Cutting for the stone

Abstract

Stone in the bladder was a common affliction throughout Europe until the early years of this century when for reasons possibly dietary but still obscure it became very much less frequently especially in children. The operation for its removal, ‘cutting for the stone’, or lithotomy, is one of the very oldest in surgery, and indeed, in many centuries of pre-anaesthetic and pre-Listerian era, lithotomy was one of the very few ’cold’ or elective operations to which man submitted, the distressing features of the malady out-weighting the hellish torments and the mortal risks of the operation. For fairly obvious reasons of relative accessibility and safety, the perineal approach to the bladder was the original and the classical one, and it is to perineal lithotomy that I shall confine myself in this account. The position in which the patient was placed, securely bound or forcibly held for the operation remains as an unforgettable feature of surgical vocabulary even though we now use it for other perineal procedures.