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The fundamental rule of the old lithotrity was that the evil consequences of the operation were in direct proportion to the length of time consumed in instrumental manipulation. It was supposed that the bladder was intolerant of all instruments, and the shortest time possible was occupied at a sitting, the smallest instruments used, and the fragments were left to be evacuated naturally. In 1878, Prof. H. J. Bigelow of Boston startled the medical profession, and started a revolution in the surgery of the bladder by proclaiming the error of the lithotritists, and by stating that the bladder was far more tolerant of prolonged manipulation than was previously supposed, and that the temporary presence of smooth instruments in the bladder caused much less irritation than the prolonged lodgement of sharp fragments of a calculus. In the pursuance of his ideas Bigelow formulated a new treatment of stone in the bladder. He
LITHOLAPAXY AND A NEW LITHOTRITE.. JAMA. 1896;XXVII(22):1161-1162. doi:10.1001/jama.1896.02431000037006