368 SURGERY 



1820, an instrument which included the tonsil in a ring, and then 

 cut it by a ring-shaped knife. The guillotine principle applied to the 

 tonsillotome was an improvement upon this instrument. 



The operation for the relief of goiter is a great advance in operative 

 work, since this was formerly one of the most serious operations in 

 surgery. Wolfer reports 60 cases collected from Billroth, Socin, and 

 his own clinics with only two deaths. Reverdin's mortality was only 

 2.8 %, Kocher's results are most brilliant, 0.2 %. Mikulicz's, 2.6 %. 

 The treatment of cretinism and myxedema by thyroid extract is 

 another method of cure that has been followed by recent success in 

 a fair percentage of cases, though the use of the drug must be con- 

 tinued for at least two years. 



The operation for rhinoplasty to restore a lost nose is one of the 

 triumphs of the century, and plastic operations for the restoration of 

 a partially destroyed nose is also a contribution of modern surgery. 

 Cheiloplasty, or the formation of a new lip, is another plastic opera- 

 tion, the product of aseptic surgery. Stomatoplasty , or the repair of 

 defects of the lips from contraction due to burns, and metoplasty, 

 or the repair of defects of the cheeks, and blepharoplasty , the repair 

 of defects of the eyelids, are illustrations of the beneficent work 

 that surgery has achieved. 



Surgery of the Genito-urinary System. In the department of genito- 

 urinary surgery a great advance has been made by the invention of 

 instruments to facilitate and improve the technic. 



The cystoscope is an American instrument, having been invented 

 by Fisher, of Boston, in 1824, Civiale and Heurteloup having in- 

 vented their instruments in 1827. The cystoscope of to-day is one 

 which has been evolved from the general principle of Fisher's endo- 

 scope. Otis has perfected the urethroscope by the addition of a new 

 lamp for the electro-urethroscope. Klotz has also devised a cysto- 

 scope which is in use at the present time. Brown has devised a most 

 useful urethral speculum for the purpose of making topical applica- 

 tion to the canal. The Gross urethrotome, also Powell's urethral 

 dilator, and the Otis dilating urethrotome, and the urethrotometer 

 are instruments deserving of worthy mention. The work of Bum- 

 stead and of Van Buren in this department of surgery have already 

 world-wide reputation. The operation of nephrectomy for the relief 

 of malignant disease of the kidney is of American origin, since it was 

 first performed by Wolcott, of Milwaukee, in 1860. British surgeons 

 give the credit of this operation to Simon of Heidelberg; but he did 

 not perform his operation until 1869, or nine years after Wolcott 's 

 operation. x 



Nephrectomy was first performed in America for gunshot wound 

 of the kidney by Keen in 1887, and again two months later for the 

 same reason by Willard, and still again for the same cause by Price, 



