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A Journal of British and Foreign Stedicine, Physiology, Surgery, Chemistry,

Criticism, Literature, and News.










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latter end of the eleventh century, (1090,) describes the operaLectures

tion of perforating and breaking up urethral calculi. In the

year 1561, Franco described a four-branched instrument, which LITHOTOMY AND LITHOTRITY. he named quadrupulus vesicæ, for the same purpose ; and

analogous instruments, with four, three, or two branches, Delivered at St. Mary's Hospital.

sometimes intended to perforate or crush, sometimes merely

to extract, were invented by Fabricius Hildanus, SanctoBY WILLIAM COULSON, Esq.,

rius, Paré, &c., and in modern times by Hunter, and Sir Astley Cooper. The greater part of the instruments prepared since

the 16th century were probably borrowed from those invented LECTURE III.

by De la Croix and Alphonso Ferri for the extraction of

bullets. GextLEMEN,- As I have already informed you, I propose In this drawing of Ferri's instrument, which I show you, evoting a few lectures to the important subject of the ex

you will at once discover many of the elements of modern action of calculus from the bladder. It is so vast a question, lithotriptic instruments--the external canula, the threead embraces such a variety of details, that you must permit bladed forceps received into it, and the screw for working. e to enter on its examination at once without any preface. The instrument of Hildanus also shows the fly screw, which et us commence with lithotrity, or that part of the subject has been claimed as a modern invention. ith which you are probably less familiar. Here a few histo

But the older surgeons did not confine their practice to the cal remarks may be interesting, for nothing is more curious simple extraction of calculi from the urethra. It is certain * instructive than to follow the history of the mechanical that they not only sought to extract stones from the bladder estruction of stone through its successive epochs.

itself, but perforated or crushed such calculi as were too large Lithotrity, in one sense of the term, is not a modern inven- to find an exit through the natural passages. on. It has been known, and occasionally practised, from The extraction of calculi

from the bladder without breaking me almost immemorial; but these isolated operations, as I them up, was practised in Egypt from time immemorial: the wall presently show, detract nothing from the merit of the French surgeons who accompanied Buonaparte in his Egyptian lustrious surgeon of modern days, to whom the honour of expedition saw the operation performed there, and it is prowving erected it into a system incontestably belongs, and who bably practised in that country at the present day. But this may therefore be regarded, as he now universally is, the rcal would evidently apply to small calculi

only. Was the operation inventor,

of perforating and crushing larger calculi known to the older The germ of lithotrity may be found in the old idea of ex. surgeons ? Undoubtedly it was. tracting calculi from the urethra without a cutting operation. Albucasis, who died in the year 1105, must have been acFrom the urethra to the bladder there is but a single step, quainted with the operation of lithotrity when he wrote the yet it required more than a thousand years to make this step, following passage: " Accipiatur instrumentum subtile quod short and simple as it may now appear to you.

nominat Mashabra Rebilia, et suaviter intromittatur in virgam, Urethral calculi were sometimes extracted whole, some- et volve lapidem in medio vesicæ, et si fuerit mollis, frangitur times broken up, to facilitate their extraction. Hippocrates et exibit.” mentions a certain Ammon, of Alexandria, who thus broke up From the context of Albucasis, however, it would appear a calculus in his own person with a statuary's scissors, from that the operation of which he speaks referred to the relief which circumstance he was named the “Lithotomos.” Colonel of retention of urine produced by the impaction of a small Martin, as you see, was not the first who operated in this way calculus either in the neck of the bladder or in the urethra. on himself.

In such cases, he says, "the calculus is to be pushed back into Albucasis , a Moorish surgeon, who lived in Spain at the the bladder, and if it is friable it breaks up and is expelled.

But if it be not expelled, the patient must be cut.” It is imFig. 1.

possible to ascertain the nature of the instrument to which 3.

Albucasis alludes, his Latin translator having preserved the

original Arabic name, apparently from not understanding what Fig. 5.

it meant.

In the year 1506, Antonio Benevieni performed the operation of percussion, for the introduction of which, in modern times, we are indebted to Baron Heurteloup. The patient, however, was a female, and the stone appears to have been impacted in the neck of the bladder. Benevieni passed a hook behind the calculus, so as to fix it, and then struck the cal.

culus with an iron rod, until by the repeated blows it was Fig.4.

broken into pieces.

In 1533, Alexander Benedetti thus alludes to perforation“ Cum vero his præsidiis (dissoluentibus) lapis non commi. nuitur, nec ullo modo eximitur, curatio chirurgica adhibeatur, et per fistulam, priusquam humor profusus dolores levet, aliquí intus, sine plagâ, lapidem conterunt ferreis instrumentis, quod equidem tutum non invenimus.”

Sanctorius, who lived in the early part of the 17th century, appears to have invented several instruments, drawings of which are before you, for perforating calculi.

Haller thus alludes to them in his “ Bibliotheca Chirurgica”“ Catbeterem delineat trifidum, per eum in grandiorem cal. culum specillum sagittatum immittit: eo, ut putat, calculum dividit, ut fragmenta inter specilli crura cadant et possint extrahi.” But Haller adds, “meram speculationem puto."

This is an extremely curious passage. Haller evidently quoted Sanctorius from memory, for on referring to the original work of this latter author, you will find that the instrument of which I have shown you a drawing was solely intended for the extraction of small calculi from the bladder, and that the arrow-headed stilet merely served to expand the branches of the three-bladed forceps. The idea of perforating the cal

culus, and extracting its fragments, was a creation of Haller's Figs. 1 and 2.- The ball-extractor of Alphonso Ferri (1553) : fig. 1,

own genius, which he attributes to Sanctorius, and calls "a the blades; fig. 2, the instrument enclosed in its sheath.

pure speculation.” Yet, one hundred years afterwards, this FIG. 3.- The quadrupulus vesicæ of Franco (1561), for extraction

speculation was converted into a reality. It would hence

appear, that the original idea of lithotrity, as a system, belonged Fios. 4 and 5.~The forceps of Fabricius Hildanas, for the same to Haller, but that Haller attributed his own idea to another, purpose (1593): fig. 4 shows the instrument shut, and grasping the stone ; dg. 5, the three bladed canula.

and discarded it as a fancy,


Fig.2 Fig.

of calculi from the urethra.

No. 1505.

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