Lithotomy? You barely know me!

December 12, 2018 2:46 PM

Extremely detailed surgical illustrations [SO NSFW] from two 19th-century medical texts.

Archive.org scans of the source works:

A Treatise on Operative Surgery by Joseph Pancoast
Précis iconographique de médecine opératoire et d’anatomie chirurgicale by Claude Bernard

posted by Johnny Wallflower (29 comments total)

For those interested in the more hair-raising accounts from medical history, there's also
Thomas Morris: Making you grateful for modern medicine, where the author posts and discusses articles from old medical journals.

You'll scream a little. You'll whimper a lot. You'll be so, so grateful you live in the modern era.
posted by Lunaloon at 3:01 PM on December 12, 2018 [6 favorites]

Please don't do any of these things to my penis. Thanks ever so much.
posted by selfnoise at 3:06 PM on December 12, 2018 [8 favorites]

You'll be so, so grateful you live in the modern era.

If there are still people around 200 years from now, they'll probably consider our current methods just as barbaric and incomprehensible as we consider these, and be grateful for 23rd century medicine.
posted by Greg_Ace at 3:21 PM on December 12, 2018 [8 favorites]

What i find incredible about these, as I do for most art of this type, is the intimate knowledge of the procedures that must have been had in order to correctly illustrate.

Secondly, the contrast between "Jab the rod up the dick and grab the stones" and "god forbid we draw a vulva"
posted by rebent at 3:25 PM on December 12, 2018 [9 favorites]

From a layperson's perspective, it looks like there's a lot of general rooting around going on in that uterine surgery. He looks like he's picking the numbers at a Bingo game.
posted by The Underpants Monster at 3:45 PM on December 12, 2018 [2 favorites]

If there are still people around 200 years from now, they'll probably consider our current methods just as barbaric and incomprehensible as we consider these, and be grateful for 23rd century medicine.

Dr. McCoy would agree
posted by Automocar at 3:57 PM on December 12, 2018 [7 favorites]

Does that mean "Sort of Not Safe for Work" or "Soooooooo Not Safe for Work?"


Clicked on link...that would the latter.
posted by Abehammerb Lincoln at 3:57 PM on December 12, 2018 [2 favorites]

Death was widely considered the soft option.

The mastectomy drawing reminded me of the astounding account of Fanny Burney, an early nineteenth-century writer who underwent the operation and survived for many years afterwards, both remarkable feats on her part.

I also couldn't help but notice the hairstyle of the model, with the wet curls just so.
posted by Countess Elena at 4:16 PM on December 12, 2018 [4 favorites]

Wait, is it the patient who's helpfully holding his cock out of the way?

Anyway, I really hope all these people got better.
posted by zompist at 4:18 PM on December 12, 2018 [2 favorites]

Samuel Pepys underwent a lithotomy at 25, made a good recovery, and subsequently held a party every year on the anniversary of the operation. He also kept the stone, which was the size of a billiard ball as a souvenir. in a specially-made case. No anesthetic or antisepsis - he must have had the constitution of an ox.

I for one (she said, desperately trying to uncross her legs) am very grateful indeed for modern medicine.
posted by Fuchsoid at 4:28 PM on December 12, 2018 [9 favorites]

the stone, which was the size of a billiard ball

That's what he gets for eating cheese he'd buried in the ground, I suppose.
posted by Greg_Ace at 4:33 PM on December 12, 2018 [2 favorites]

Huh, looks not that different from how many of these procedures are done today. I mean, we now have anesthesia, and lithotripsy instead of lithotomy (it hadn't even occurred to me till this post that lithotomy was an actual procedure, as opposed to "that somewhat ridiculous position we insist on for childbirth and Paps"), but like, there are only so many ways to remove a cataract, y'know?
posted by basalganglia at 6:04 PM on December 12, 2018 [2 favorites]

Man, I can barely handle the comments. I think I should skip the link.
posted by 4ster at 6:12 PM on December 12, 2018 [2 favorites]

Amazing artistic skill, powers of observation, and engaging POV compositions. You can see why illustrations, done well, can be superior to photography.

Here's a beautiful portrait by Pancoast from a first edition of his A Treatise on Operative Surgery (1844), offered in Christie's auction Anatomy As Art: The Dean Edell Collection, October 2007:

FIRST EDITION OF ONE OF THE MOST SPECTACULARLY ILLUSTRATED AMERICAN SURGICAL TREATISES OF THE 19TH CENTURY, with 80 plates comprising 486 separate illustrations. Some of the plates were after paintings by Nicholas-Henri Jacob (1782-1871) and may have been reduced or adapted from the larger surgical images in the atlases of Bourgery and Jacob. The work includes one of the most important and extensive sections on plastic surgery published in America during the period. Professor of anatomy and surgery at Jefferson Medical College, Pancoast developed a number of new operations, including the first successful plastic operation for exstrophy of the bladder, the "plow and groove" suture for rhinoplasty, and the neurosurgical procedure of sectioning the second and third branches of the fifth pair of nerves as they emerge from the base of the brain. His Treatise also includes one of the earliest accounts of a free skin graft, used in this case in the reconstruction of an earlobe.

Browse the auction lots to view dozens of historical illustrations, then compare the 2017-2009 Salon Winners at the Association of Medical Illustrators > View Art & Animations (see also their Historical Art gallery).
posted by cenoxo at 12:14 AM on December 13, 2018 [7 favorites]

These illustraations should replace the “which frowny face” pain scalei in doctor’s offices. “Doc, I’d say I’m halfway between tweezer-in-my-eye amd butterknife-up-my-ass.”
posted by Abehammerb Lincoln at 1:03 AM on December 13, 2018 [9 favorites]

What I find remarkable about illustrations like this is the meticulous, dispassionate detail. Beautifully drawn and rendered without any emotional reference to what is actually happening.
posted by Nelson at 1:04 AM on December 13, 2018

Claude Bernard's work is excellent, also. His Instruments De Chirurgie bring to mind Jeremy Irons' disturbing portrayal of twin gynecologists in Dead Ringer (1988) [SLYT trailer, probably NSFW].
posted by cenoxo at 1:12 AM on December 13, 2018 [2 favorites]

> ...without any emotional reference to what is actually happening.

Fleeting moments like those are where a camera — with a sensitive eye behind it — excels: Behind the Picture: George Lott, Wounded Warrior [Ralph Morse, 1944 —Time & Life Pictures/Getty Images].
posted by cenoxo at 1:45 AM on December 13, 2018

First link was enough.

All I could think was: HOW THE FUCK CAN YOU DO THAT SHIT WITHOUT ANAESTHETIC?!?!?!
posted by Pouteria at 3:13 AM on December 13, 2018 [1 favorite]

Something Mr. Morris mentions in several of his posts on operations to remove stones is how very common this malady was in olden times. In fact, there was a section of rural England that was known for its inhabitants disproportionately suffering from stones. Why this was more prevalent in the past, and why certain geographic locations were even more prone to stones is not completely understood; researchers speculate that it had to do with diet. Grain, meat, and alcohol have been pointed to as possible causes.

My own amateur guess is that perhaps it's connected to the tendency back then to drink more alcoholic beverages and less non-alcoholic fluids, and to relieve themselves less frequently. They drank a lot of alcohol back then; alcohol tends to be dehydrating. Well water was probably hard, meaning it contained calcium, and perhaps that contributed to the formation of stones (whereas nowadays it's common to reduce the calcium content via water-softening systems). And people probably didn't regularly ingest as much liquid as they should have due to the sheer inconvenience of having to too-frequently use the privy or retreat to a room and a chamberpot. Concentrated urine and retaining urine for long periods in the bladder can also apparently contribute to the formation of stones.

In short, maybe the reason stones aren't as prevalent nowadays is because we drink a lot more fluids, we drink a lot less alcohol, and (thanks to modern plumbing) we pee a lot more often.
posted by Lunaloon at 5:48 AM on December 13, 2018 [4 favorites]

Huh, looks not that different from how many of these procedures are done today.

I had the same thought, and I actually have seen some of them done very many times. The biggest difference to me is that now the surgeon wears gloves.
posted by TedW at 8:22 AM on December 13, 2018 [1 favorite]

From Old Book Illustrations — Kidney and Bladder Stones by Max Brödel, Diseases of the Kidneys, Ureters and Bladder (1914).
posted by cenoxo at 8:23 AM on December 13, 2018

All I could think was: HOW THE FUCK CAN YOU DO THAT SHIT WITHOUT ANAESTHETIC?!?!?!

There were some good old-fashioned alternatives like strapping people down or employing large men to hold them. And, of course, there was alcohol, although it never worked that well. But a major technique that surgeons employed was speed. They learned to work very, very fast, and speed was the hallmark of a skilled man. Robert Liston could take off a leg and sew it up tight in two and half minutes. Contrast this to today, when surgeries can take hours on end.
posted by Countess Elena at 8:32 AM on December 13, 2018 [1 favorite]

The lithotomy illustrations are helpful, but they don’t include the critical second part of the procedure (18th c, colourised).
posted by a halcyon day at 12:43 PM on December 13, 2018

I've seen so many pictures of my own innards that my strongest emotional reaction is, "Wow, these innards are a lot better-looking than mine."
posted by The Underpants Monster at 2:58 PM on December 13, 2018 [1 favorite]

The look of mild peevishness on the face of the woman having her "mammary gland" removed kind of amused me. Then for some reason I absolutely cannot think of, a lot of acid rose up in my throat. Cough.

I stopped looking after that. I think this is NSFMe.
posted by 41swans at 3:07 PM on December 13, 2018

The Underpants Monster wins the award for Weirdest Humblebrag.
posted by Johnny Wallflower at 4:41 PM on December 13, 2018 [1 favorite]

“I got a diagram of your intestines here. Well, it's not actually YOUR intestines. Unless it was you what modeled for it. It couldn't have been you what modeled for it, cause you have to be dead before you can model for intestines.”

posted by The Underpants Monster at 6:38 PM on December 13, 2018

I know it's apples and oranges but I'm so glad I saw this post two days after, rather than two days before, my vasectomy. Sheesh.
posted by RolandOfEld at 9:37 PM on December 14, 2018 [3 favorites]