370 SURGERY 



which is gradually improving each year from about 6 % as reported 

 by Mayo. 



The operation for suprapubic prostatectomy was first performed 

 in this country by Belfield, in October, 1886. Prostatectomy is an 

 operation, the technic of which has been devised in recent years, and 

 it gives great comfort to the patient and saves life. Murphy has 

 reported 34 consecutive cases without a single death due to the 

 operation. This operation has been greatly improved upon by 

 the use of Gouley's prostatectome, which facilitates the removal 

 of the gland. 



In lithotomy American surgeons have achieved brilliant results. 

 McDowell did 32 lithotomies in succession without a death. Dudley 

 performed over 100 consecutive operations without a fatal case. In 

 1846 Willard Parker removed a calculus from the bladder by pro- 

 ducting a rectovesical fistula; and subsequently performed this 

 operation for the cure of chronic cystitis, and in 1861 Bozeman did 

 this same operation to relieve a chronic cystitis in the female. In 1836 

 Physick removed over 1000 calculi. These brilliant results in lith- 

 otomy are most remarkable when it is considered that there was a 

 time in the medical history of this country when a patient actually 

 made the pilgrimage across the ocean in order to secure the services of 

 a surgeon to perform lithotomy. 



Litholapaxy is an operation that was introduced by Bigelow in 

 1878, and has been the means of saving thousands of human lives 

 within the past quarter of a century. It forms one of the most promi- 

 nent advances in surgery that has distinguished the century. By 

 litholapaxy is meant the crushing of a stone in the bladder with an 

 instrument called a lithotrite and the immediate rapid evacuation of 

 the fragments from the bladder by a syringe especially made and 

 adapted for this purpose. It is a matter of surprise and interest 

 that Bigelow's entire apparatus for litholapaxy remains essentially 

 the same to-day as it did a quarter of a century ago, which demon- 

 strates how complete the mechanism is in all its minor details. Keyes 

 has made some great improvements in litholapaxy, thereby reducing 

 the mortality of the operation, among which may be mentioned in the 

 list of improved instruments the modern evacuating-tube, the altera- 

 tion in the mechanism, and other improvements in the technic of 

 the operation. Keegan performed Bigelow's operation 59 times in 

 children, with one death, and Freyer performed it 49 times without 

 a death. The record of Bigelow's, or the American operation of lith- 

 olapaxy, has certainly won for itself a fixed place in the annals 

 of surgery. 



Rupture of the bladder was operated upon successfully by a lapa- 

 rotomy by Walters, of Pittsburg, in 1862, but to Sir William Mac- 

 Cormack is justly due the credit of establishing this operation. 



