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]
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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![resisting', this part is in children more dilatable, and would ad- mit the entrance of portions of stone too large to pass through the rest of the canal. There are, besides, other objections to lithotri- ty in children, as the greater degree of susceptibility of their ner- vous system, and of irritability of the parts, which would render the repeated introduction and action of instruments in the bladder liable to be attended with serious consccjuences. On the other hand, all the conditions are most favourable for lithotomy in young subjects, and it is successful in the great majority of instances, the stone being frequently removed in two or three minutes, while the symptoms (which are generally induced by its presence, and not dependent upon previously existing disease), most usually sub- side alter the removal of their cause. 'I’lie operation being com- paratively easy of performance, owing to the trifling depth of the perineum, which enables the operator readily to reach the interior of the bladder with his finger, and generally to touch the stone, is also a principal cause of success ; added to which, the patient’s moral constitution is not disagreeably affected, with respect to the result of the operation, as is often the case in adults. Hence, it is obvious that in general lithotomy is in an especial manner the operation best adapted to children affected with stone ; yet, even under the most favourable circumstances, the operation is fatal in a certain pro])ortion of cases, which may be seen from the tables in the ap- pendix, so that even in children lithotrity may be the preferable operation in some instances, as when the stone is small and likely to be destroyed in two, three, or four sittings, and where there is not much irritability of the parts on the introduction of instriHuents. It has been several times performed on children with success, both in England and abroad ; but I am not aware that in any instance it has been attended with a fatal result. Of the cases which have come to my knowledge, the youngest patient on whom lithotrity was performed was forty months old. M. Segalas was the opera- tor on this occasion, though few persons would be inclined to fol- low his example on so young a subject. In proportion, however, as the patient approaches nearer to puberty, lithotrity might be performed with greater prospect of advantage. Stone cases in females being of rare occurrence compared with their frequency in males, the question relative to the operation to be preferred in them resolves itself into a very narrow compass. In fact, the shortness, width, and great dilatability of the urethra in women, admits of the passage or extraction of calculi, which in the other sex would require an operation of lithotomy or lithotri - ty for their removal; and when one of these operations becomes necessary, the surgeon will not experience much difficulty in de- termining to which the preference should be given. Lithotomy, though attended with comparatively little difficulty or danger in](https://iiif.wellcomecollection.org/image/b22335948_0052.jp2/full/800%2C/0/default.jpg)
