The First Case Of Medical Negligence Will Make You Cross Your Legs Forever

A man going through a lithotomy. Image credit: Wellcome collection (CC by 4.0)

In the 18th century, one man suffering from a stone in his bladder set about gathering some tools. He got himself a nail of the length you might use for some serious woodwork, before sitting down and using a blacksmith's hammer to bash it right into his penis.

The man, the medical historian Dr Lindsey Fitzharris writes, was attempting to break a stone in his bladder into smaller pieces so that he could pass them, chiseling away at it like a door hinge. Though the act was clearly a desperate one, it's somewhat understandable given the alternatives available at the time, which were essentially one of the worst surgeries imaginable (potentially followed by death) or a painful death.

Bladder stones – mineral deposits that form in the bladder when urine sits in there for a long time, or when the urine is too concentrated following dehydration, before hardening into stones – hurt like hell, and if left untreated can cause terrible complications. If large enough, they can stop urine from making its way from the kidneys into the bladder (resulting in kidney damage) or the urine's exit from the body (boom goes the bladder). Smaller stones can cause infections, as well as the intense pain of having a stone on the inside of your body.

Should the stone not pass out naturally, for many years the alternative was pretty grim. One particularly bad surgery would result in the first recorded medical malpractice lawsuit, leading to much-needed reforms.

Lithotomies go back around 2,500 years in their various forms. For instance, in the 16th century, the urethra was often expanded using a lithotomy dilator, pictured below, and the stone removed with instruments or fingers.

It worked exactly the way you're picturing it. Image credit: Wellcome Collection (CC BY 4.0)

By the time 53-year-old Stephen Pollard required surgery for a relatively unremarkable stone, the practice in certain areas was to take the patient and tie their lower legs to their upper legs while they were naked from the waist down. Several assistants would also hold the legs of the patient during the operation.

The surgeon would take a curved metal tube and insert it into the patient's urethra and up into the bladder. The surgeon would then put a finger inside the patient's rectum and feel around, attempting to locate the stone. Once found, the metal tube was removed and replaced with a wooden staff, which the surgeon would use as a guide, so as not to tear the patient's rectum or intestines.

In male patients, they would then cut through the scrotum and head towards the bladder, widening the hole with a probe. The wooden staff was then taken out while the surgeon removed the stone, often using forceps. People skilled at this operation could do it in minutes.

In the case of Stephen Pollard, it took nearly an hour. He had the unfortunate luck that his surgeon was only really there because of nepotism, being the nephew of a much better surgeon. The stick was inserted correctly, but the surgeon could not for the life of him locate the stone, after cutting away at the patient for some time, an account of the surgery in the Lancet details.

After a slip of the knife, the surgeon attempted to widen the incision first with the knife, and then with the forceps. 

"They were pushed onwards to a considerable distance, and with no small degree of force," the report notes. The surgeon – Mr Bransby Cooper – began to make his excuses. 

"It's a very deep perineum," he told the staff and spectators. "I can't reach the bladder with my finger." 

The team did some more cutting, more widening, and more digging, all while the unanaesthetised patient waited patiently. Cooper then began asking other staff members "have you a long finger?"

The surgeon would then shush everyone while he tried to locate the stone, during which the only sound was "the horrible squash, squash, of the forceps in the perineum."

The patient, of course, began to beg that they just leave the stone in there. Eventually, though, the job was completed.

"The stone was eventually laid hold of, and never shall we forget the triumphant manner in which the assistant surgeon raised his arm and flourished the forceps over his head with the stone in their grasp."

The patient died the following day. Before that happened, the medical team bled him from the arm, and took out more blood using leeches. An autopsy revealed that the problem was the poor skills of the surgeon, and not that he had an unusually large perenium, which surely was of great comfort to his family.

 


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