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]

L0015225 Lithotomy scene

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.

Houses of Death: Walking the Wards of a Victorian Hospital

9deb7918e7e1d5281d6cfba4eafb711dThe following blog post relates to my forthcoming book THE BUTCHERING ART, which you can pre-order here

Today, we think of the hospital as an exemplar of sanitation. However, during the first half of the nineteenth century, hospitals were anything but hygienic. They were breeding grounds for infection and provided only the most primitive facilities for the sick and dying, many of whom were housed on wards with little ventilation or access to clean water. As a result of this squalor, hospitals became known as “Houses of Death.”

L0059152 Trade card for a 'Bug Destroyer' Andrew Cooke, LondonThe best that can be said about Victorian hospitals is that they were a slight improvement over their Georgian predecessors. That’s hardly a ringing endorsement when one considers that a hospital’s “Chief Bug-Catcher”—whose job it was to rid the mattresses of lice—was paid more than its surgeons in the eighteenth century. In fact, bed bugs were so common that the “Bug Destroyer” Andrew Cooke [see image, left] claimed to have cleared upwards of 20,000 beds of insects during the course of his career.[1]

In spite of token efforts to make them cleaner, most hospitals remained overcrowded, grimy, and poorly managed. The assistant surgeon at St. Thomas’s Hospital in London was expected to examine over 200 patients in a single day. The sick often languished in filth for long periods before they received medical attention, because most hospitals were disastrously understaffed. In 1825, visitors to St. George’s Hospital discovered mushrooms and wriggling maggots thriving in the damp, soiled sheets of a patient with a compound fracture. The afflicted man, believing this to be the norm, had not complained about the conditions, nor had any of his fellow convalescents thought the squalor especially noteworthy.[2]

Worst of all was the fact that a sickening odor permeated every hospital ward. The air was thick with the stench of piss, shit, and vomit. The smell was so offensive that the staff sometimes walked around with handkerchiefs pressed to their noses. Doctors didn’t exactly smell like rose beds, either. Berkeley Moynihan—one of the first surgeons in England to use rubber gloves—recalled how he and his colleagues used to throw off their own jackets when entering the operating theater and don ancient frocks that were often stiff with dried blood and pus. They had belonged to retired members of staff and were worn as badges of honor by their proud successors, as were many items of surgical clothing.

llanionmilitaryhospitalmoreThe operating theaters within these hospitals were just as dirty as the surgeons working in them. In the early decades of the nineteenth century, it was safer to have surgery at home than it was in a hospital, where mortality rates were three to five times higher than they were in domestic settings. Those who went under the knife did so as a last resort, and so were usually mortally ill. Very few surgical patients recovered without incident. Many either died or fought their way back to only partial health. Those unlucky enough to find themselves hospitalized during this period would frequently fall prey to a host of infections, most of which were fatal in a pre-antibiotic era.

419c2b28d1b137197a21298b24a604c0In addition to the foul smells, fear permeated the atmosphere of the Victorian hospital. The surgeon John Bell wrote that it was easy to imagine the mental anguish of the hospital patient awaiting surgery. He would hear regularly “the cries of those under operation which he is preparing to undergo,” and see his “fellow-sufferer conveyed to that scene of trial,” only to be “carried back in solemnity and silence to his bed.” Lastly, he was subjected to the sound of their dying groans as they suffered the final throes of what was almost certainly their end.[3]

As horrible as these hospitals were, it was not easy gaining entry to one. Throughout the nineteenth century, almost all the hospitals in London except the Royal Free controlled inpatient admission through a system of ticketing. One could obtain a ticket from one of the hospital’s “subscribers,” who had paid an annual fee in exchange for the right to recommend patients to the hospital and vote in elections of medical staff. Securing a ticket required tireless soliciting on the part of potential patients, who might spend days waiting and calling on the servants of subscribers and begging their way into the hospital. Some hospitals only admitted patients who brought with them money to cover their almost inevitable burial. Others, like St. Thomas’ in London, charged double if the person in question was deemed “foul” by the admissions officer.[4]

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Before germs and antisepsis were fully understood, remedies for hospital squalor were hard to come by. The obstetrician James Y. Simpson suggested an almost-fatalistic approach to the problem. If cross-contamination could not be controlled, he argued, then hospitals should be periodically destroyed and built anew. Another surgeon voiced a similar view. “Once a hospital has become incurably pyemia-stricken, it is impossible to disinfect it by any known hygienic means, as it would to disinfect an old cheese of the maggots which have been generated in it,” he wrote. There was only one solution: the wholesale “demolition of the infected fabric.”[5]

fitzharris_butcheringart_021417It wasn’t until a young surgeon named Joseph Lister developed the concept of antisepsis in the 1860s that hospitals became places of healing rather than places of death.

To read more about 19th-century hospitals and Joseph Lister’s antiseptic revolution, pre-order my book THE BUTCHERING ART by clicking here. Pre-orders are incredibly helpful to new authors . Info on how to order foreign editions coming soon. Your support is greatly appreciated. 

 

1. Adrian Teal, The Gin Lane Gazette (London: Unbound, 2014).
2. F. B. Smith, The People’s Health 1830-1910 (London: Croom Helm, 1979), 262.
3. John Bell, The Principles of Surgery, Vol. III (1808), 293.
4. Elisabeth Bennion, Antique Medical Instruments (Berkeley: University of California Press, 1979), 13.
5. John Eric Erichsen, On Hospitalism and the Causes of Death after Operations (London: Longmans, Green, and Co., 1874), 98.

The Surgeon who Operated on Himself

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Leonid Ivanovich Rogozov (pictured above and below right) knew he was in trouble when he began experiencing intense pain in lower right quadrant of his abdomen. He had been feeling unwell for several days, but suddenly, his temperature skyrocketed and he was overcome by waves of nausea. The 27-year-old surgeon knew it could only be one thing: appendicitis.

blog3The year was 1961, and under normal circumstances, appendicitis was not life-threatening. But Rogozov was stuck in the middle of the Antartica, surrounded by nothing but thousands of square miles of snow and ice, far from civilization. He was one of thirteen researchers who had just embarked on the sixth Soviet Antarctic Expedition.

And he was the only doctor.

At first, Rogozov resigned himself to his fate. He wrote in his diary:

It seems that I have appendicitis. I am keeping quiet about it, even smiling. Why frighten my friends? Who could be of help? A polar explorer’s only encounter with medicine is likely to have been in a dentist’s chair.

He was right that there was no one who could help. Even if there had been another research station within a reasonable distance, the blizzard raging outside Rogozov’s own encampment would have prevented anyone from reaching him. An evacuation by air was out of the question in those treacherous conditions. As the situation grew worse, the young Soviet surgeon did the only thing he could think of: he prepared to operate on himself.

Rogozov was not the first to attempt a self-appendectomy. In 1921, the American surgeon Evan O’Neill Kane undertook an impromptu experiment after he too was diagnosed with a severe case of appendicitis. He wanted to know whether invasive surgery performed under local anesthetic could be painless. Kane had several patients who had medical conditions which prevented them from undergoing general anesthetic. If he could remove his own appendix using just a local anesthetic, Kane reasoned that he could operate on others without having to administer ether, which he believed was dangerous and overused in surgery.

Lying in the operating theater at the Kane Summit Hospital, the 60-year-old surgeon announced his intentions to his staff. As he was Chief of Surgery, no one dared disagree with him. Kane proceeded by administering novocaine—a local anesthetic that had only recently replaced the far more dangerous drug, cocaine—as well as adrenalin into his abdominal wall. Propping himself up on pillows and using mirrors, he began cutting into his abdomen. At one point, Kane leaned too far forward and part of his intestines popped out. The seasoned surgeon calmly shoved his guts back into their rightful place before continuing with the operation. Within thirty minutes, he had located and removed the swollen appendix. Kane later said that he could have completed the operation more rapidly had it not been for the staff flitting around him nervously, unsure of what they were supposed to do.

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Emboldened by his success, Kane decided to repair his own inguinal hernia under local anesthetic eleven years later. The operation was carried out with the the press in attendance. This operation was more dangerous than the appendectomy because of the risk of puncturing the femoral artery. Unfortunately, this second surgery was tricky, and ended up taking well over an hour. Kane never fully regained his strength. He eventually came down with pneumonia, and died three months later.

Back in Antartica, Rogozov enlisted the help of his colleagues, who assisted with mirrors and retractors as the surgeon cut deep into his own abdomen. After forty-five minutes, Rogozov began experiencing weakness and vertigo, and had to take short breaks. Eventually he was able to remove the offending organ and sew up the incision (pictured below, recovering). Miraculously, Rogozov was able to return to work within two weeks.

blog4The incident captured the imagination of the Soviet public at the time. After he returned from the expedition, Rogozov was awarded the Order of the Red Banner of Labour. The incident also brought about a change in policy. Thereafter, extensive health checks became mandatory for personnel before their departure for Antartica was sanctioned.

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Under the Knife – Sneak Peek!

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In my new YouTube series, Under the Knife, I will take you on journey into a curious past—one which is riddled with blood-sucking leeches, spring-loaded knives and rotting corpses. Together, we will visit a world where surgeons and executioners share a common goal; where colluding with murderers and thieves is a pre-requisite for gaining entrance into the dissection theater; and where ‘well-bred’ families are horrified at the thought of one of their own becoming a surgeon.

Thanks to the inexhaustible efforts of my talented friend, Alex Anstey, I’m thrilled to release the opener to Under the Knife. I know a lot of you have been waiting patiently for me to unveil this project. I hope you’ll agree it’s been worth the wait!

Please remember to subscribe to our YouTube Channel so you can receive updates when we post new videos. The first episode will be released once I hit my goal on Patreon – so kindly consider supporting my content.

Most importantly, please tweet, post and share this video so we can get people buzzing about Under the Knife! My friends and I can’t wait to show you more!

Click HERE to view video.