Lectures ON LITHOTOMY AND LITHOTRITY

William Coulson
1852 The Lancet  
portion of the task which I have undertaken, and that is, to lay before you a parallel between the two grand methods for the cure of vesical calculi which we have already passed in review. At an earlier period of lithotrity, it would have been nearly impossible to institute a comparison between the two operations in an unbiassed manner. Lithotomy and lithotrity were then regarded as rivals-I might almost say, as enemies. The surgical world was divided into two companies, one supporting with all
more » ... supporting with all the authority of experience the pre-eminence of the old method, the other advocating with all the fervour of enthusiasm the adoption of a new, and, as they considered, superior operation. A parallel was drawn between the methods, taken in the abstract. The questions debated were-" Is lithotomy superior to lithotrity ?" or " should lithotrity altogether supersede the cutting operation?" This erroneous mode of examining the subject led to fruitless and almost interminable debates ; after which, each party continued more rooted in its opinion than ever. Nearly thirty years have passed away since the time to which I now allude. Reason and experience have dissipated the prejudices on both sides; and we are now, I believe, in a condition to examine this once thorny question in a cool and impartial manner. And here, at the commencement, I would observe to you, that I do not propose comparing lithotomy and lithotrity in the abstract. I shall not attempt to determine whether lithotomy should exclude lithotrity, or, vice versd, whether the former be the general rule, and the latter only its exception. This would lead us to the errors I have just alluded to. Although the object of the two methods be the same, the means employed are extremely different, and the cases to which each method is specially applicable are also very different. Hence it would be illogical ' , in the very highest degree, to institute any general or abstract parallel between the two operations. I shall pursue a different course, which I trust may bring us nearer to the truth. On some few points common to both, general remarks may be admissible ; for the rest, I shall compare, first, the operative proceedings ; second, the obstacles peculiar to both methods ; third, the accidents, primary and secondary, by which each may be followed; fourth, the cases to which each is applicable; and finally, the statistical results of both methods. Lithotomy and lithotrity, as now performed, have been reduced to a wonderful degree of simplicity ; and this, for many reasons, is a great advantage in any surgical operation. With respect to the operative proceedings in both methods, we may consider the means of arriving at the bladder, of seizing the calculus, and of
doi:10.1016/s0140-6736(02)21099-5 fatcat:vdaopygssjeqnfyt7s2xmf6gii