1 76 Report on Calculous Affections. 



under three general heads; and each of these, though identical 

 in their object, admit of various differences of procedure, which, 

 however, we cannot enumerate here. First, It has been at- 

 tempted , hitherto in vain, to dissolve the stone by the action of 

 pretended lithontriptics, direct or indirect, general or Jocal. SJZy/, 

 There are the diiFerent modes of extraction by cutting ; and, 

 8 JZ?/, There is the bruising, in situ, by mechanical means. The 

 first of these M. Civiale has passed over nearly in silence ; but 

 not so the commissioners ; they wish to cherish and excite human 

 ingenuity, and the advance of science; and remark, that be- 

 tween the first thought of Albucasis, to whom is probably to be 

 referred the original idea of breaking the stone, and this im- 

 portant operation, now for the first time realized, and definitely 

 inscribed in the annals of science and of art by Civiale, there 

 elapsed first six centuries, then many a vain effort, then many 

 a sarcasm, and much incredulity. But, notwithstanding, all this 

 did not prevent the discovery. Who can say it will not be the 

 same with lithontriptics ? 



M. Civiale institutes a comparison solely between the cutting 

 and the breaking method?. And in the past history of the art, 

 many a time has the power of figures been invoked to appre- 

 ciate the relative value of former methods, but with little or no 

 benefit. The 4500 operations attributed to Frere Jacques ; the 

 1547 of Raw; the 316 of Baseillac; the 310 of Lecat ; the 

 150 of Pouteau, which have been used as basis on which to 

 support the surpassing excellence of the methods employed by 

 these several practitioners, are for the most part unauthenticated 

 facts, devoid of details, and of value. More lately analogous 

 calculations have been published. Of these we cite those of 

 Drs Marcet, Smith, Prout, and Yelloly, with which M. Ci- 

 viale is familiar ; but of these, likewise, it must be observed, 

 that there is a want of sufficient detail and of desirable preci- 

 sion, and they will not even afford data by which to determine 

 the numerical proportions of the mortality resulting from tlie 

 operation. 



aii'In this work, which we are charged to make known to the 

 academy, M. Civiale has succeeded in collecting a total of more 

 than 5000 facts, all supplied from the practice of the principal 

 living surgeons of Europe. The following are the general con- 



