On the Treatment of Stone in the Bladder, by Medical and Mechanical Means
Journal: BMJ (1842)

Dr. Willis shews but a dull picture of lithotomy.The brilliancy, he says, ?i the procedure apparently has dazzled both the operator and spectator, and disastrous consequences in unfortunate cases have always been Merged in the temporal redemption that is achieved for the sufferer in those that prove successful.But of all of every age and sex who submit to lithotomy one in seven or eight will inevitably be lost immediately, and among those who are in years when the life of man is most truly pre- cious, one at least in three or four will fall its victim.This is, no doubt, pretty true, discouraging as it may be.But what says Dr. Willis of hthotrity ?Nothing flattering.This, he tells us, is beyond all question a rotten staff, which leaned upon by all who suffer from stone will cer- tainly fail five-sixths of the number; nearly one-half will find that it is totally inapplicable to their case; from one-third to one-fourth will fall ^mediate victims to its determined application; and from one-third to one-fourth will escape to lead miserable lives from diseased bladder, and then to die of diseased kidneys; not more than one in three or four of all ?who were held favourable subjects will find it a safe, effectual, and final remedy for their disease.The public and professional mind has been singularly abused in regard to the value of lithotrity as a general means of treating stone in the bladder.Although we believe that the success of lithotrity has been greatly over- rated, still we would not venture to lay down its statistics so confidently as Dr. Willis.The data have hardly been acquired for any such piositive conclusions.However, Dr. Willis does not leave us with this gloomy prospect.The following remarks are of a more encouraging description." Conviction of these truths has lately led physicians back to the long neg- lected class of medicines called Lithontriptics, and there is already evidence enough extant to satisfy us that these medicines, taken internally and used in the Way of injection, have even greater powers than were suspected in the palmy days of their employment some century ago.But lithontriptics, like all other medicines, have no more than a certain limited range of power; and supposing them to fail, and manual interference to become indispensable that the sufferer from stone may have a chance for his life, have We no resource but lithotomy as the general and lithotrity as the exceptional rule ?I believe that we possess an almost unfailing refuge in the operation which I have described under the title of Lithectasy.By this procedure the brilliancy of the operation by which a stone is now generally extracted from the bladder will be gone ; but the life of the patient will be safe; and this surely is the end which all who are engaged in the practice of medicine as an art, or who are striving to advance it as a science, have in view.Surgical operations generally have been becoming less frequent and less dangerous, ever since the Revival of Letters in Europe.I believe that by the judicious use of lithontriptic medicines, and the adoption of lithectasy, they may be made both much less frequent and infinitely H h 2