Clinical Reviews in Bone and Mineral Metabolism, vol. 2, no.

3, 177–185, Fall 2004

© Copyright 2004 by Humana Press Inc.
All rights of any nature whatsoever reserved.
1534-8644/02/3:177–185/$25.00

History of Urolithiasis
Garabed Eknoyan, MD
Baylor College of Medicine, Houston, TX

Abstract
The history of urolithiasis dates back to the dawn of civilization. The symptoms, signs, and treatment of
kidney and bladder stones are chronicled in most extant ancient medical texts, and cutting for stones in the
bladder is one of the oldest elective surgical procedures recorded. Physicians performed perineal lithotomy
until the Middle Ages, when prejudice against surgical procedures relegated them to barber surgeons, litho-
tomists, and the clergy. The anatomical studies of the Renaissance led to the emergence of surgeon anatomists
and a gradual integration of surgery and lithotomy into the medical profession. Apart from instrumental refine-
ments, surgical progress had to wait for the advent of anesthesia and aseptic techniques in the 19th century
when suprapubic lithotomy became possible. Surgery for kidney and ureteral stones was not possible until the
discovery of the X-ray. This was also the age when chemical analysis of stones began to provide a rational
basis for the medical management of urolithiasis.

Key Words: History of nephrology; history of urology; Hippocratic Oath; urolithiasis; history of litho-
tomy; bladder stones; nephrolithiasis.

Kidney and urinary tract stones have tormented
humans for ages. The history of urolithiasis dates
back to the dawn of civilization. Paleopathology
documents their occurrence in preserved mummies
throughout the world dating back 7000 yr (1,2).
Historical evidence exhibits a striking prevalence of
bladder stones in the past, with an increasing inci-
dence in kidney stones over the past century accom-
panied by a simultaneous decrease in the occurrence
of bladder stones. This accounts, at least in part, for
the lengthier discussion of bladder stones compared
to kidney stones. Progress in their surgical treatment
has been recorded in extensive detail in the urologi-
Address correspondence to Garabed Eknoyan, MD, Depart-
ment of Medicine, Baylor College of Medicine, One Baylor Plaza,
Houston, TX 77030. E-mail: geknoyan@bcm.tmc.edu
177
cal literature, beginning with the original seminal
work of Ernest Desnos (1852–1925), whose Histoire
de l’Urologie (1914) has served as the basis of most
subsequent histories of urology (3–13).
For the most part, these writings have focused on
the activities, prowess, and technical contributions of
selected individuals to the excision of bladder
stones. This article focuses on the ideas and events
that shaped the history of urolithiasis, its treatment,
and chemical analysis.
An Approach to the History
of a Disease
As detailed elsewhere (14), the conceptual
emergence of a disease and its management can be
analyzed within the framework of what constitutes
“medical care” and its evolution within the histor-
ical past.
178
The central participants in a medical care
encounter—until the recent advent of managers—are
the patient who seeks relief, and the physician who
makes a diagnosis and prescribes a treatment (Fig. 1).
Diagnosis is based on identifying an illness from its
symptoms and signs, and giving it an accepted desig-
nation within a standardized taxonomic system of
nomenclature. The more common an illness or the
more severe its symptoms, the sooner this component
is achieved. Prescribed treatment is based either on
empirical experience or clinical research and, as such,
it is usually only palliative and provides relief of
symptoms until the disease runs its course or the
patient expires. Treatment can also be based on basic
research that identifies the cause of the disease and
formulates a specific treatment that is curative
(Fig. 1). For most of recorded medical history, and
well into the present, it is predominantly the former
approach that has guided therapy.
This form of analysis, examined within the con-
text of the “historical past,” provides a fairly uniform
framework for the conceptual evolution of the his-
tory of a disease (Fig. 1). Throughout antiquity, in
Egyptian, Mesopotamian, and Far Eastern medicine,
it was the presenting symptom that constituted a
“diagnosis” toward which treatment was directed.
With the advent of Greek rational medicine, the clin-
ical course of a disease—usually based on recount-
ing the illness observed in a single patient—was first
recorded. This continued and evolved with the addi-
tion of “experience” (research) during Greco-Roman
medicine, culminating in the voluminous work of
Galen (131–201) that dominated medicine through-
out the Middle Ages and influenced it well into the
17th century (15).
The rudiments of anatomy that flourished for a
brief period in early Ptolemaic Alexandria and blos-
somed in the Renaissance, were the first basic sci-
ences to provide a scholarly basis for the recognition
of organ-based disease, and subsequently, by encour-
aging postmortem examination, the passage from
individual case histories to the collection of clinical
information from several similar cases observed at
postmortem.
Another derivative of anatomical studies was sur-
gical information and the beginning of incorporating
surgery back into the medical profession after being
relegated to barber-surgeons or the clergy during the
Clinical Reviews in Bone and Mineral Metabolism
Eknoyan
Middle Ages, particularly when Monastic Medicine
was at its prime.
The Scientific Revolution and the Enlightenment
provided for the emergence of the basic sciences
from what began in the 17th century as natural phi-
losophy. The beginnings of research into organ
function, the biochemical basis of diseases, and the
elements of a rational approach to therapy came
about as a result. Towards the end of the 19th cen-
tury, these fundamental principles blossomed and
provided the final link to the specific treatment of
diseases during the course of the 20th century—a
process that has grown exponentially in the past
six decades.
Cutting for the Stone
Early in the course of history, it was the sympto-
matic nature of an illness that determined its recog-
nition and the attention devoted to its treatment. It is
not unexpected, then, that the harrowing pain of
urolithiasis, one of the most painful disorders to
afflict humans, attracted medical attention early, and
its treatment came to occupy an increasing propor-
tion of medical texts (Fig. 1). The origins of the sur-
gical removal of a stone are buried in the mist of
history. What is evident is that well before any
recorded history, someone did “cut for the stone” to
relieve the agonizing pain of an obstructing bladder
stone. Over time, trial and error led to the refine-
ment, standardization, and recording of the proce-
dure. Descriptions of transverse perineal lithotomy
can be found in ancient Indian, Chinese, Babylonian,
and Greek texts. In its clearest form, the procedure
was recorded in Greek texts of the first century CE,
notably those of Rufus of Ephesus (c. 53–117CE),
the author of the first monograph on Diseases of the
Kidney and Bladder (c. 80–90CE) (15,16), and in its
most detailed ancient description in the seventh vol-
ume of De Medicina (c. 10–20CE) by the encyclope-
dist Celsus (25 BC–50 CE) (17).
Much has been made of the injunction in the
Hippocratic Oath of “Neither will I cut them that
have the stone,” without due emphasis on its subse-
quent qualification “…but will leave this operation to
those who are accustomed to perform it.” Given the
ghastly nature of the procedure when no anesthetics
were available, and when neither asepsis nor antisep-
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Fig. 1. A timeline of the history of urolithiasis. The upper part is a schema for the analysis of any disease based on
its diagnosis (Dx) and treatment (Rx) within the broad context of the historical past (heavy line). The lower part (thin
line) shows the history of urolithiasis from its origins in early antiquity to its present treatment by extracorporeal shock
wave lithotripsy (ESWL).
180 Eknoyan

tics were even conceived, the outcomes of perineal

lithotomy were damnable and it was invariably rec-
ommended as a last resort. Although its mortality and
morbidity (bleeding, fistulae, infection, impotence,
incontinence) were high, its mortality was relatively
low compared to other emergent visceral operations,
and an appreciable number of those operated on sur-
vived. Actually, as recorded by Rufus of Ephesus, the
procedure was performed by Hippocrates and others,
and it was not prohibited as shown in the concluding
sentence describing the procedure in Diseases of the
Kidney and Bladder: “This is the manner to recog-
nize and treat bladder stones; most physicians suc-
ceed by following this method” (16). As such, what
Hippocrates was actually implying is no different
from the current practice of referral to a specialist.
Why then single out cutting for the stone in the Oath?
Merely because it was one of the few—and one of the
earliest (only circumcision and trephination are as
Fig. 2. Panel (1513) by Tilman Riemenschneider from
old)—elective surgeries of the past.
the Imperial Tomb of Heinrich II, Bamberg Cathedral,
It was during the Middle Ages that prejudice against Bamberg, Germany. Legend has it that on his way to
surgery in general, and lithotomy in particular, rele- Rome, Heinrich became ill with the stone and had to stop
gated them to barber-surgeons, phlebotomists, and at the Montecassino Monastery. While asleep, St.
charlatans who acquired their skills through appren- Benedict appeared and “cut the stone” out. The relief
ticeship. The fame and notoriety achieved by some shows St. Benedict on the left with a knife handing the
lithotomists constitutes much of the lore associated removed bladder stone to Heinrich. The doctor, on the
with the procedure (2,5,7,9). Taking the name and don- right, mourns his failure to cure the emperor. Heinrich II
ning the habit of fraternities of the church by some of died from bladder stones in 1024.
them such as Frère Jacques (1651–1714) and Frère
Côme (1703–1781) reflects on another group of prac-
titioners of lithotomy—the clergy. Beginning with the gradual rapprochement between surgeons and physi-
emergence of the School of Salerno, members of reli- cians and the ultimate return of surgery into the med-
gious orders (most notably the Benedictines) began to ical profession. The resurgence of interest in surgery
assume an increasing role in the delivery of medical was coupled with an increasing interest in instru-
care and became known for their surgical skills. mentation for lithotomy. Actually, specialized instru-
Monasteries located at a fixed site allowed for the sick, mentation was a component of the procedure from
usually the rich and mighty to travel there to seek care, the outset. Celsus and Galen both dedicate several
rather than wait for itinerant practitioners to visit their paragraphs to describing the shape and specifying
isolated villages. One of the panels of the imperial the curvatures of the instruments used to remove the
tomb of Heinrich II of Bavaria (972–1024), carved by stone. Albucassis, Abu-l-Quasim Khalaf ibn Abbas
the famed Tilman Riemenschneider (1450–1531), al-Zahrawi, (1050–1106) elaborates on instruments
clearly illustrates the role of monks in the “miracle” of and describes several modifications and refinements
cutting for the stone (Fig. 2). to them (18). But it was during the 16th century that
With increasing interest in anatomy during the the number and sophistication of instruments began
16th century, surgical information and training to evolve, and the procedure came to be known as
began to improve, and an increasing number of the Method of the Great Apparatus, or “Apparatus
anatomists evolved into surgeon-anatomists who Major,” as opposed to that of the Minor, which had
began to undertake surgical procedures.This led to a fewer, but nevertheless special, instruments for litho-

Clinical Reviews in Bone and Mineral Metabolism Volume 2, 2004

History of Urolithiasis
tomy. Most famous amongst these innovators was
Marianus Sanctus Barolitamus (1490–1550), whose
contributions led to dubbing the method of the great
apparatus the Marian operation (9–11).
This new endeavor entailed close cooperation
between surgeons and master toolmakers, a prevail-
ing collaborative effort that proved vital not only to
the progress of surgery, but also to the progress of
the sciences and industry during this period (19).
Dilators, grooved probes to direct the cutting, were
refined; as were clamps and tools to grasp and break
larger stones to ease their removal or allow their elim-
ination naturally. This procedure, known as lithotrity
and its special instruments, are described by Celsus,
recorded in Indian texts, expounded on by Albucasis
in the 11th century, and commented on by several
others well before the 16th century. It is an evolution
that reached its apogee in the 20th century with the
introduction of extracorporeal shock wave lithotripsy.
Instrumental refinements notwithstanding, litho-
tomy remained an extremely painful procedure that
depended on the stoicism of the patient, the assis-
tance of several burly attendants to keep the patient
down, and the aptitude of the surgeon who had only
minutes to operate and often staged the procedure
over several days. Large amounts of alcoholic bever-
ages, opium, laudanum, and mandragora were used
to ease the pain. In the 13th century the “soporific
sponge” was introduced. This was a sponge steeped
in a mixture of opium, hyocyamus, mulberry juice,
lettuce, hemlock, mandragora and ivy, that was
allowed to dry up and then moistened before being
inhaled at the time of surgery by the patient, who
was later awakened by applying fennel juice and
vinegar to the nostrils (5). The usefulness of this
concoction and others remained limited until the
advent of anesthesia in 1846, which finally allowed
for the proper and deliberate execution of this elec-
tive procedure. The introduction of antiseptic and,
later, aseptic methods in the 1860s allowed for a
more deliberate approach to operation and the grad-
ual adoption of the current preferred suprapubic
approach to lithotomy (Fig. 1). Suprapubic litho-
tomy, also known as “Apparatus Altus,” was
described but rarely performed before antiseptics
were introduced (4,8,11).
It was the study of anatomy and careful dissec-
tions in the 16th century that led to the recognition
Clinical Reviews in Bone and Mineral Metabolism
181
that the distended bladder could be opened extraperi-
toneally through a suprapubic midline abdominal
incision, that led to the proposal of its being supe-
rior and more practical than the perineal route.
By the beginning of the 18th century, John Douglas
(d 1759) elaborated in his “Lithomia Douglassiana
with a course of operations” (1720) on the advan-
tages suprapubic approach, which began to gain
popularity but never ceased to have its strong oppo-
nents (4,6). Controversy and fear of violating the
peritoneum continued to haunt the procedure well
into the 19th century.
Although bladder stones occupied most of the
attention devoted to urolithiasis, kidney stones were
well recognized, and several authors of the past sug-
gested the kidney as the source of stones that lodged
and grew in the bladder (6). The symptoms of
nephrolithiasis are described in accurate and varying
detail in ancient texts. It was recognized that if a kid-
ney stone could not be passed, the condition was
incurable and surgery was not recommended. This is
summed up by Guy de Chauliac (1300–1368),
whose writings dominated surgical practice in the
14th and 15th centuries: “He who has the stone in
the kidneys does not live without danger, for if it is
retained and blocks the passage it leads to dropsy
and death. It ought not to be cut for in the kidney…”
(13). By contrast, drainage of a retroperitoneal or
perirenal abscess was described and practiced from
Hippocratic times (15,16). The occasional finding of
a stone in the discharge was attributed to its having
originated in a pus pocket behind the kidney, rather
than an obstructed kidney that had become purulent.
Thus, nephrolithotomy could have been done, but if
so it was inadvertent. Actually, cutting for stones of
the kidney and ureter had to await the discovery of
the X-Ray by Roentgen in 1895. Coupled with anes-
thesia, aseptic surgery, and the ability to localize
stones, the surgical removal of kidney and ureteral
stones became possible.
Medical Treatment of the Stone
From the outset, cutting for the stone was the last
resort that, in the words of Celsus, was to be per-
formed only ‘if the disease is so bad that it cannot be
relieved by medicaments, or endured by the patient
without shortly bringing his life to a close” (17).
Volume 2, 2004
182
Indeed, it was only patients whose pain was severe
and persistent who were subjected to the greater but
shorter pain of lithotomy that provided hope for
relief. Medical treatment, such as it may have been
at various times, was empiric but intelligent. It con-
sisted of relief of obstruction, alleviation of acute
pain, use of diuretics and solvents to expel the stone,
and prevention of their recurrence.
For obstruction relief, postural changes or rectal
manipulation were used to dislodge the stone from
the bladder neck. If this failed, urethral catheteriza-
tion was used to dislodge the stone and drain the
bladder. Catheters were made from metal, ivory, car-
tilage, reed, or feather shafts.
Methods for alleviation of pain consisted of oral
drugs (herbal concoctions that came to include lau-
danum, mandragora, opium and poppy seeds), warm
poultices and plasters applied to the flanks for kid-
ney stones and the suprapubic region for bladders
stones, baths and warm clysters that were sometimes
medicated (20,21).
As for diuretics, Rufus of Ephesus describes a
choice of cold diuretics (celery, cucumbers, hyacinth
seeds, wall flower, asparagus, safran roots and violet
petals) or warm ones (iris, cumin, figs, cinnamon,
acorn and cistres). Dioscorides (first century CE)
describes 29 plants used to dissolve or facilitate the
natural elimination of stones (21). In addition to the
diuretics mentioned by Rufus, Dioscorides includes
chamomile, laurel, parsnip, mint, fenugreek, dande-
lion, and wormwood among others. In addition to
their diuretic properties, plants were recommended
for assumed muscle-relaxing properties (gravel root,
hydrangea) or relieving mucosal irritation (marsh-
mallow, hollyhock, yarrow). Over time, mixtures,
concoctions, and diverse combinations of these and
other plants in varying proportions and in different
solvents (beer, honey, wine, vinegar, asses milk, tea)
were used and each promulgated by its proponents
as superior to others. Cantharides (dried Spanish
flies) and the mucilaginous extract from ash trees
(gumma arabica) and bear berries (uva ursis) were
also used for their diuretic properties (23).
Herbals continued to dominate the materia medica,
and remained at the core of it well after Paracelsus
(1493–1541) introduced the use of metals. As part of
his homeopathic principles he recommends: “To cure
stone, use stone— such as crab’s claws, lapis lazuli,
Clinical Reviews in Bone and Mineral Metabolism
Eknoyan
sponges, eaglestone, selenite…first it is crushed and
dissolved in venous essence in vitro. The crushed and
dissolved stone will thus crush and dissolve the stone
in vivo…” (22). Minerals were also recommended in
Mesopotamian medicine (shells of ostrich eggs), by
Galen (powder found in sponges), and Avicenna
(980–1037), Abu Ali Husayn ibn Abdullah ibn Sina,
(eggshells, snail shells, ashes of scorpions).
As the analysis of the chemical nature of stones
began, alkalinizing agents (potassium carbonate,
potassium citrate, sodium carbonate, calcium oxide)
were first prescribed not only to gout patients, in
whom they were shown to be effective, but also to
those with stones (2,12). Other alkalinizing agents,
such as lime and lye solutions, and the avoidance of
acids in the diet were recommended by Thomas
Sydenham (1624–1672) and William Heberdeen
(1710–1801) (23,24).
Installation of solvents into the bladder was also
tried as early as Babylonian times, as illustrated in the
following text: “You boil together 2 shekels of myrrh,
2 shekels of balukhu(?), 2 sita-measures of grape
juice…cool it and mix it with equal parts of pressed
oil. Pour half of the mixture into his urethra through
a bronze tube.” The other half was to be drunk on an
empty stomach (25). The success of this and other
local installations, if any at all, can be only specu-
lated on. As the chemical composition of stones
came to be known, various chemical solvents were
attempted but soon abandoned because of the irrita-
tion and ulcerations they produced in the bladder.
Among the luminaries to experiment in the chemical
solution of bladder stones is Stephen Hales
(1677–1761), whose Statical Essays (1733) con-
tains, in addition to his studies on arterial blood pres-
sure, “an account of some experiments on stones in
kidnies and bladder.”
Prevention was actually a component of hygiene,
which comprised most of Greek medicine and dom-
inated the field of therapeutics through the centuries.
For urolithiasis, the regimen consisted of avoiding
crudities and milk particularly if sour, sexual absti-
nence, increased fluid intake, and shunning loosen-
ing of the bowel “because with an abundant stool the
urine becomes concentrated and less voluminous.”
Drinking water was specified as being from clear
sources but not from cold sources or soils, with strict
avoidance of turbid or murky waters and any liquids
Volume 2, 2004
History of Urolithiasis 183

Table 1
Leaders and Creators Afflicted by the Stone

Heinrich II 972–1024 Samuel Pepys 1633–1703

Louis VI 1081–1137 Louis XIV 1638–1715
Frederick III 1463–1525 Peter the Great 1642–1425
Erasmus 1466–1536 Marin Marais 1656–1728
Michelangelo 1475–1564 Herman Boerhave 1688–1738
Ignatius of Loyola 1491–1556 Voltaire 1694–1778
John Calvin 1509–1564 Benjamin Franklin 1706–1790
Francis Bacon 1561–1626 Louis XV 1710–1774
William Harvey 1578–1626 Napoleon Bonaparte 1769–1821
Pope Innocent XI 1611–1689 Leopold I of Belgium 1790–1865
Thomas Sydenham 1624–1672 Napoleon III 1808–1873

that formed a sediment. Over time, details and char-
acteristics of drinking water assumed an increasing
role. Traveling to specific spas, springs, and sources
or importing water became an important component
of management for the rich. In The Principles and
Practice of Medicine, William Osler (1849–1919)
specifically commented on the topic: “Many patients
find benefit from a stay at Saratoga, Bedford, Poland
or other mineral springs in this country, or at Vichy
or Ems in Europe” (26).
Apart from water the drinking of tea, beer, and
other concoctions were promulgated by one or
another author from the earliest times as illustrated
in the following quote from a Babylonian cuneiform
tablet: “a man…suffers from a stone which does not
come out…that man must drink beer and the stone
will be passable. If that man does not drink beer but
a lot of water, he will be assigned to his fate” (25).
That is confirmed by subsequent comments by Galen
that he had never operated for the stone on a beer
drinker, and the personal account of Thomas
Sydenham, himself a victim of gout and urate stone,
that: “To prevent bloody urine, I take care, as often
as I drive any distance over stones, to drink a free
draught of thin small beer, upon getting into my
coach, and also, if I am out long, before my return—
a precaution which has always been sufficient” (23).
Many of these treatments remained in vogue well
into the present and are quite similar to those recom-
mended in most texts of the 20th century, including
Osler’s textbook.
Leaders and Creators Afflicted
by the Stone
No history of urolithiasis would be complete with-
out mention of the leaders and creators who were
afflicted by it (Table 1). The correspondence and
extant medical records of leaders who were treated
for urolithiasis provide valuable detail and insight
into the history of the disease and its management
through the ages, as well as speculation of how the
course of history may have been altered had the treat-
ment succeeded or had the patient survived. This is
best illustrated in the history of Napoleon III (9).
The personal accounts recorded by creators pro-
vide insight into the agony, torture, and human suf-
fering associated by the disease. The literary aspects
recorded by Samuel Pepys (1633–1703) and their
clinical components by Thomas Sydenham have
been quoted often. Less well known, but more uni-
versal in its tone, is the music of Marin Marais
(1656–1728), who in one of his short pieces for viola
vividly illustrates the shock and fear of lithotomy.
Importantly, leaders and creators have brought
notoriety to urolithiasis, a rare event for most other
ailments, except for infectious diseases such as
syphilis, tuberculosis, and acquired immune defi-
ciency syndrome.
Analyzing the Stone
Analysis of ancient stones reveals no difference in
their composition from present day stones. Stones

Clinical Reviews in Bone and Mineral Metabolism Volume 2, 2004

184
Principal Contributors to the Chemical Analysis of Stones
A.S. Marggraf 1709–1782
Carl W. Scheele 1742–1786
Antoine F. Fourcroy
Nicolas L. Vauquelin } 1755–1809
1763–1829
William H. Wollaston
George Pearson } 1776–1828
1785–1828
Alexandre Marcet 1770–1822
William Prout 1785–1850
Note: Fourcroy and Vauquelin in France, and Wollaston and Pearson in England collaborated or confirmed each
other’s results shown in the third column.
removed from Egyptian mummies have been shown
to consist of a uric acid nidus with concentric lami-
nations of mixed phosphate salts indicating their
infectious nature. Stones with an oxalate nidus have
also been described (2,12,3). Obviously, not all
obstructive symptoms treated as outlined above were
due to stones. They may have been the consequence
of congenital abnormalities in children, prostatic
hypertrophy in the elderly, calcified ova of bil-
harzias, and neurogenic bladder or tumors in others.
Their differential diagnosis is clearly discussed by
Galen (27) and by Heberdeen (23).
From the outset, the nature of stones was used to
determine their treatment. Assyrians distinguished
hard stones from soft ones and attempted to correlate
symptoms with the kind of stone and guide its ther-
apy. Rufus of Ephesus classified stones by their
hardness and color. Surgery was reserved for hard
stones and medicaments for soft stones (16). The lat-
ter, described as mulberry-shaped with spikes and
having the color of “baked earth ware,” likely repre-
sented oxalate stones, whereas the harder stones
were infected triple-phosphate ones.
In the wake of iatrochemistry in the 17th century
came attempts to identify the structural and chemical
composition of stones. By the end of the 18th cen-
tury, stones began to be collected and analyzed by
workers in England and France—–often independent
of each other (Table 2). Although Paracelsus,
Stephen Hales, and others made attempts at this,
Clinical Reviews in Bone and Mineral Metabolism
Eknoyan
Table 2
Extracted phosphorus and calcium phosphate from urine
Isolated lithic acid from a bladder stone and urine
⎧ Lithic acid is uric acid
⎪ Ammonium salt of urate in stones
⎨ Calcium, magnesium, and ammonium phosphate
⎪
⎩ Triple phosphate salts
⎧ Sodium urate (uric acid) in gouty tophi
⎪ Oxalic acid
⎨ Cystine oxide stones
⎪
⎩ Triple phosphate salts
Xanthine stones, familial xanthinuria
Familial cystinuria
Role of urea in supersaturation
analysis of the nature of calculi is said to have started
in earnest in 1776, when Carl Welheimer Scheele
(1741–1786), a Swedish apothecary investigating
solid elements in the urine, isolated uric acid in a
bladder stone. He called it “lithic acid,” or acid in the
stone. Within two decades, William H. Wollaston
(1776–1828)) showed lithic acid to be present in the
joint deposits and stones of gout patients and termed
it “uric acid.”
By 1820, the chemical composition of most forms
of stones had been analyzed (Table 2). By the end of
this golden age of stone analysis, there was sufficient
information for several authors, notably Alexandre
Marcet (1770–1822), to compile handbooks on the
analysis and composition of stones whose accuracy
and methods remain valid to this day (12,13,28).
Metabolic studies soon followed and by the mid-
dle of the 20th century, these studies began to pro-
vide a scientific basis for the medical treatment of
stones. Much has been unraveled since then, but
more remains to be explored. The breakthroughs that
have been accomplished and the questions that
remain to be answered constitute the series of arti-
cles that follow in this journal.
References
1. Shattock L. 1905 A prehistoric or predynastic Egyptian cal-
culus. Trans Pathol Soc of London 56:275–290.
2. Goldman IL, Resnick MI, Buck AC. 1990 The history of
urinary lithiasis and its treatment, in Renal Tract Stone.
Volume 2, 2004
History of Urolithiasis 185

Wickam JEA and Buck AC, eds. Churchill Livingstone, 16. Darenberg C, Ruelle CE 1879 Oeuvres de Rufus d’Ephèse.
Edinburgh, UK,.pp. 3–18. Balliere, Paris. Reprinted by Hackert, Amsterdam 1979.
3. Desnos E. 1914 Histoire de l’Urologie. In Encyclopedie 17. Celsus. 1979 De Medicina. Translated by Spencer WG.
Francaise d’Urologie. Puoson A and Desnos E, eds. Octaur Harvard University Press, Cambridge, pp. 427–453.
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Clinical Reviews in Bone and Mineral Metabolism Volume 2, 2004