Lithotomy by Empirical Doctors in the 19th Century: a Traditional Surgical Technique That Lasted Through the Centuries

Abstract

Lithotomy is an ancient surgical procedure, well-known in the history of urology. We describe the method as it was performed by empirical doctors in Greece during the 19th century and compare it to older techniques. The original Greek text of a doctor's autobiography includes a description of a lateral perineal cystotomy performed by empirical doctors in 1818. The technique is compared with that described by Celsus and Byzantine medical writers. A study of the sources revealed that the 2 itinerant doctors who specialized in lithotomy used a lateral perineal cystotomy to remove stones from the bladder. Consent was obtained from the parents of the patient. The patient adopted the standard lithotomy position, the surgeon located the stone with his finger via the anus and immobilized it, and made a lateral perineal incision to remove it. A newly killed fowl was then placed on the wound. The ancient surgical lithotomy technique seems to have been passed on almost unchanged from father to son and has influenced urology in Europe since the time of Celsus (1st century AD) and the Byzantine surgeon Paul of Aegina (7th century AD). Postoperative therapy is similar to that of other Byzantine techniques, and it is interesting that written informed consent was obtained, signed in the presence of witnesses.