LITHOT'OMY (Gr. lithos, a stone; WO, the act of cutting), the technical name for the surgical operation popularly called cutting for the stone.
As most of the symptoms of stone in the bladder (which are noticed in the article CALcunus) may be simulated by other diseases of the bladder and adjacent parts, it is necessary to have additional evidence regarding the true nature of the case before resort ing to so serious an operation as lithotomy. This evidence is afforded by sounding the patient—a simple preliminary operation, which consists in introducing into the bladder, through the natural urinary passage (the urethra), a metallic instrument, by means of which the stone can be plainly felt and heard.
Lithotomy has been performed in various ways at different times. The earliest form of lithotomy is known as cutting on the gripe, or Celsus's method. It received the former name from the stone, after being fixed by the pressure of the fingers in the anus, being directly cut upon and extracted; and the latter, from its having been first described, so far as is now known, by Celsus, although it had probably been practiced from time immetnorial. At a later period this operation received from Marianus the name of the apparatus minor (from a knife and book being the only instruments used), to distinguish it from his own method, which he called the apparatus major, from the numerous instruments he employed. The Marian method was founded on the erroneous idea that wounds of membranous parts would not heal, while their dilatation was comparatively harmless. The object was to do as little as possible with the luilfe, and as much as possible with dilating instruments; and the necessary result was laceration and such other severe injury, that this became one of the most fatal operations in surgery. Nevertheless. it was the operation mainly in vogue for nearly 200 years, till Frere Jaques, in 1097, introduced what is essentially the method now in use.
The lateral operation, so called from the lateral direction in which the incision is made into the neck of the bladder, in order to avoid wounding the rectutn, is that which, with various minor modifications, is almost universally employed at tbe present day. Frere Jaques, a priest, seems to have learned the method from a provincial surgeon named Pierre France, and to have practiced it with much success, and in 1607 he came to Paris in order to make it publiclyknown. The advantage of this operation, by which
a free opening, sufficiently large for the extraction of a stone, can be made into the bladder without laceration of the parts or injury to the rectum, was immediately recog nized by the leading surgeons of the timc, and the Marian process was at once univer sally given up.
can only very briefly indicate the leading steps of the operation. The patient being laid on the table, and chloroform being administered, an instrument termed a curved staff, with a deep groove, is passed into the bladder. An incision is then made on the left side of the mem] line, about an inch and three-quarters in front of the anus, and extending downwards to midway between the anus and the tuberosity of the left ischium. The incision should be sufficiently deep for the operator, on introducing a finger of the left hand, to feel the groove of the staff. The knife, directed by this finger, is now fixed in the groove, ana sliding along it towards the bladder, divides the membranous portion of the urethra, the edge of the prostate, and the neck of the bladder. The knife is uow withdrawn, as also is the staff, and the surgeon introduces the forceps over the finger of the left hand into the bladder, feels for the stone, and draws it out.
It is unnecessary to enter into any of the details of the after-treatment. At first the urine escapes through the wound, but in favorable cases it is voided by the natural pas sage in a week, and the wound heals in the course of a month.
From the shortness of the female urethra and the extent to which it can be dilated, and, additionally, from the comparative rarity of calculous affections in women, the operation of lithotomy is exclusively restricted to the male sex.
The danger of the operation seems to vary with the age of the patient. Out of 186 cases collected by Mr. Hutchinson of the London hospital, 137 were under the age of 20, and of these, 123, or nearly 90 per cent, recovered; while of the 49 who were over 20 years of age, 26, or more than 53 per cent, died.