Hugh H. Young

Congenital Obstruction of the Posterior Urethra1

An obstruction more or less complete, due to the presence of abnormal valves or folds in the posterior urethra has occasionally been described in the literature. The condition has always been regarded as one of great rarity. The great majority of the cases has been recognized only at autopsy, the diagnosis made during life having had no relation to the lower urinary tract. On reviewing the records of The Johns Hopkins Hospital, twelve cases not previously reported have been found, in which the diagnosis has been confirmed by instrumental methods, operation or autopsy. It seems probable, therefore, that the condition is considerably more frequent than would be inferred from the attention given it in the past. The earliest mention of the condition found in the literature is in the work of Langenbeck on Lithotomy, published in 1802. Thirty years elapsed before the subject was again referred to by Velpeau (1832), who described several anatomical specimens in which there were present in the posterior urethra valve-like folds which he felt might be of clinical importance. Tolmatschew, in 1870, was the first to give a comprehensive discussion of the subject and recognized the condition as a pathological entity. But these were all chance autopsy findings and it was not until 1912 that the first clinical diagnosis of valvular obstruction of the posterior urethra was made, this case being operated by one of us at this hospital. This and three other similar cases were reported before the Johns Hopkins Medical Society in November, 1913.

The early diagnosis and radical cure of carcinoma of the prostate: Being a study of 40 cases and presentation of a radical operation which was carried out in four cases

The recent publication of Courvoisier, Wolff, Socin and Burckhardt, and Albarran and Hall~, have furnished a considerable stimulus to the study of cancer of the prostate, but although the disease has been shown to be much more frequent than was formerly supposed, and the pathological aspects have been well elucidated, practically nothing has been suggested in recent years as a routine operation for its radical cure. Albarrans startling announcement that in 100 specimens of supposed benign hypertrophy he found more or less pronounced invasion of carcinoma in 14, seems not to have suggested the necessity of a radical excision, and even at this late date we find Pousson and Hawley advocating a mere enucleating prostatectomy, leaving behind the prostatic capsule, urethra, anterior commissure, the adjacent vesical mucosa and the seminal vesicles--structures which are manifestly in int imate contact with cancerous lobes. The need of early diagnosis and radical methods of removal has been brought forcibly to the writer s attention in the past two years by the sad results arising from his failure to recognize, and to operate radically in six cases of early carcinoma of the prostate--several of which ought certainly to have been cured by the operation which he has since carded out in four cases. The object of this paper is to give in detail: I. The six cases of early carcinoma in which the malignant nature of the disease was not recognized and a partial operation performed. ~ , II. A radical operation, proposed as a routine for cases of cancer of the prostate, with histories of four operated cases. III. A clinical and pathological study of 40 cases of carcinoma of the prostate. IV. A comparison with cases in the literature in which operations for carcinoma of the prostate were performed. V. Conclusions as to the practicability of early diagnosis and the radical cure of the disease.