DEVELOPMENT IN NINETEENTH CENTURY 369 



successfully, in 1888. The first successful operation for the relief of 

 extroversion of the bladder was performed in New York by Carroll 

 on April 13, 1858. Pancoast performed the same operation success- 

 fully the same year, and Ayres in 1859. All of these cases antedate 

 the British successes of Woods and Holmes, although there are two 

 operative failures reported by Crook and Lloyd in London in 1851. 

 In plastic surgery of the urethra another brilliant triumph has been 

 made by American surgeons. In 1892 Alexander succeeded for the 

 first time in the history of genito-urinary surgery in making a new 

 urethra, the retentive powers of which were perfect in a case of 

 complete epispadias in the female. There have been 12 cases in all of 

 complete epispadias, in none of which heretofore has the urine been 

 completely under the control of the patient. Physick did an internal 

 urethrotomy by a concealed lancet, and Stevens, in 1817, was the 

 first surgeon in this country to perform external perineal urethro- 

 tomy. He revived the operation, which had fallen into desuetude, 

 since at the close of the last century the mortality was so great that 

 the operation was practically abandoned. Prior to 1840 the opera- 

 tion was performed in this country by several surgeons; notably, 

 in 1820 by Jameson, in 1823 by Rodgers, in 1829 by Warren, and 

 later by several surgeons connected with the New York Hospital, 

 among whom may be mentioned Hoffman, Post, Watson, and also 

 by Alden March, of Albany, and Wood, of New York City. With- 

 out doubt the operation has reached its present state of perfection 

 through the labors of Gouley, who suggested the whalebone guide, 

 the tunneled catheter staff, and the beaked bistoury. 



Hypertrophy of the prostate is a distressing and fatal condition 

 which modern surgery in the course of its development has to a 

 certain extent relieved, if not cured, in a large percentage of cases. 

 It is one of the triumphs of the art within the period of time of which 

 an inventory of the present surgical operations is taken. A review of 

 the operation for the relief of hypertrophy of the prostate would be 

 incomplete without an acknowledgment of the work of Reginald 

 Harrison, Alexander, and White. As regards the benefits which have 

 accrued to these sufferers from castration, it may be stated that White 

 has shown that 66 % or more have return of the power of micturition, 

 most of them a relief of the cystitis, and nearly all freedom from pain. 

 In a series of 98 cases with 7 deaths estimated by White, the mor- 

 tality of the operation was only about 7 %. This is after eliminating 

 a few deaths which had no relation to the operation itself. These 

 figures are striking, and as the time goes on and diagnosis is im- 

 proved and technic is perfected, and early operations are resorted to, 

 the percentage of alleviation of symptoms and of mortality will be 

 even better than those just mentioned. Castration will never take 

 the place of modern prostatectomy with its present low mortality, and 



