ster Medical Society, on the 8th of December, 1832. It differed little from the instruments now employed, being composed of two pieces of steel, instead of three as was Baron Heurteloup's. The female branch resembled a hollow catheter, with a small sharp curve; and to allow of the introduction of the male branch, a longitudinal slit was carried from one extremity to the other along the upper surface. The male branch was a solid piece of steel, which fitted exactly into the female one, with all the points of which it was in close contact, except of course along the groove; but here the edges of the groove in the female branch slightly overlapped the body of the male one, and the latter was thus kept firmly in its place; this solid manner of uniting the two branches while they slide, enabled the operator to employ any degree of pressure without danger of forcing the joints or branches of the instrument.

Fig. 38.-Dr. Costello's percutor. A, the handle; B B, the male branch; c, the female branch.

Fig. 39 a shows a section of the male and female branches with the vice.
Fig. 39 d shows a section of the female branch.

Dr. Costello also removed the teeth from the concavity of the female branch, and placed them along its edges.

The instrument now described, enabled the surgeon to employ crushing with perfect safety, and it may be

regarded as the starting point for all those subsequently introduced. It is, however, but justice to state Mr. Weiss positively affirms that his original instrument of 1824, was composed of two pieces sliding on each other in exactly the same way as Dr. Costello's, while the latter gentleman asserts, in an equally positive manner, that the instrument shown by Mr. Weiss to the Westminster Medical Society in 1832, was constructed on the same defective principle as that of Baron Heurteloup, that is to say, with two lateral pieces and a central male one sliding vertically between them.

Mr. Weiss, at all events, was the first who formed an idea of the advantages of the screw; and it is curious to observe how the progress of lithotrity in this direction was retarded by what we might call an accident. In the year 1824, Mr. Weiss demonstrated the power of his screw instrument to Sir Benjamin Brodie. The screw acted with so much power on a hard calculus, that it was feared the bladder might be injured by the force with which the fragments would be propelled against its walls; and to obviate such an occurrence Sir Benjamin suggested the addition of a saw.

Fig. 40

Fig. 40.-Mr. Weiss's instrument for sawing stones in the bladder (1825).

The principle of crushing by means of the screw was, however, rejected for the time; no trials were

made on the living body, and it was not until 1832, when the public use of Baron Heurteloup's percutor had refuted the theory of "danger from explosion of fragments," that Mr. Weiss's principle began to attract attention, and was finally converted into a method.

From this brief sketch, it will be seen that England may claim the chief part in the introduction of the crushing system. The oval slit in the side or back of the female forceps, for the discharge of detritus, was, I believe, invented by the late Mr. Oldham, a gentleman attached to the Bank of Ireland; while Mr. L'Estrange, of Dublin, claims the merit of having first applied a wire stilet for the purpose of removing the detritus. Mr. L'Estrange also claims the honour of having been the first to apply the principle of the screw as a means of crushing calculi in the bladder: but I cannot see on what this claim is founded. If Mr. L'Estrange's invention bears date from July, 1834, I have merely to remark that the screw was employed by Weiss in 1824, by Haygarth in 1825, again by Weiss in 1825, by Retoré in 1825, and by numerous French surgeons in 1833.

Since 1834 many changes have been made in the details of various parts of lithotritic instruments, but none affect the principle on which they work. The blade of the female branch has been made wider and deeper, to receive the detritus; the screw has been replaced by the rack and pinion; the latter furnished with a round handle, as in Charrière's, or with a T-shaped one, as in the English instrument, to give it additional force.

It is unnecessary for me to notice all these improvements, as they have been called, for almost every

surgeon who has occupied himself with lithotrity appears to have thought it incumbent on him to make some change in the apparatus-occasionally for the better, often for the worse.

A few words concerning Baron Heurteloup's percutor, and the operation of percussion, are necessary, although the original cumbersome apparatus is never used at the present day. Baron Heurteloup considered the position of the patient as a matter of importance, and invented a peculiar couch or bed of a rectangular form.

Fig. 41.-Baron Heurteloup's bed. a. The percussor, fixed by a screw in the upright rod, b. b. The upright rod, or "fixed point," which is itself firmly fixed to the framework of the couch by a wedge, c, driven in.

On the upright rod, which M. Heurteloup calls his "fixed point," is a wedge to fix this branch solidly, and a grooved head, with a screw at the upper end of the branch, to fix the percussor. The object is to hold the percussor so steadily, that when the male branch is

struck with the hammer, no movement of any other portion except the male branch shall take place. Anteriorly there are two pieces of wood, having at their extremities two slippers for the patient's feet. These can be lengthened or shortened at pleasure, to suit the height of the patient. In front there is a cross piece of wood, very thick, uniting the two triangles together. In this is seen a mortice for the small vice to play in, which holds the instrument during its action on the stone. This bed can be lowered, if required, to an angle of 45°, a strap being passed behind the neck and before the shoulders, and attached to a buckle on each side of the bed, so as to prevent the patient slipping off.