Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson.

  • Thompson, Henry, Sir, 1820-1904.
Date:
1882
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Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson. Source: Wellcome Collection.

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    be expected to endure. We know that the excreta of fishes have been preserved for many thousands of years, and I doubt not that some of these human excreta might be found also, and that oxalate-of- lime calcuH, at least, must exist among other ^human remains. As so many ob- servers are seeking the early records of the human race, I throw out the hint ; and certainly, if I were so searching, I should not forget to seek, among other things, the matters in question. Whether we shall thus ever find any instruments which could be identified as the means by vs^hich those stones may have been re- moved is extremely doubtful. We will, however, not occupy our time with speculation, but will be satisfied to begin with such facts as we can find, say about 2,300 years ago. The first allusion on record is in the works of Hippocrates [born B.C. 460], who obliged his pupils to take an oath that they would never practise lithotomy, but leave the operation to those who -were in the habit of performing it; thus indicating his sense, at all events, of the gravity of the proceeding, which he appeared to think too hazardous for men to undertake who were not specially trained for the purpose. To such he recommended that stone cases should be left; it is clear, therefore, that at this early period the operation was recognised as an established surgical pro- cedure. But it was practised, not as any part of general surgical duty, but as an occupation by itself, and, at any rate in the estimation of physicians, not a very exalted one, being only in the hands of certain itinerant performers. After this, Celsus, who probably flourished about the commencement of the Christian era, de- scribed the operation as it was practised by these men. In his seventh book he gives the details, and termed it * cutting on the gripe.' The method was simple, and so were the instruments, on which account they were long afterwards termed the * apparatus minor,' to distinguish them from the ' apparatus major' of another operation, which came into vogue in the second period. The ancient or classical method was thus conducted. The opera- tor commenced by placing his patient, usually a boy, upon the knees of a man who was seated. If it was an adult patient (but such were rarely cut), two men sat side by side (their legs forming the operating table), so that their arms might clasp the patient and control his struggles. The operator used no staff whatever, but inserted two or three fingers into the rectum, and endeavoured so to feel the stone, which he could only do when it was large. If he succeeded in recognising it, he firmly fixed, or ' griped ' it with the ends of his fingers—hence the term ' cutting on the gripe ; ' and pressing it down towards the perineum, he made a semi-lunar cut with a broad scalpel until he reached it. Then, if unable to press it out with his fingers, he drew it out with a hook. Now, this very rough pro- ceeding universally prevailed until about the sixteenth century; indeed, up to the seventeenth century it was largely prac- tised in Europe. Even in the latter part of the seventeenth century, when Frere Jacques appeared, the ancient mode of cutting on the gripe was chiefly practised. We now reach the second period, or that of the Renaissance, when at least three diflerent operations appeared. Ap- propriately enough, too, a brother of one of those monastic orders which had che- rished and exercised most of the arts hitherto, figures now as the most famous operator. First, we will consider the ' Marian method' or * apparatus major'—a median operation, originated by Johannes de Romanis, but receiving its name from his pupil, Marianus Sanctus, who published the first account of it a.d. 1524. It is called the' apparatus major' because, Avhile * cutting on the gripe ' required only a knife and a hook, this small table would be scarcely large enough for the instruments employed for the Marian operation. They are not here, but you may see them at the College of Surgeons. By this method, a simple cylindrical stafl having been intro- duced into the bladder, a vertical incision was made by the side of the raphe, and the urethra was opened on the staflf at about the membranous portion. A dilator was then passed into the wound, and upon that another (male and female dilators they were called), and the canal and the neck of the bladder were torn asunder with great rudeness. Its only resemblance to the present median operation is, that the incision is in nearly the same place. But anything more barbarous than the practice you can hardly conceive. The stones were larger then than they are now, and the incision was small; and in order to dilate it and extract the stone, various