occasionally either practised, or at all events, theoretically entertained.

Albucasis, who died in the year 1105, may have been acquainted with the operation of lithotrity when he wrote the following passage :-" Accipiatur instrumentum subtile quod nominat Mashabra Rebilia, et suaviter intromittatur in virgam, et volve lapidem in medio vesicæ, et si fuerit mollis, frangitur et exibit."

From the context of Albucasis, however, it would appear that the operation of which he speaks, referred to the relief of retention of urine produced by the impaction of a small calculus either in the neck of the bladder or in the urethra. In such cases, he says, "The calculus is to be pushed back into the bladder, and if it is friable it breaks up and is expelled. But if it be not expelled, the patient must be cut." It is impossible to ascertain the nature of the instrument to which Albucasis alludes, his Latin translator having preserved the original Arabic name, apparently from not understanding what it meant.

In the year 1506, Antonio Benevieni performed the operation of percussion, for the introduction of which, in modern times, we are indebted to Baron Heurteloup. The patient, however, was a female, and the stone appears to have been impacted near the neck of the bladder. Benevieni passed a hook behind the calculus, so as to fix it, and then struck the calculus with an iron rod, until by the repeated blows it was broken into pieces. "Uncum calculo injecio ne silicit concussus iterum in vesicam revolveretur. Tum ferramento priore parte retruso, calculum ipsum percutio donec sæpius ictus in frustra comminuitur."

In 1533, Alexander Benedetti thus alludes to perforation "Cum vero his præsidiis (dissolventibus) lapis non comminuitur, nec ullo modo eximitur, curatio chirurgica adhibeatur, et per fistulam, priusquam humor profusus dolores levet, aliqui intus, sine plagâ, lapidem conterunt ferreis instrumentis, quod equidem tutum non invenimus."

Sanctorius, who lived in the early part of the 17th century, is generally stated to have invented several instruments for perforating calculi in the bladder.

Haller thus alludes to them in his "Bibliotheca Chirurgica"-" Catheterem delineat trifidum, per eum in grandiorem calculum specillum sagittatum immittit eo, ut putat, calculum dividit, ut fragmenta inter specilli crura cadant et possint extrahi." But Haller adds, "meram speculationem puto."

This is an extremely curious passage. Haller evidently quoted Sanctorius from memory, for, on referring to the original work of this latter author, it will be found that his instruments were solely intended for the extraction of small calculi from the bladder, and that the arrow-headed stilet merely served to expand the branches of the three-bladed forceps. The idea of perforating the calculus, and extracting its fragments was a creation of Haller's own genius, which he attributes to Sanctorius, and calls "a pure speculation." Yet, one hundred years afterwards, this speculation was converted into a reality. It would hence appear, that the original idea of lithotrity, as a system, belonged to Haller, but that Haller attributed his own idea to another, and discarded it as a fancy.

Fig. 8.

Fig.6.

Fig.7.

未未

Figs. 6, 7, 8.-Sanctorius' instruments (1626) for the extraction of stone from the bladder. Fig. 6, the perforator closed. Fig. 7, the barbed stilet. Fig. 8, the forceps for extracting the calculus.

In 1671, Ciucci, an Italian surgeon, speaks of a "tenacula tricuspis" (as the most effectual mode of curing stone), with which the calculus was seized and broken up into fragments.

In 1791, Thomassini established the possibility of breaking up small friable calculi in the bladder; and it is asserted that a Spanish surgeon, named Rodriguez, performed this operation at Malaga in the year 1800. The well-known facts of Colonel Martin and the Citeaux monk, I need merely allude to; the former delivered himself from calculus by filing the stone, the latter by percussion. Sir Philip Crampton mentions a fact long

anterior to either of them-the history of an Irish gentleman, in 1559, who was cured of stone by some instruments passed into the bladder, and employed to break up the calculus.

These are all isolated facts. It is impossible to determine from them the precise nature of the operation employed, or whether it was ever converted into a system. Besides, they were completely forgotten or unknown.

In 1813, M. Gruithuisen, a Bavarian surgeon, published two memoirs on lithotrity in the Saltzburg Medico-Chirurgical Gazette. These were remarkable productions in every respect; and if M. Gruithuisen did not discover lithotrity, we must at least acknowledge that he was very near doing so. On looking at the drawings of his instruments, we perceive a straight canula, intended to pass into the bladder, and serve as a conductor for a perforator, which was either lanceshaped or dentated, a wire for seizing and fixing the calculus, a handle rapidly moved by a bow drill, a branched forceps and a hook for the purpose of crushing the fragments of stone when divided by the perforator.

Here, then, for the first time in the history of lithotrity, we find a whole and complete system, embracing all the essential parts of the operation, such as it is performed at the present day; and we may conclude that if M. Gruithuisen had possessed but a tithe of the perseverance displayed by M. Civiale, the honour of having discovered lithotrity would have belonged to Germany, not to France. It should, however, be observed that the operation of lithotrity could never have been performed

with the apparatus invented by Gruithuisen. The wire could never seize a calculus, and the forceps, from its shape and construction, could have little, if any, crushing power. It does not appear that the instruments were ever tried on the dead body,-certainly not on the the living; the project received little attention, and was soon forgotten, like those which had preceded it. Besides, it does not appear that M. Gruithuisen's proposal exercised any influence on the subsequent discoveries of Civiale, to whom it was entirely unknown, and it is quite obvious that it would have remained

Figs. 9, 10, 11, and 12.-Gruithuisen's instruments for perforating and crushing calculi. (1812-1813.) Fig. 9, the canula, perforator, and wire loop for fixing the calculus. Fig. 10, the canula, containing a toothed perforator.

Fig. 11.-Gruithuisen's forceps for crushing the calculus after it was perforated. Fig. 12. His hook for crushing fragments against the end of the canula.

a barren speculation, perhaps for centuries, had not the genius of the French surgeon been directed to the same