LITITOTRITY (from Wel, a stone, and the ,root. eel, to pierce); 1.ithotripsy (from Meer, and rpf$w, to break), " the reduction of a calculus in the bladder into small pieces, by means of instruments passed into that organ through this urethra, so that the fragment° may be discharged through the latter tube, and no necessity remain for the performance of lithotomy." This operation, which must be ranked among the most brilliant achievements of modern surgery, was first seriously proposed in 1812, and Oruithuisen, a Bavarian surgeon, con structed an apparatus for performing it. But the originality of the idea was probably derived from ancient writers, several of whom speak of the practicability of breaking stones within the bladder, although they make no mention of the mode of performing it. At the corn. mencement of the 19th century, Rodriquez, a physician of Malaga, is said to have broken a atone in the bladder by striking it with a catheter ; but the first suggestion we meet with of an apparatus con structed expressly for this purpose is by Oruithuisen. It consisted of a wide straight tube, which was introduced through the urethra into the bladder. Through the tube was passed a noose of oopper wire (by which the etono was caught hold of and fixed) and a rod ter minating in a circle of teeth or a spear point; is drilling-motion was now given to the latter instrument by means of a bow, and the stone was thus perforated or broken. Since this period, the operation has undergone emcee/wive improvements in the hands of Leroy, Civiale, and Ileurteloup. The following is the mode of proceeding adopted by this List gentleman. The patient is placed on an operating bed, so con structed as to admit of any inclination being given to it that the operator may think proper. At its foot is an apparatus for affording a fulcrum to the instrument which is to be passed into the bladder ; and two slippers, securely fixed at a short distance on each side of the apparatus alluded to, serve for securing the feet of the patient, who is placed in a position nearly resembling that chosen for the operation of lithotonly.
The bladder is now moderately distended with warm water injected through a catheter. A pair of strong sliding forceps, the opposite sur faces of which are furnished with teeth, are then introduced ; and the calculus having been seized, the lower piece of the furcepa is fixed to a vice at the foot of the bed serving as a fulcrum, and the upper piece is struck with a hammer and the calculus broken. Thus, neither the shock arising from the concussion is communicated to the bladder, nor is this organ liable to be injured by the fragments being forcibly projected against its internal surface. The instruments are then withdrawn, and the fragments are afterwards voided with the urine ; or if any remain too large to be thus discharged, the operation is repeated from time to time till all is got rid of. It were to be desired that an operation so simple, productive of so little pain, and so entirely free from the dangers attendant on the operation of lithotomy, was more generally applicable than it is found to be, but it is subject to the following disadvantages. The patient does not obtain a cure at once, and in many instances the operation is required to be repeated several times ; and as the smallest fragment which remains behind will form the nucleus of a new stone, a recurrence of the disease is more likely to take place after this operation than after lithotomy. It is unfit for calculi formed on extraneous substances which have entered the bladder, for encysted or adherent calculi, for large or very hard calculi, for patients with enlarged prostate gland or diseased bladder, and for children. The accidents liable to arise from the operation are generally less grave than those to which the operation of lithotomy is subject ; two of the most serious that have taken place are perforation of the coats of the bladder and the breaking of the instrument within this viscus. But where' the stone is small and not too hard, and other favourable cir cumstances are present, we imagine few could be found who would not give it the preference over the operation of lithotomy.