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Introduction and Objective In the early nineteenth century, a trend arose that spread quickly to surgeons interested in bladder stone surgery that required new instrumentation to break stones instead of cut for them. This was an epic moment in the history of stone disease because it was a quantum leap of faith requiring surgeons to rethink the entire method. There were false starts and great philosophical battles to be fought before clear strategies could be developed and patient truly benefitted.

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Lithotrity at one sitting, as planned and developed by Prof. Bigelow, has revolutionized the treatment of vesical calculus. Those most familiar with this method will agree with me that it is destined not only to supersede the slow lithotrity, but to abolish lithotomy itself in forty-nine fiftieths of the adult cases. I have now performed this operation eighteen times with only one death, though the patients averaged nearly sixty years of age, and the stones were mostly very large. In one of the successful cases the crushed fragments weighed two ounces and five drams, and the patient was about 70 years of age. No such success could have been obtained by cutting on such unpromising cases. Passing by as irrelevant the unpleasant personal controversy between Prof. Bigelow and Sir Henry Thompson, a few words are proper respecting the newly coined word, litholapaxy. By the laws of literature, Prof. Bigelow is

To our knowledge of the very perfect operation of litholapaxy I can contribute nothing important. Indeed, I can add but little to what I said about it in 1899 before the Section on Surgery and Anatomy of the American Medical Association 1 at Newport. At that time I stated my opinion that litholapaxy was the operation of choice for the removal of most stones in the bladder. After a much enlarged experience I wish to express the belief that litholopaxy is the operation of choice in all uncomplicated cases of stone, and having seen this opinion constantly supported and confirmed by such masters of genito-urinary surgery as M. Guyon, Freyer, Keyes, Keegan, Chismore and others, it has been a source of surprise to me to find the operation imperfectly understood and little practiced among the younger generation of surgeons. So great has seemed to me the indifference toward this operation even

In order to make the drift of this paper at once clear, I wish to state at the outset the conclusions I have reached by a study of the results of others in stone operations, and from the moderate experience I have had in these cases myself. Unfortunately, residence in a region where stone in the bladder is rather rare has made the accumulation of personal observations slow, but, on the other hand, my association with Dr. Bigelow has given me unusual advantages in getting an understanding of the operation which he devised and christened "litholapaxy," and of which I shall especially speak to-day. In my opinion, we have in litholapaxy the operation of choice for the removal of most stones. While this is the rule, there are exceptions to it, and the varying conditions surrounding stone in the bladder, will now and then lead us to choose some other

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