Painful Operations: Removing Bladder Stones before Anesthesia

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If you visit the Gordon Museum at Guy’s Hospital in London, you’ll see a small bladder stone—no bigger than 3 centimetres across. Besides the fact that it has been sliced open to reveal concentric circles within, it is entirely unremarkable in appearance. Yet, this tiny stone was the source of enormous pain for 53-year-old Stephen Pollard, who agreed to undergo surgery to remove it in 1828.

People frequently suffered from bladder stones in earlier periods due to poor diet, which often consisted of lots of meat and alcohol, and very few vegetables. The oldest bladder stone on record was discovered in Egyptian grave from 4,800 B.C. The problem was so common that itinerant healers traveled from village to village offering a vast array of services and potions that promised to cure those suffering from the condition. Depending on the size of these stones, they could block the flow of urine into the bladder from the kidneys; or, they could prevent the flow of urine out of the bladder through the urethra. Either situation was potentially lethal. In the first instance, the kidney is slowly destroyed by pressure from the urine; in the second instance, the bladder swells and eventually bursts, leading to infection and finally death.

2Like today, bladder stones were unimaginably painful for those who suffered from them in the past. The stones themselves were often enormous. Some measured as large as a tennis ball. The afflicted often acted in desperation, going to great lengths to rid themselves of the agony. In the early 18th century, one man reportedly drove a nail through his penis and then used a blacksmith’s hammer to break the stone apart until the pieces were small enough to pass through his urethra. It’s not a surprise, then, that many sufferers chose to submit to the surgeon’s knife despite a very real risk of dying during or immediately after the procedure from shock or infection. Although the operation itself lasted only a matter of minutes, lithotomic procedures were incredibly painful and dangerous—not to mention humiliating.

The patient—naked from the waist down—was bound in such a way as to ensure an unobstructed view of his genitals and anus [see illustration below]. Afterwards, the surgeon passed a curved, metal tube up the patient’s penis and into the bladder. He then slid a finger into the man’s rectum, feeling for the stone. Once he had located it, his assistant removed the metal tube and replaced it with a wooden staff. This staff acted as a guide so that the surgeon did not fatally rupture the patient’s rectum or intestines as he began cutting deeper into the bladder. Once the staff was in place, the surgeon cut diagonally through the fibrous muscle of the scrotum until he reached the wooden staff. Next, he used a probe to widen the hole, ripping open the prostate gland in the process. At this point, the wooden staff was removed and the surgeon used forceps to extract the stone from the bladder. [1]

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Unfortunately for Stephen Pollard, what should have lasted 5 minutes ended up lasting 55 minutes under the gaze of 200 spectators at Guy’s Hospital in London. The surgeon Bransby Cooper fumbled and panicked, cursing the patient loudly for having “a very deep perineum,” while the patient, in turn, cried: “Oh! let it go; —pray, let it keep in!’” The surgeon reportedly used every tool at his disposal before he finally reached into the gaping wound with his bare fingers. During this time, several of the spectators walked out of the operating theater, unable to bear witness to the patient’s agony any longer. Eventually, Cooper located the stone with a pair of forceps. He held it up for his audience, who clapped unenthusiastically at the sight of the stone.

Sadly, Pollard survived the surgery only to die the next day. His autopsy revealed that it was indeed the skill of his surgeon, and not his alleged “abnormal anatomy,” which was the cause of his death.

1200px-Thomas_Wakley72But the story didn’t end there. Word quickly got out about the botched operation. When Thomas Wakley [left]—the editor of The Lancet—heard of this medical disaster, he accused Cooper of incompetence and implied that the surgeon had only been appointed to Guy’s Hospital because he was nephew to one of the senior surgeons on staff. Wakley used the trial to attack what he believed to be corruption within the hospitals due to rampant nepotism. Outraged by the allegation, Cooper sued Wakley for libel and sought £2000 in damages. The jury reluctantly sided with the surgeon, but only awarded him £100. Wakley had raised more than that in a defence fund campaign and gave the remaining money over to Pollard’s widow after the trial. [2]

Bransby Cooper’s reputation, like his patient, never did recover.

If you’re interested in the history of pre-anesthetic and pre-antiseptic surgery, you can pre-order my book The Butchering Art in the US (click here) and in the UK (click here). Information of foreign editions to come!

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1. Druin Burch, Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon (2007), p. 26. I am greatly indebted to his work for bringing this story to my attention.
2. Thomas Wakley, A Report of the Trial of Cooper v. Wakley (1829), pp. 4-5.

Pre-Order My Book! The Butchering Art

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I’m thrilled to reveal the cover for the US edition of my forthcoming book, THE BUTCHERING ART, which will be published by FSG on October 17th.

The book delves into the grisly world of Victorian surgery and transports the reader to a period when a broken leg could result in amputation, when giving birth in a squalid hospital was extraordinarily dangerous, and when a minor injury could lead to a miserable death. Surgeons—lauded for their brute strength and quick knives—rarely washed their hands or their instruments, and carried with them a cadaverous smell of rotting flesh, which those in the profession cheerfully referred to as “good old hospital stink.” At a time when surgery couldn’t have been more dangerous, an unlikely figure stepped forward: Joseph Lister, a young, melancholic Quaker surgeon. By making the audacious claim that germs were the source of all infection—and could be treated with antiseptics—he changed the history of surgery forever.

Many of you have been devoted readers of my blog since its inception in 2010, and I can’t thank you enough for your continued interest in my work. Writing a book has been the next logical step for a very long time. The idea of telling this particular story arose during a very difficult period in my life when my writing career was at risk. It is therefore with great pride (and some trepidation) that I am turning this book loose into the world, and humbly ask you to consider pre-ordering it. All pre-orders count towards first-week sales once THE BUTCHERING ART is released, and therefore give me a greater chance of securing a place on bestseller lists in October. I would be hugely grateful for your support.

Pre-order from any one of these vendors using the links below:

*Please note that THE BUTCHERING ART will also be published by Penguin in the United Kingdom, as well as several other publishers around the world. I’ll be revealing covers for these foreign editions in the coming months, along with information on where to buy a copy.

Disturbing Disorders: Sirenomelia (Mermaid Syndrome)

The sea king down there had been a widower for years, and his old mother kept house for him…she was an altogether praiseworthy person, particularly so because she was extremely fond of her granddaughters, the little sea princesses. They were six lovely girls, but the youngest was the most beautiful of them all. Her skin was as soft and tender as a rose petal, and her eyes were as blue as the deep sea, but like all the others she had no feet. Her body ended in a fish tail.

Hans Christen Anderson, The Little Mermaid, 1837.

Mermaids have teased our imagination for thousands of years. One of the earliest tales originated in ancient Assyria, where the goddess Atargatis transformed herself into a mermaid out of shame for accidentally killing her human lover. Homer called them sirens in the Odyssey, and described them as beautiful singing creatures who lure sailors to their deaths. Throughout history, these seductive beings have been associated with floods, storms, shipwrecks and drownings. They have been depicted in countless mediums: in Etrurian sculptures, in Greek jewelry, and in bas-relief on ancient Roman tombs. Christopher Columbus even reported seeing these mythical creatures on his voyage to the Caribbean in 1493.

But could our concept of what a mermaid looks like actually have originated from a real medical disorder?

M2Sirenomelia is a lethal condition characterised by rotation and fusion of the legs, resulting in what often looks like a fish tail (left). It occurs when the umbilical cord fails to form two arteries, thus preventing a sufficient blood supply from reaching the fetus. As a result, the single artery steals the blood and nutrition from the lower body and diverts it back up to the placenta. Due to malnutrition, the fetus fails to develop two separate limbs.

Sirenomelia, also known as ‘Mermaid Syndrome’, is extremely rare. It affects 1 in 100,000 babies and is 100 times more likely to occur in identical twins. Usually, those born with this condition die within days.

Over the course of my research, I’ve found very little about  the disorder’s history. There are snippets here and there which claim that fetuses born with sirenomelia were sometimes preserved in jars and put on display in ‘freak shows’ during the 19th century—but these sources are frustratingly vague. There is brief mention of the condition in a four-volume atlas published in 1891 titled Human Monstrosities, but nothing that hints at how medical practitioners understood sirenomelia in earlier periods.

Perhaps because the disorder is so rare, it’s also been hard for me to locate specimens in anatomical collections. My search in the Hunterian Museum at the Royal College of Surgeons in London came up cold. I did, however, find an early 20th-century example at the National Museum of Health & Medicine in Washington D.C. There are also three fetuses in the Anatomical Museum of the Second University of Naples, which have undergone 3D bone reconstructions (two pictured below).

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By far the largest number of fetuses comes from the Vrolik Museum in Amsterdam, which consists of more than 5,000 specimens of human and animal anatomy, embryology, pathology and congenital anomalies. The collection was founded by Gerardus Crolik (1755 – 185) and his son, Willem Vrolik (1801 – 1863), who both wrote extensively on anatomical deformities in the 18th and 19th centuries. The Vrolik Museum has both wet preparations and skeletal remains, all of which are on display to the public today.

Unlike the first disorder I examined in this series—Harlequin Ichthyosis—sirenomelia is extremely fatal. There are no accounts of anyone with this condition surviving in the past. Most died within days of being born due to kidney and bladder failure. Even today, the odds are against those with sirenomelia, though there are a handful of examples of children living past infancy.

In 1988, Tiffany Yorks underwent surgery to separate her legs before her first birthday. She continues to suffer from mobility issues due to her fragile leg bones, and compensates by using crutches of a wheelchair to move around. At the age of 26, she is the longest-surviving sirenomelia patient to date.

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