A system of practical surgery / [Sir William Fergusson].

  • William Fergusson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / [Sir William Fergusson]. Source: Wellcome Collection.

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    which can be caused to open by means of a stilot, connected with a kind of trigger near the handle. When in the bladder the blades are opened, and allowed to shut again, which they do by their own elasticity, provided the trigger is not meddled with ; and, more per- haps by chance than by dexterity or precision of movement, one, two, or more of the concretions are probably caught within the hollow chops. By a repetition of such proceedings from day to day, as circumstances may permit, the malady may thus be removed. The method, however, is of older date than Sir Astley’s operation, although the instruments do not seem to have been so perfect. Sir William Blizzard was occa- sionally in the habit of resorting to it, and the proposal is at least two centuries old. But cases where such practice may be deemed advisable, or may actually prove of service, are truly of rare occurrence, and in by far the greater number of cases of stone some more effectual means must be resorted to. In modern times the methods of drilling, percussing, and crashing the stone into sand, or into such small fragments as to pass away spontaneously, or to be removed by appropriate instruments, have been devised, proposed, and carried into execution, with the excellent motive of saving the necessity for resorting to a cutting operation, which until within these twenty years was deemed the only certain method of cure,—although one attended with so much difficulty and hazard as to make it in every respect a last resource. ■It is compatible neitherwith the limits nor with the arrangement of this volume, that I should enter upon the particular history and pro- gress of the subject of lithotrity, which now occupies so large a share of modern surgical literature. The celebrated cases of General Martin and the monk of Citcaux seem invariably to be put at the top of the list of all lithotritic proceedings. The former relieved himself by frit- tering the stone into sand by means of a steel bougie made rough like a file on its convexity : the latter, by means of a kind of chisel intro- duced through a canula, and made to act on the stone by percussion with a hammer. The General’s bladder is said, however, to have held a stone within it when he died, and the relief which he experienced may probably, after all, be attributed to some of those accidental alter- ations as to position of the stone and otherwise, which are occasionally met with in practice where no mechanical means have been adopted, and which are well ascertained to have occurred in some instances during the exhibition of the nostrum of Madame Stephens. Although Gruithuisen of Munich proposed, in 1813, to seize and then perforate a stone in the bladder by the process of drilling, and though Dr. James Amott, in 1821, proposed applying a small circular saw, introduced through a canula, to rasp off a portion of the concretion (the latter for the purpose of chemical examination,—the former to permit of the more advantageous contact of solvents,) though Elderton, in 1819, first proposed a curved lithotritic instrument, and though Amussat, Leroy, and Civialc were busily engaged on the project of destroying stone in the bladder by mechanical means, the first operation on the living sub-
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