wrong to expose innocent persons, however unfortu- 
nate, to the risk of contracting this fearful diease. 2 
Of the need of better nursing there can be no question. At present 
the so-called nurses are all paupers, many of whom cannot read or 
write, wrecks of humanity, heartless and filthy, with two or three 
exceptions, who deserve more credit than they get. Few people 
realize that the entire Almshouse has had over 1,000 inmates for 
some time during the past year, and over 200 in the hospital. These 
are human beings, sick or helpless, and should have proper care. 
The negroes are the the greatest sufferers from this state of things. 
With them it is almost impossible to have the simplest treatment 
carried out; meanwhile they lie in filth and wretchedness. An annual 
appropriation of $2,000 by the city and county or 2\ cents per annum 
for each voter in Baltimore city, would remedy all this. It would 
maintain a training school with a matron and a corps of skilled nurses, 
who, with the assistance of the inmates, could provide all necessary 
attention for the sick. 
The pool is a tank in which all patients entering Bay View must 
bathe unless especially exempted by the resident physician. 
The water is changed for reasons of economy but three times daily. 
Many of those applying for admittance have large ulcers, or are in 
full bloom with syphilis. Consequently a number of people must 
bathe in the water used by diseased persons. If separate tubs were 
provided, the same amount of hot water would suffice, and the tubs 
could be scrubbed after each bath, by some of the many idle inmates. 
The whole number of surgical cases under my care from January 
1st to April 1st was 50. 47 females and 3 boys. Of the 50 there were 
Whites, ------- 36 
Colored, - - - - - - - - 14 
5° 
Of these, 22 were born in Maryland; 11 not stated ; 8 born in Ire- 
land ; 4 in Germany; 2 in Pennsylvania; 2 in other places; 1 in 
England. 
Of these 17 were persons affected with syphilis, or 36 per cent., 
of 47 females. The diagnoses were as follows, viz: 
Chronic Ulcers, ' -13 
Sinuses from Caries or Necrosis, ..... 3 
Primary Syphilis, - - - x 
Syphilitic Buboes - 3 
Secondary Syphilis, 9 
Tertiary Syphilis, 4 
Chancroidal Buboes, ---1 
Chancroid, --------- 1 3 
and one each of Femoral Hernia, Abdominal Cyst, Anterior 
Staphyloma, Universal Eczema, Fracture of Humerus, Cortical 
Cataract (senile), Syphilitic Cataract, Wound of Face, Gangrene 
from Frostbite, Procidentia Uteri, Pediculi Pubis, Elephantiasis Cli- 
toridis, Fracture of Spine, Fissure of Anus, Diphtheria. 
[Two of the cases of syphilis are also reckoned among the ulcers.] 
Regarding the treatment of chronic ulcers, a word or two will 
suffice. 13 chronic ulcers were treated. Of these there were 6 
simple chronic ulcers. 2 Syphilitic. 2 Traumatic. 1 Bubo. 1 
Eczematous. 1 Lupous.—Total, 13. 
All patients with chronic ulcers were kept in bed as far as possible. 
Rubber bandages were not used on account of the expense. The 
large granulating surface after a burn did better with ung. zinc oxid. 
benz., than with any other treatment. The eczematous ulcers healed 
rapidly under the diachylon ointment of Hebra after entire failure of 
every other treatment. 
The lupus ulcer did well after excision. 
Of the remaining ten ulcers, the treatment was as follows: 
All excavated ulcers, syphilitic or otherwise, were poulticed until 
the granulations were on a level with the surrounding skin, when 
iodoform and strapping were employed. The remainder, with two 
exceptions, did better with iodoform and strapping than with other 
treatment. The so called “clay treatment” was faithfully tried in two 
cases. In one case, it answered admirably up to a certain time, when 
it excited great local irritation and had to be omitted. The ulcer 
healed very rapidly under its influence for some days. I attribute 
its beneficial effect to the following causes : 
1st. It gives the granulating surface rest, as the part need be 
but seldom dressed. 
2d. The ulcer remains clean, since the discharge is absorbed as fast 
as formed. 
3d. Continuous pressure. 
Syphilitic patients were put upon antisyphilitic treatment. In 
two cases among negroes iodoform used locally, caused an acute 
dermatitis. The operations for which anaesthesia was necessary, 
were: 
1st. Enucleation of the eye. 
2nd. Amputation of an elephantiasis clitoridis. 
3rd. Amputation of toes for gangrene from frost-bite. 
4th. Emmet’s operation for procidentia uteri. 4 
5th. Stretching of anus for fissure. 
6th. Excision of lupus of the skin over the patella. 
7th. Tracheotomy for diphtheria. 
A short summary of these cases may be of interest, and one or 
two will be given in detail. 
Case i st, Enucleation of eye. 
The patient was a female, aet., about 28, single, colored. There was 
no history or evidence of syphilis—duration of disease of eyes, five 
years. There was an anteria staphyloma of the right eye, of which 
the cornea was mostly opaque. It is transparent only in a small place 
above. In the left eye the vision is entirely gone. Cornea opaque, 
(it is in fact a mass of cicatricial tissue) globe somewhat shrunken 
and tension less than normal. 
The patient has been suffering with much pain for two months in 
the left side of the head in the region of the temple, orbit and eye. 
The pain has been mitigated only by morphia. To relieve pain, 
and also to preserve the sight in the remaining eye, it was determined 
to remove the left eye. This was done in the usual way, by dividing 
the conjunctiva of the globe in a circle near the cornea, cutting the 
muscles of the globe close to their insertions, and lastly, dividing the 
optic nerve close to the globe. When this was done, instead of leav- 
ing the conjunctival wound open, the sides were brought together, 
with three fine sutures over the stump of the optic nerve. The 
wound united well, leaving an excellent base for an artificial eye. 
The pain was entirely relieved. 
The case of lupus of the skin, over the patella, occurred in a 
female, (S. R.,) white, married, aet. about forty. There is a history 
of rheumatism in the right knee, elbow and shoulder. No history 
or evidence of syphilis. The right elbow cannot be fully extended. 
The patient is very anaemic. Five months ago a swelling formed in 
the tissues over the right patella and front of knee joint. 
The swelling soon ulcerated. It occasionally gives pain. In the 
region mentioned the skin and tissues just beneath are raised, thick- 
ened, bluish, and slightly harder than the neighboring skin. The 
entire surface measures 4! by 3J inches. The surface of this area is 
covered with ulcerations f of an inch in diameter and less. These 
secrete pus and readily scab over. Anti-syphilitic remedies have 
been tried without avail. I placed the leg on a back-splint and 
applied ung. ox. zinc. benz. The ulcers improved at once to a limit- 
ed extent. Then iodoform in powder was given a fair trial with- 5 
out much benefit. Iodoform ointment was used, and hypodermic 
injections of iodoform in glycerine were made into the swollen tissue. 
This last treatment did more toward healing the ulcers than anything 
heretofore employed. The ulcers which had healed, soon broke 
down again while the disease slowly spread in the periphery. After two 
months of this treatment the patient was etherized, the growth 
excised; and what could not be excised, was spooned out. The 
edges of the gaping wound were approximated, as far possible by 
silver wire supported by china buttons at the ends, and broad strips 
of adhesive plaster over all. At the end of my service, three weeks 
later, there was only a granulating surface, horse-shoe shaped, six 
inches long and less than an inch wide. This appears perfectly 
healthy, and is rapidly healing, excepting at one place, at the lower 
end, where some of the growth was evidently left behind, and will 
require removal. It is seldom practicable to remove a lupus 
completely in one operation. 
The case of diphtheria in which tracheotomy was done occurred 
in a healthy male, white child, three years of age. 
Mother and child were found wandering in the woods near Bay View 
during the coldest March weather. They were placed in the chil- 
dren’s ward on the ground floor. Within 24 hours the child was 
slightly hoarse, at the evening visit, but nothing abnormal was visible in 
the pharynx or tonsil. The next morning there was much dyspnoea 
—occasional croupy cough, and large white adherent patches on the 
tonsils. Within four hours the dyspnoea was intense, the sternal 
region was drawn in at each inspiration, and the sterno-mastoid and 
scaleni muscles worked actively to assist in breathing. The trachea 
was opened in the usual manner just below the cricoid cartilage. 
The hemorrhage was very free, and the operation unusually difficult 
owing to the short fat neck of the child. As is usual the bleeding 
ceased soon after as the trachea was opened. This child at all times 
eagerly took food and stimulus, had a strong pulse, and no appar- 
ent constitutional depression until death from suffocation occurred the 
third day after the operation. The autopsy showed the trachea 
to be occluded at the bifurcation of the bronchi, the membrane had 
also formed around the tube, which had once been removed for the pur- 
pose of cleansing it and to see if it would be safe to omit it. There 
was also some purulent capillary bronchitis. The treatment con- 
sisted of milk, at frequent intervals, stimulants, tr. chloride of iron, 
and corrosive sublimate. 6 
Spray from a steam atomizer was directed toward the child’s face 
constantly. 
The case is of interest from the fact that although there were patches 
of membrane on the tonsils, there was no constitutional depression. 
It was a localized diphtheria, or a croup with patches on the tonsils, 
as one chooses to name it. 
Hypertrophy of Clitoris—Amputation. 
(With Photograph.) 
L. F., single, bright mulatto, aet., 23, born and lived in Canada 
until 5 years since; occupation, servant. The only credible history 
the patient affords is that she lived rather a free life, and three years 
ago first noticed something abnormal in the region of the clitoris, 
which has continued to grow until it attained its present dimensions. 
It now hangs down, completely concealing the vulva from view, in- 
terferes with urination, and causes a dragging sensation in the small 
of the back. It cannot be raised parallel to the long axis of the body 
without causing pain. There is no history of any power of erection 
of this body, or of self-abuse. 
Inspection shows an elongated tumor 5$ inches long and 8 inches 
in circumference at its largest part.,,. It hangs down in the median 
line from a base about if inches in diameter. It is two lobed, nod- 
ulated, and at the distal end a little on one side is the glans clitoridis, 
fully as large as the adult glans penis. The growth is covered by a 
thin skin, is of a pale bluish-slate color and firm in consistence. The 
labia, nymphae and urethra are not involved. At the base of the 
growth, where it joins the body, is an area I of an inch in 
diameter occupied by “cauliflower excrescences,” which secrete a 
thin,milky fluid. There are abundant, large, flat, condylomata about 
the anus; enlarged glands in both groins, abundant cicatrices old 
and recent, on both sides of the neck ; sores about the mouth ; ptosis 
of right eyelid ; a supra-trochlear gland to be felt, and other evi- 
dences of secondary syphilis ; an iritis also appeared during her stay 
in the hospital. The patient was put upon bichloride of mercury, 
grs. 1-16, with 8 grains of potassium iodide thrice daily. Hot water 
vaginal injections and good diet were ordered. The patient was 
very anemic when she entered the hospital. The patient was consid- 
erably improved in general health a week later, when she was ether- 
ized (March. 9th) and the growth removed. 
A ligature was passed through the tumor by which to hold it. 
The puncture bled freely. A lateral skin flap was dissected back ELEPHANTIASIS CLITOpiDIS. 
X)R. PLATT’S CASE. 7 
from the left side of the growth, the incision on the right side being 
made close to the pubes. A wire ecraseur was then applied, and 
tightened until the soldering of the end of the wire gave way. A 
chain ecraseur also broke but was adjusted so as to last during the 
operation. The instrument was slowly worked and about twenty 
minutes occupied in dividing the pedicle. 
There was very little hemorrhage from the stump ; the bleeding 
from two points in the corpora cavernosa was stopped by a touch 
with the Paquelin cautery. The flap was now brought over the 
stump and a drainage tube, to the right side, and stitched in 
place with silver wire. Iodoform was dusted on and absorbent cotton 
applied under a T bandage. The growth is in the Johns Hopkins 
collection. 
March 15th. There has been no fever or pain since the opera- 
tion Drainage tube and stitches removed. 
March 31st. The patient has gained in flesh and has a good color. 
At the site of operation is a small oval granulating spot £ inch long 
Patient is practically well. 
Such an hypertrophy as is here mentioned, is very unusual in this 
country. 
Little is known of the causes of such a growth. It is however 
very frequently associated with syphilis. 
Schroeder* speaks of it as very uncommon in Germany. 
Emmet f mentions but one case. The common opinion that it is 
due to self-abuse or to sexual irritation is quite unfounded. Parent 
Duchatelet is quoted as stating that among 6,000 registered pros- 
titutes in Paris he met with but three cases. 
Dr. Ashwell has been struck with the integrity of the external 
genitals in prostitutes while the uterus and ovaries have been bound 
in all directions by false membrane. 
The largest museum specimen of which I have accurate record is 
that belonging to the University of Rouen, which weighs eight 
pounds, and is fourteen inches in circumference. 
The specimen exhibited before this Faculty by Dr. Wm. T. How- 
ard of this city, ten years since, was exactly the size of the one 
removed by the writer. 
Cases of this kind are often associated with hypertrophy of one 
or both labia majora or of the nymphae. The most probable cause 
*Schroeder, Krankh. d. Weibl. Geschleohtsorg. 
tEmmet, Gynmcology. 8 
I believe to be some long continued chronic inflammation in the imme- 
diate neighborhood of the clitoris, as a chancre compressing the 
veins and lymphatics going from the clitoris, while at the same time 
it causes increased arterial supply, by irritation of the nerves leading 
to the part. 
The following references are made to the Army Medical Museum 
catalogue. 
L. Appia. Hyp. d. clit. guer. par. etrangl. en. 24 years T. de Med. 
Chir. et Pharmac. Brux. 1861, xxxiii, 149-155. 
Archincloss (W.) Extirp. of ent. clit. and Nymph. Glos. M. T. 
1858, ii, 165-167. 
Bainbridgc (W.) Case of enl. clit. Med. Times and Gazette, Lond. 
i860, i, 45-50. 
Baekel (V.) Elephantias, du Clitioris. amp. galv. caustic, Gaz. Med 
de Strasb. 1875 3. S., iv, 133-137. 
Buck (W. P.) Hyp. of clit. Phot. Rev. Med. and Surg. Phila. 1871- 
2, ii, 22, 1 pi. 
Baiimstead {¥.].) Hyper, clit. fibro cell, outgrowth. Ibid 1870-71, 
i, 11, 1 PI. 
Canton. Hypertroph. clit. and areal, tissue, etc., 3 years’ growth; 
removal. Lancet, Lond., 1856, ii, 650. 
Caradic (T.) Cas curieux de tumeur fibro-plastique d. clit. etc., Un- 
ion Med. Par., 1861, 2, S, xii, 115-122. 
Case Hypt. d. clit. etc., Med. Ztg, Russland St. Petersb. 1858, xv, 
363- 
Clemens (A.) Extirp. ein. Monst. Clit. Deutsch. Klinik, BqtI. 1863, 
xv, 344. 
Dawson (W. W.) Hyp. d. clit. Cincin. Lancet and Obs., 1868, xi, 
9597- 
Hergott. De la degen. hypertroph. d. part. gen. est. ch. la femme. 
Mem. Soc. de Med. de Strasburg, 1872, ix, 177-187. 
De I'ls&re. (C.) Dis. of clit. case of excess, enlar. Proc. Am. Phil. 
Soc. Phila. 1844, iv, 129. 
Jamieson. (A.) Enorm. hyp. clit., etc. Med. Rep. Shanghai, 
1879-80. No. xix, 23. 
Jones (S.) Spec, enlar. clit. Tr. Path. Soc. Lond. 1857-8, ix, 305, 
Lewis (W. M.) Case of morbid enlarg. of clit. Med. and Phys. J. 
Lond. 1811, xxv, 236-238. 
Bibliography of Hypertrophy of Clitoris. 9 
Marsden (A.) Case of elephan. of clit., etc., Lancet, Lond , 1857 
ii, 196. 
Maury (F. F.) Tumor of clit, Phil. M. Times, 1871, ii, 33. 
Masi. Elephan. d. clit, Spallanz. Modena, 1874, xii, 79. 
Pluchkel (F. S.) Monstros. Clit. Obst. Med. Woch. Wien, 1843. 
703 
Raumeshur Awasihee, Tumur of Clit. India J. M. & Phys. Soc. 
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