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.

    87/192 (page 75)
    Lithotrity, as an operation, owes its existence to the French surgeons, mainly to Civiale; but the labours o£ Leroy d'Etiolles, Arnussat, and others were not without value in developing a system. My old friend Civiale, who died in 18G7, at a good old age, and full of honours, was the first surgeon to crush a stone successfully ; and this he did in the year 1824, with m- struments which he had designed in 1817. No doubt something resembling the pro- cess had occasionally been accomplished by patients themselves. In one instance a man had managed to grind down with a small file a little stone in the bladder, a circumstance which has been dignified with the title of an operation of lithotrity. But the first man who designed and per- formed a systematic operation on the living patient was Civiale, and he operated on his first two patients before a committee of the Academy of Medicine, with this instrument that I hold in my hand. You see how different it is from anything we now employ. It is a straight instrument, with a central axis and three claws, which were made to project after its introduction into the bladder. [The manner of using it is shown.] You see what a very differ- ent mode of proceeding that is from the method now adopted. It consisted in drilling holes in the calculus in various directions until it gave way, and each fragment was subjected to a similar pro- cess, until the whole was converted into debris. Notwithstanding the tedious char- acter and the difficulty of the procedure, it was, to a certain extent, a successful operation. I cannot now describe to you all the varied proposals made about and soon after this time, but the most impor- tant change was the production of an instrument in which pressure between two blades placed at nearly a right angle with the shaft, constituted the agency by which force is applied. This was a great im- provement, to which the profession is in- debted to a late Mr. Weiss, of London, at so early a period as the date of Civiale's first operation (1824). This system of crushing soon replaced the perforator, and although Weiss's instrument has since been modified in several particulars, his system is still the favourite one with all operators. While the method of Civiale was originally perforation and grinding, lithotrity became after Weiss's instru- ment what it still is, a process of crush- ing- Let me here ask you to observe that a lithotrite always consists of two chief parts: viz., the prehensile part, which deals with the calculus ; and the power- regulating part, or that which receives and distributes the force applied by the hand. It was the first-named part above referred to, which had at this early period so nearly approached perfection. The next im- provements were those which related to the opposite end of the instrument which transmits the force to the crushing blades. Various ways of aiding and modifying this were tried : in one, the patient being fas- tened to a special bed, the lithotrite, which was extremely large and clumsy, was fixed in a vice, and the force was communicated by the blows of a hammer. [Baron Ileurteloup, 1832.] The screw was used also in some form at or before this period— it is said first at the suggestion of Mr. Hodgson, of Birmingham. Costello sub- sequently made mechanical modifications in the details of the screw lithotrite, which still continued to be an unwieldy and dangerous instrument. Mr. L'Estrange, of Dublin, also made a useful alteration in it. The apparatus thus gradually im- proved, and used here long after this time (1840-55), is the next which I show you. It has become somewhat smaller, and therefore less likely to injure the urethra than its predecessors, but the power is applied only by means of a thumb-screw, which works very slowly. Nevertheless, it is the instrument with which Sir B. Brodie earned his success, and it is handled thus. [Explanation.] You see how much time is wasted, not only in the action of screwing home to crush a fragment, but in unscrewing in order to prepare the blades to seize another. No amount of crushing worth the performance could be executed in less than a quarter of an hour, and sittings of a much longer duration than this were quite common in using this instrument in order to reduce a small stone. Another change, useful in its day, was that in which the power was regulated by means of the rack and pinion ; this was due to Sir William Fergusson, who used it almost to the end of his career, and by its means he shortened the process con- siderably. The next improvement was a very- great one, and is due to Civiale and to the late M. Charriere, of Paris. An ingenious mechanism in the handle, moved by a disc there, enables the operator to exchange