Hermann Boerhaave (1668–1738) was one of the most important figures in 18th-century medicine. With his particular contribution surgery began its transition to a real clinical medical activity becoming increasingly based on linking symptoms with the knowledge of anatomopathological transformations. Lithiasis of the urinary tract was a very common disease throughout Europe. During the early 18th century the surgical approaches for lithotomy to treat lithiasis had very high risks of complications. In the face of the very common and dangerous complications, the doctors and surgeons actively sought all possible solutions short of surgery, and left lithotomy as the last alternative. Boerhaave dedicated a chapter in his ‘Institutiones medicae’ to the treatment of lithiasis of the urinary tract. His recommendations included an increase in liquid intake, a hot bath in order to induce vasodilation, and exercise. Using these methods, Boerhaave felt that stone removal should be achieved, and perhaps reflecting both the status of surgery in the early 18th century and an appreciation of the risks of the surgical procedures available. Boerhaave’s opinion of lithomy as a last resort when other approaches failed was, ‘I think lithotomy is an act of pure faith’.