Abstract of Tommasio Alghisi’s “Litotomia Ovvero del Cavar la Pietra”

Abstract of Tommasio Alghisi’s “Litotomia Ovvero del Cavar la Pietra” (“Lithotomy or Cutting the Stone”) published in 1707 in Florence:

“After drying the scrotum and perineum the lithotomist lubricates a large grooved silver catheter in rose-oil and passes it into the patient’s bladder. The assistant astride the patient elevates the scrotum and holds the perineum taut. The operator manipulates the silver catheter so that it bulges into the perineum. He ascertains the position of the groove by palpation with the finger the same way one does when searching for a vein. Then he places the point of the knife against the groove in the catheter and cuts directly down towards the anus and then up and down again to be sure that he has incised the urethra perfectly.

Then a conductor is introduced into the bladder guided by the groove in the catheter. With the conductor in place, the catheter is removed from the penis. A stone-grasping forceps of appropriate size is passed along the groove of the conductor and introduced into the bladder. The conductor is then removed. The forceps is then opened and closed in various directions to dilate its pathway. It is advanced in various directions  until the stone is encountered…. The stone should not be extracted by one sudden and violent move but with great caution, giving the forceps gentle half turns to the right and to the left, up and down, after which, most slowly, one can extract it without great lacerations.

While performing the movements with the forceps the lithotomist should stop from time to time to give respite to the patient, encourage him and assure him that the stone will soon be removed. The same should be done by the patient’s father-confessor, since he can do much to help him bear his pain with patience…”