Difficult Operations Mastered

Gallstones

Over one hundred years ago abdominal surgery seemed impossible.  However, the removal of gallstones from the abdomen proved that surgery could be safe and effective.    Gallstones, also known as choleliths, occur when components of bile adhere into a relatively large group.  Gallstones can be extremely painful and can lead to back aches and spasms.  The gall bladder becomes inflammed and bloating can occur.

In the mid-1800s, Irishman, Robert Graves successfully removed gallstones from a patient using a complex method.  Only a few years later, 1867, a new method was developed and John Bobbs, an American, was able to remove gallstones even quicker than before.  The removal of gallstones soon became known as a cholecystotomy. Surgeons then began to remove the gallbladder altogether by 1882, in a procedure called a cholecystectomy.  During this era, the rate of survival after surgery increased but infection was still a very real possibility.  Until 1930, less than 25% of people diagnosed with gallstones had surgery to remove them.  With the advancement of surgery and antibiotics, now over 60% of people diagnosed with gallstones get them removed surgically.     

Bladder Stones

Bladder stones are small crystals within the bladder that form into small pellets which can often become lodged in the urethra causing pain and disabling the ability to urinate, especially among males.  By the 1800s surgeons had the technology and techniques to remove the stones.  However, most surgeons hesitated to do so because of other complications such as infection.  Surgeons of the 18th century, like Cheseldon and Douglas, conducted the removal of bladder stones as best they could but they did not share even a small amount of the success that 19th century.

In the early 19th century lithotripsy, a process by which bladder stones were surgically crushed and later removed by urination, became the most effective way to treat bladder stones.  A Frenchman by the name of Jean Amussat developed a device in the 1820s that crushed stones using levers.  However, this device was replaced later by the "trilabium," created by Jean Civiale, Amussat's fellow countryman.  The trilabium drilled stones into extremely small pieces where they could easily be passed through the urethra.  Civiale's great success in 1823 allowed him to rise in the ranks of urologists and soon he became Europe's leading urological surgeon.  Only a few decades later, the year 1877, Max Nitze, a urologist from Berlin created the first usable cytoscope which allowed surgeons to see down the urethra.  The cytoscope made removing bladder stones less painful and shorter in duration.

Breast Surgery

 Although cancer was nearly always the reason for breast amputation, a mastectomy, there were many other cultures that cut off the breast or breasts for a variety of reasons.  However, in western culture breasts are seen as a symbol of fertility and women who lost them were seen as inferior.  The social idealism that women's breasts were perfect made the removal of tumors so complicated.  Up until the 18th century a  knife and cautering iron were usually implemented but often failed to work effectively.  In fact, such methods would hasten the disease's spread throughout the body.  However, Angelo Nannoni, a Florentine doctor, recommended immediate operation of breast tumors by a large margin including underlying soft connective tissue, the large pectoralis muscle, and even the proximal lymph nodes.  These precautions ensured that the tumor would not spread.  Nevertheless, breast surgery was extremely dangerous and many women died of infections as well as complications during the surgery itself.