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from the author
LITHOL A PAXY
HENRY J. BIGELOW, M. D.,
PROFESSOR OF SURGERY IN HARVARD UNIVERSITY; SURGEON OF THE
MASSACHUSETTS GENERAL HOSPITAL.
From the American Journal of the Medical Sciences, Philadelphia, January, 1878.
LITHOTRITY WITH EVACUATION.
WHEN Sydney Smith asked, “ What human plan, device, or invention two hundred and seventy years old does not require reconsideration ?” he would no doubt have regarded with favor an occasional reconsideration of the theory and practice of medicine and surgery, - especially in view of the current belief that their traditions had been kept alive and their rules prescribed in part by authority. The surgical literature of Lithotomy, both French and English, so long showed the influence of the early specialists, that we have hardly now escaped from its exaggerated circumstance and detail. And yet, with attention to a few precise rules, the operation of lithotomy is quite a simple one, — much less difficult, for example, than the dissection of tumors. It is not impossible that convictions in some degree traditionary may prevail in regard to certain points connected with the practice of the more recent art of Lithotrity.
Civiale was among the first to inculcate the excessive susceptibility of the bladder under instruments. Later surgeons, perhaps influenced in part by his teaching, have continued to invest the operation of lithotrity with precautions which, though by no means groundless, because under certain conditions both the bladder and urethra are actively resentful of even slight interference, are nevertheless greater than this operation generally requires. As a rule, there is little difficulty in it. The stone is readily caught and broken into fragments, of which a few are pulverized ; a large-eyed catheter is then sometimes introduced ; a little sand and a few bits of stone are washed out; after which the patient is kept quiet, to discharge the remainder and await another “sitting.” Under