Conservative perineal prostatectomy. Part first; part second. In Stereo-Clinic [Section XII] by Howard A. Kelly

Troy, NY: Southworth Company, 1910. FIRST EDITION. With 44 mounted photographs (as stereo cards). Preserved in the publisher’s slipcase (as issued). Stamp of Mercy Hospital, Durango, Colorado. First edition of each part. In an earlier work from 1905, the father of modern urology, Hugh Hampton Young (1870-1945), described his outcomes with perineal prostatectomy for both benign and malignant cancer. The major insights from this earlier work include:

– prostate cancer occurs in approximately 10% of cases of benign prostatic enlargement
– marked induration in any man greater than 50 years of age should be considered suspicious for cancer
– advocating frozen analysis of prostatic tissue if the diagnosis of cancer is uncertain
– the definition of pathways of local (along the ejaculatory ducts, between the prostate and seminal vesicles) and metastatic spread (out through the lymphatics near the trigone of the bladder to the pelvic lymph nodes and osseous sites)
– radical prostatectomy (removal of the prostate, vasa and seminal vesicles) as the only means of cure for men with prostate cancer

This work is a step-by-step description of a case Young was treating, including a discussion of the symptoms and the surgery. The instruments required are illustrated in photographs; also illustrated is the position of the patient during surgery as well as each and every cut, stitch, and the set-up of the bed for post-operation continuous irrigation. It is as if the reader was actually in the operating room.

Young “devised several new surgical procedures for treating genito-urinary diseases; did the first perineal prostatectomy which soon replaced the more dangerous suprapubic approach, and performed the first radical operation on a cancerous prostate gland. Young trained many of the leading urologists of his time” (Dictionary of American Medical Biography, 2:832-833). Baltimore photographer Anthony Murray took the photographs that were used in Kelly’s ambitious Stereo-Clinic series that was designed to provide surgeons with a combination of high quality, close-up photographic images accompanied by a description of each step in a specific operation.