Report cm Calculous Affections, 177 



elusions which they supply : — Of the 5715 operations for the 

 stone he has analyzed, he finds that 1141 have died ; 4478 have 

 been completely cured, and in about a hundred, certain unplea- 

 sant symptoms have remained. Thus, in the instance in which 

 alone the results have been well ascertained, the mortality is 

 about one-fifth for all ages. And here it should not be forgot- 

 ten, that the half of these individuals have not attained their 

 fourteenth year ; and it is well known that at this age the pro- 

 babilities of cure are at least doubled. 



On the other hand, these same tables present a table of 257 

 individuals operated upon by lithotritis, with only six deaths, 

 although in the whole number there were not above two or three 

 under the age of fourteen ; and this does not give one death up- 

 on every forty-two persons subjected to this operation. 



And to complete the demonstration of the superiority of litho- 

 tritis over lithotomy, we shall add, that since the discovery of 

 the former, among a very considerable number of surgeons who 

 have been troubled with stone, scarcely one can be cited who 

 has had recourse to lithotomy. All have been operated upon by 

 lithotritis. 



But, in sound logic, as well as in good practice, it is not on 

 this footing that the discussion should now be placed. No one 

 should now contend for the entire rejection of lithotomy, and the 

 invariable substitution of lithotritis ; and it should be universal- 

 ly allowed that in a great number of cases the latter operation 

 would be diflicult, dangerous, and impossible, and that, conse- 

 quently, in these lithotomy would be preferable, and even indis- 

 pensable. The question, then, accurately stated, should stand 

 thus : What are the pathological conditions in which lithotritis 

 promises the greatest probability of success, and what the cir- 

 cumstances in which it is necessary to have recourse to lithoto- 

 my ? or in other terms, the formula is wanted for the respective 

 indications of the two operations. 



The commissioners remark, that they are extremely happy to 

 have this occasion of expressing their sentiments upon the ap- 

 plication of the doctrine of probabilities to the science of medi- 

 cine. They add that it is especially questions of this kind 

 which physicians should introduce into the Academic des Sciences^ 



VOL. XX. NO. XXXIX.— JANUARY 1836. H 



