On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other : being the dissertation for which the Jacksonian Prize for 1838 was awarded / to Edwin Lee.

  • Lee, Edwin, -1870.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other : being the dissertation for which the Jacksonian Prize for 1838 was awarded / to Edwin Lee. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    at once, yet if it fail, the use of tlie eye will, in all probability, be irremediably lost; so with regard to the breaking up a stone in the bladder, if it should not sueeeed, the failure would not, except in a few' cases, be fatal; and the ]>atient might undergo with ad- vantage another operation ; whereas, if lithotomy be performed and fail, it almost necessarily induces the patient’s death. Seve- ral instances have occurred in which patients who had been sub- jected to lithotrity w'cre subsequently cut for the stone, and re- covered ; on the other hand, some of these patients died after the operation, which was not unlikely to have happened, even if litho- trity had not been attempted ; though it cannot be denied that the failure of lithotrity would frequently place the patient in a less favourable condition for supporting lithotomy, not only with re- spect to the local condition of the parts, but also as far as his ge- neral state of health and moral arc concerned. Lithotrity may be considered as more especially suited to adults whose general health is good, and w hose urinary organs arc free from any other disease than the presence of stone ; in whom the blad- der is moderately capacious, not prcternaturally irritable, and con- tains a single stone of small size, (as not exceeding the size of a filbert), and not excessively hard. A j)aticnt in whom these con- ditions arc met with may be regarded as being under the most fa- vourable circumstances for the operation, which in all probability would require but few sittings for its completion, without the oc- currence of any of the more serious accidents which sometimes at- tend it. Nor are the instances in which all these propitious cir- cumstances arc united at all unfrcqnent; a large proportion of stone patients who apply to the surgeon for relief have, in fact, no disease but the stone, the presence of which is frequently not even manifested by the symptoms, but only becomes evident on sound- ing. It is true that a person under similar conditions is also in a very favourable state to undergo lithotomy, and would most pro- bably recover; yet it must be borne in mind that, even in the most favourable cases, the mortality from lithotomy is great; that it is an operation of a most painful nature, and one of whicli patients entertain so great an apprehension, as not unfrequently to liave a prejudicial effect on tlie result; that unex])ected difficulties may arise during the o))eration, and accidents may supervene, compro- mising the patient’s life ; and that, even if every thing were to go on well, the patient must still be almost entirely confined to his bed, till the complete healing of the wound. Few surgeons, there- fore, conversant with both operations, would hesitate in a similar case to recommend lithotrity ; and even were the surgeon dis- posed to prefer lithotomy, many patients would decline adopting his recommendation, and would very likely apply to others whom they might think better able to cure them, without subjecting them to so formidable an operation.