The Norwich school of lithotomy.

A NOTABLE cHAPTER in the long history of human bladder stone has been contributed from Norwich and its county of Norfolk and this came about for several reasons. The main reason was that Norfolk enjoyed the unenviable reputation during the latter part of the eighteenth and throughout the nineteenth centuries of having the highest incidence of bladder stone among its inhabitants of any county in Great Britain. As a result of this high prevalence of bladder stone a local tradition of surgical skill in the art of lithotomy emerged and when the first general hospital in Norfolk, the Norfolk and Norwich Hospital was founded in 1771-2 there were appointed to its surgical staff local surgeons who were most experienced lithotomists. Their skill was passed on to those who followed them and earned for the hospital a European reputation for its standards of lithotomy. Sir Astley Cooper" when at the height of his professional fame and influence in 1835 spoke of these standards as follows, 'the degree of success which is considered most correct [for lithotomy] is that taken from the results of the cases at the Norfolk and Norwich Hospital'.2 There were not only able lithotomists on the early staff of the Norfolk and Norwich Hospital but also physicians who wrote on the medical aspects of bladder stone with special reference to the problems of incidence and chemical analysis. These writings were based on the registers of admissions to the hospital which were kept from the hospital's inception. The keeping of a hospital register was an uncommon practice at the turn of the eighteenth century as is revealed by Alexander Marcet3 in a monograph on calculous disease of the urinary tract which he published in 1817. Marcet wrote 'In my enquiries I have met with great disappointments . . . it will appear scarcely credible that in the larger hospitals in London, St. Bartholomew's, St. Thomas's, Guy's and the London Hospital, no regular or at least no ostensible records of the cases of lithotomy which occur in them should be preserved. It is with great pleasure, however, that I am enabled to mention one striking exception to this unaccountable oversight in public hospitals. The Norfolk and Norwich Infirmary [Hospital] in this and several other respects, stands as a model of regularity and good management'.4 The final reason for Norwich and Norfolk acquiring their reputation in the field of bladder stone is that from the foundation of the Norfolk