How To: Remove a bladder stone in the days before anesthesia

The Chirurgeon's Apprentice is an entire blog dedicated to eye-witness accounts of surgery in the days before anesthesia. Oh, Internet. Thou art wonderful and horrible.

Collected by University of London medical historian Lindsey Fitzharris, the stories come from well-documented sources, from the 17th century onward. Part of the goal here is to follow the path of surgery as it really started to become its own profession ... separate from that of barber. Yes, this is going to be every bit as gory as you imagine. I'll start looking for a unicorn now.

If you visit the Gordon Museum at Guy’s Hospital in London, you will 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.

Although the operation itself lasted only a matter of minutes, lithotomic procedures were painful, dangerous and 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]. 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 prostrate gland in the process. At this point, the wooden staff was removed and the surgeon used forceps to extract the stone from the bladder.

Unfortunately for Stephen Pollard, what should have lasted 5 minutes ended up lasting 55 minutes under the gaze of 200 spectators.

Via Ed Yong

Image: Ouch, again., a Creative Commons Attribution (2.0) image from rberteig's photostream
Image shows a kidney stone. Kidney stones and bladder stones are basically the same thing, though. Their names signify where the stone formed. Either way, they're made of the same stuff. And more people post images of their kidney stones to Flickr.

Maggie Koerth-Baker is the science editor at BoingBoing.net. She writes a monthly column for The New York Times Magazine and is the author of Before the Lights Go Out, a book about electricity, infrastructure, and the future of energy. You can find Maggie on Twitter and Facebook.

Maggie goes places and talks to people. Find out where she'll be speaking next.

MORE: bladder stone • History • horrors • ouch • Science • surgery

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millie fink

So basically, a bladder stone is a turd that ends up in the wrong part of the body?
- http://maggiekb.com/ Maggie Koerth-Baker
  
  Ahhh, no. Not at all. These stones are made from minerals, like calcium. Basically, they’re crystals. Unless you are more magical than the rest of us, your turds are not made up of crystals.
  - Felton / Moderator
    
    Unless you are more magical than the rest of us
    
    Like, say, a unicorn. :-)
    - mguffin
      
      You had to go there? Unicorn turds? Oh thanks. So that whole unicorn mental palate cleanser’s soiled forever now. Some moderator you turned out to be….
      - OldBrownSquirrel
        
        I take it you’ve never seen the t-shirt.
      - mguffin
        
        Well actually I thought they just shat adorably fluffy kittens that smelled minty fresh with a light citrus overlay, but though you’re very nice and trying to trying to mollify me with your cunningly photoshopped “photographic evidence” to the contrary, it’s all just spoiled now…
      - codesuidae
        
        > I thought they just shat adorably fluffy kittens that smelled minty fresh with a light citrus overlay
        
        I wouldn’t mind seeing gif of that.
    - https://plus.google.com/104067355242126774300/posts?hl=en Dennis Smith
      
      Yeah, they shit diamonds.
    - Antinous / Moderator
      
      Like, say, a unicorn. :-)
      
      Coprolites are unicorn poo?
  - millie fink
    
    Right, thanks. Photos can be so deceiving. I should pay more attention to the fine print.
    
    And your print is always especially fine.
    
    http://instantrimshot.com/
oschene

Samuel Pepys was cut for the stone on March 26, 1658 and lived on for many years after. A discussion can be found here:
http://www.pepysdiary.com/p/346.php
http://www.geekforce.com Hugh Johnson

gah!
OldBrownSquirrel

Were bladder stones more common in those days? Or is it just that we hear about them less often today because they’re more easily treated?
grimatongueworm

Ask Neal Stephenson.
Blaine

If memory serves, that was part of the Hippoctratic Oath, that you would not cut for stones. It was saved for specialists.
http://watercooler.iridesco.com/ EvilPRGuy

Wow, this completely derailed my breakfast eating. I actually had trouble reading that description. I had kidney stones a few years back, and it was far and away the most painful thing I’ve gone through (and I race bikes so I’m no stranger to broken bones and stitches). Fun Fact: I passed my kidneys stone in the pitch black during the NYC Blackout! Anesthesia, I love You!
styrofoam

The key takeaway I got from the Quicksilver trilogy was that bladder stones were a bitch to take out, and everybody seemed to get them.
Ralph Kramden

The “prostrate” gland? Does no one edit these things?
- dculberson
  
  You might try complaining at the source rather than here. Note what you’re pointing out is in a quoted area.
- millie fink
  
  One of these days, Kramden, straight to the moon!!
- http://thechirurgeonsapprentice.com Lindsey Fitzharris
  
  Thanks for spotting this! I have changed it in the original posting on The Chirurgeon’s Apprentice! Please read more at http://thechirurgeonsapprentice.com
- Culturedropout
  
  Hey – if you had a “wooden staff” up your John-Thomas, your gland would be laying down too…
bobledrew

I’ve had a few runins with bladder cancer, necessitating 3 TURBT (transurethral resection of the bladder tumour) procedures and many more cystoscopies. The TURBTs I’ve been put out for; the cystoscopies are done using a topical anasthetic. After reading this post, I will NEVER complain about the discomfort. EVER.
Mister44

OH fuck – oh fuck – oh fuck fuck fuck fuck fuck…. fffffffuuuuuucccccckkkkkkkkk!!!!

ETA – this is the illustration that is mentioned in the article. http://thechirurgeonsapprentice.files.wordpress.com/2011/10/648e163f91cf5f20e075e4d0c576.jpg
bigorangemachine

What has been read, cannot be unread.
imipolex

This procedure is also depicted in The Thousand Autumns of Jacob de Zoet by David Mitchell. Made me squirm.

http://en.wikipedia.org/wiki/The_Thousand_Autumns_of_Jacob_de_Zoet
- garyg2
  
  Nooo! I have that book right at the top of books to read pile… now I’m all apprehensive…
http://www.jjsaul.com Jim Saul

The scenes in Deadwood were pretty hard to watch even without the cutting. They’re not much fun, but I still don’t buy the “like giving birth” thing. Though my youngest here is about ready to start walking on its own.
- Marco Antonio Morales
  
  I’ve known women who have both given birth AND had kidney stones. (One in particular, had both at the same time!) – and they all concede: kidney stones are worse.
  
  I’ve had my share of them, and it’s a pain so striking that you are no longer able to think (except the words ‘MAKE IT STOP’) … and basically thrown up out of sheer pain when trying to convince the doctor that yes, I’ll have some anesthetics now please.
  
  I’m thankful I’m born in this century and not earlier, though. I surely hope for a future in which prevention becomes the best cure!
  - http://www.jjsaul.com Jim Saul
    
    Each has been unique for me… that last one I thought was a slipped lumbar disc for a week.
    
    I guess I start with that experience, then project “at least it’s not a 7 pound baby”, even knowing all the reasons that’s an irrational comparison.
http://thechirurgeonsapprentice.com Lindsey Fitzharris

Big thanks to Maggie Koerth-Baker for sharing this article from The Chirurgeon’s Apprentice! More gruesome entries about the history of early modern surgery to come! Please read the full story about Stephen Pollard at http://thechirurgeonsapprentice.com/2011/10/04/cutting-for-the-stone-the-case-of-stephen-pollard/
skabob

Should have used Stephen Maturin’s suprapubic lithotomy procedure: safe and quick, and only 40% mortality rate.
http://twitter.com/writebastard Ian Wood

Oh! Sort of like a thesis defense, then
CH

Do I remember totally wrong, or wasn’t there somebody who did the same to himself? Hmm… gotta go google… back in a sec… Ah, yes… http://en.wikipedia.org/wiki/Jan_de_Doot

Kids, don’t try this at home!
http://www.paradea.org/notes/ Teirhan

i’ve tried and failed to come up with a cogent response to this article, so here is my original response:

eughhhhhhhh. *clutches protectively at his nethers*
- http://thechirurgeonsapprentice.com Lindsey Fitzharris
  
  To see an illustration of this procedure from the 17th century, see the original post on The Chirurgeon’s Apprentice: http://thechirurgeonsapprentice.com/the-chirurgeons-casebooks-1-2/ Enjoy :)
  - http://www.paradea.org/notes/ Teirhan
    
    Ok, I’m an even sadder panda now.
Antinous / Moderator

I had a stone in my ureter. In order to do lithotripsy (blasting with sound waves), they had to insert a catheter and push the jagged rock back through my narrow, little ureter (a procedure called a pushback) until it was in my Ureteropelvic Junction, where it could be blasted. Then I got to pass the fragments through my scraped up ureter for a few days.
- Marco Antonio Morales
  
  Ouch, dude!!!!
  - – -
  Strangely enough, I feel a deep empathic ‘survivor’ connection to other stone sufferers. A ‘you know, and I know – what we both know’ type empathy. You piss rocks, you got my respect.
- patrick dodds
  
  I don’t suppose any of that hurt much Antinous?
  - Antinous / Moderator
    
    For about a week afterward, I would have a spasm in that brutalized ureter about once a day and end up taking 6 percodan. I still have the occasional minor spasm 30 years later.
    
    When I was in the ER with the stone, I had 500 mg of Demerol IV and 50 mg of Phenergan (which potentiates the Demerol) in three hours. Horse doses, but those of us with Scottish DNA do seem to soak up the intoxicants with great efficiency.
Anne Hunter

I can understand why someone would choose surgery without anesthesia to get rid of a kidney stone, for I’ve had one. It is as bad as they say, and the worst pain I’ve ever felt. The pain from the spasms was so bad, I would vomit and lose bladder/bowel control simultaneously.
- http://thechirurgeonsapprentice.com Lindsey Fitzharris
  
  In the 18th century, one man reported drove a nail through his penis and then used a hammer to break apart the stone so he could pass it through his urethra. To read the entire article, check out http://thechirurgeonsapprentice.com/the-chirurgeons-casebooks-1-2/
  - http://www.paradea.org/notes/ Teirhan
    
    In the 18th century, one man reported drove a nail through his penis and then used a hammer to break apart the stone so he could pass it through his urethra.
    
    Ok, that’s the second most horrible thing I’ve read today. (and how did i miss that on my first readthrough of the article!?)
    
    I need to stop reading this thread (but we all know I won’t).
Festus

Drink water. Drink it now.
http://twitter.com/infontology Infontology

Marin Marais composed “Le tableau de l’operation de la taille” as an account of such a self-experienced operation. Here in an English language version on Spotify: http://open.spotify.com/track/1wgelRexzQauShOdptwaqW
george57l

I do not know offhand if it is available as a podcast (but should be on iPlayer) but this week BBC Radio 4 is serialising Samuel Pepys diary. Yesterday’s episode included a section about him describing to his friends (regaling them with his anecdote) how his stone was extracted “I was bound and gagged and …. they went up through the cods ….. and it was the size of a tennis ball” (quote may not be 100% acccurate)

(Tennis balls may have been smaller in those days, perhaps)