1899 Journal of the American Medical Association (JAMA)  
testicles are now found and dissected and wrapped in another towel, and laid out of the way. Fig. Ill shows the tumor from behind, with the skin dissected off ready to be cut away. The tumor is handled with a rope and tackle, the rope being supplied with two snaps at one end to snap into the handles of a large pair of tumor forceps. This is not needed in small tumors, but for those of forty-five to eighty-five pounds or more, it will be found very convenient. The tumor is now lifted by the
more » ... lifted by the tackle, and the tissues put on the stretch. Then with a pair of pedicle forceps the base of the Fig. IV.-Tumor removed. tumor is grasped close down to the perineum and cut away. Then another pair is clamped on above these and again cut away, and so on until the tumor is freed from its attachment. Care must betaken not to injure the urethra or the spermatic cords. The flaps of skin are now trimmed and fitted for sewing up the scrotum. The skin is trimmed over the perineum so as to come nicely together and from two to three stitches taken in it, as when the repair of the perineum is made in the female, only that not so much tissue is pulled into the wound. Fig. IV shows the tumor removed with Fig. V.-Operation complete. the flaps of integument drawn off on either side, the penis held perpendicular, and the testicles wrapped in a towel. After the perineal stitches are placed, the testicles are brought down into place and the flaps are trimmed to make the new scrotum, which is then sewed up to near the base of the penis. Then the integument which was the former covering of the penis, and which has been pulled over the glans penis like a skinned rabbit, is thoroughly trimmed and drawn back over the penis into its proper place. The superficial integument is now trimmed off all round, the edges sewed together, and the operation is completed, as in Fig. V . The present epidemic of smallpox in this Province may be said to be practically at an end. No new cases are appearing; all unprotected persons have been vaccinated, and all infected houses have been disinfected. We have isolated and treated in our isolation hospitals more than twelve hundred cases. These hospitals are located at convenient centers of i nspecti on\p=m-\Hol gui n, Gibara, Auras, Fray-Benito, Puerto Padre, Las Nuevas, La Caridad and Mayari, Their records show respectively, 475, 230, 210, 123, 50, 93, 15 and 5 cases. At the present time there are less than three hundred cases under treatment, most of which are convalescent. Our rate of mortality has been less than 12 per cent. We attribute this excellent result to open-air treatment and to bichlorid baths \p=m-\everypatient receiving daily baths in strong solutions (1 to 1000) of bichlorid of mercury. The openair treatment is a necessity in this locality, the open Spanish sheds constructed of palm leaves, of which the hospitals are composed, affording but little protection, and likewise affording but little lodging for the germs of disease and consequent virulence of infection. This treatment is permissible in this warm, equable climate. The low rate of mortality can not be attributed to the mild type of the disease, for, as a matter of fact, the disease is of more than average severity. Nor can it be attributed to previous vaccination, for our records show only 2 per cent, of persons possessing such partial immunity, with no deaths. The municipal records of Holguin during the past summer show an average of six deaths a day, with 800 deaths, all told, from smallpox during the year. There have occurred in Gibara 25Q deaths from smallpox during the same period. Numerous other small towns have become depopulated and deserted, and have converted their cornfields into graveyards. No effort had been made by the Spanish authorities to combat the disease ; indeed, it would appear instead that they had, with devilish intent, encouraged its ravages as a method of inhuman warfare against the Cubans. The Cubans themselves seemed to have accepted the inevitable with dogged resignation. Twelve thousand Spanish soldiers had been quartered in Holguin for three years, until the city was submerged in filth and overwhelmed with disease. Such were the conditions met by Hood's Regiment upon taking possession of this district. We are happy to repeat that after two months of arduous labor we have placed the district in an excellent condition and have done much toward relieving the oppression and misery consequent upon the Spanish domination. On January 7 the lazaretto of Holguin was destroyed by fire, it having outlived its usefulness. The lazaretto at Gibara was likewise destroyed some days previously. Our methods of control have been : 1. the establishment of isolation hospitals as above; 2, the isolation of all cases therein; 3, house-to-house inspection; 4, the establishment of convalescent hospitals for final disinfection; 5, the | vaccination of all unprotected persons; 6, the disin-Downloaded From: by a University of Iowa User on 05/25/2015
doi:10.1001/jama.1899.92450350013002d fatcat:xq4bhxpuhrgzpkrsamkywf7rf4