A Christmas Story.

Abstract

a chronic ulcer with indurated edges and no disposition to heal, and glandular enlargement comes late in the course of the disease. All these diagnostic points should be taken into consideration, as was done in this case, before a final amputation is made. A competent microscopist can settle the question by a careful examination of a section of the tumor.Treatment.-As the prognosis of the disease is always grave, I told the patient after the diagnosis had been made positively that the disease would progress from bad to worse and that there was no hope for recovery from local or constitutional treatment, and that his only chance would be immediate removal of the organ. He had heard the siren tale of all the quacks; in fact, he had tested some of their wares at enormous expense and pain to himself, only to see the disease progress with more rapidity than before; hence he was reconciled to radical and rational treatment, and when I assured him that the element of pain would not enter into the case at all he readily consented to an amputation of the organ, which was done in the following manner:'Operation: The pubis and scrotum were shaved and thoroughly cleansed with soap, water and the usual antiseptics. The mechanical cleansing had been done previously. The head of the organ was thoroughly hooded so as to prevent the possibility from infection from the ulcer during the operative proceedings. A strong rubber band was rendered aseptic, doubled on itself, and thrown around the penis, close to the symphysis pubis. The penis was firmly held, though not stretched, and after a cuff of healthy skin had been dissected back the cut was made through the corpora cavernosa about two inches proximal to any evidence of the diseased tissue and a beveled incision made which left the urethral portion one inch longer than the corpora; the diseased portion was thus ablated. At this point the rubber band was loosened and four small vessels were either twisted or ligated with catgut. The urethra was split up for a small distance and its edges stitched to the skin, which had previously been approximated over the amputated stump of the penis. A soft rubber catheter was left in the bladder in order that the wound might not become infected by the urine passing over it. A light sterilized gauze dressing and T bandage were applied to the perineum. The parts were occasionally washed off with boraeic acid or carbolic acid solution.Result.-An uninterrupted recovery was the result and no recurrence of the trouble has appeared, though seven years have elapsed since the operation was performed.Remarks.-In neglected cases in which the disease has progressed even to the roots of the penis and in which the inguinal glands are enlarged, it becomes necessary to enucleate the glands from the groin as well as to amputate the penis from the symphysis pubis; as a matter of course this is a much more serious operation and the liability to recurrence is much more probable. Castration of the patient at the time this amputation is done has been advocated by so...