History of Medicine

                AMERICA’S FIRST GALLBLADDER SURGERY

 

     Mary E. Wiggins, a thirty-year-old seamstress, arrived in Indianapolis in 1867 to consult a surgeon about a severe pain in her right side. Four years earlier she had noted a lump near her right pelvic brim that grew in size and became tender. By the time of the consultation she had lost considerable weight and could not work. Eating and mere walking produced crippling pain. Her physician, Dr. Newcomer, thought she had a large ovarian cyst, as did other physicians that she consulted. Knowing that a number of these had been successfully removed, Newcomer brought her to see Dr. John S. Bobbs, a respected Indianapolis surgeon. 

Dr. John S. Bobbs (Ind Med J, Hathi Trust)

     Dr. Bobbs examined her carefully. He could only partially outline the mass and pelvic examination did not suggest any attachment to the uterus or its appendages. He told Mary that he doubted that this was an ovarian cyst. Desperate from pain, she begged for surgery, regardless of the diagnosis. Bobbs, uncertain, waited, but after a second examination revealed nothing new, he decided to operate. 

     He had Mary taken to a room on the third floor over a local drugstore, a room that he rented at times for surgery. Inside were a plain wooden table for operating, a bed, a chamber pot, and chairs. At the time there were no hospitals for private patients and no trained nurses available. Present at the surgery were Dr. Newcomer, five other physicians, and a medical student, the nephew of Bobbs’ wife. Chloroform anesthesia was given. 

     Dr. Bobbs made an incision from the umbilicus to the pubis. Because of numerous adhesions he had to push his gloveless fingers through to reach the mass. It was about five by two inches, had a thin, translucent wall, and appeared to be attached to the liver. He opened the lower end and clear, colorless fluid gushed out, ejecting several small concretions ranging in size up to that “of ordinary rifle bullets.” After removal of additional stones, Bobbs sutured the open end of the gallbladder to the abdominal wall to allow further drainage. Antisepsis was still unknown, but Bobbs was said to always wash his hands before surgery. 

Mary Wiggins, 38 yrs after surgery
(Ind Med J, Hathi Trust)

 An Englishwoman was hired to provide nursing care. Aside from a small stitch abscess, Mary Wiggins recovered uneventfully. Her portrait shown nearby was taken thirty-eight years after the surgery. 

     Dr. Bobbs was born in Green Village, PA, in 1809. He grew up speaking Pennsylvania Dutch, a German dialect, and learned English a little later. He was apprenticed to a Doctor Martin Luther, practiced a short time, and moved to Indiana in 1835. He later enrolled in a one-year course at Jefferson Medical College. Another pupil while at Jefferson was J. Marion Sims, later famous as a gynecological surgeon and important to this story. Bobbs returned to Indianapolis where, in 1854, he contracted cholera. His physician, as treatment, rubbed morphine on his tongue, gave frequent small feedings of crushed ice and champagne, and applied hot water bottles and massages to his cramping extremities. He survived.

     Dr. Bobbs was active in the establishment the Indiana State Medical Society and of the Indiana Medical College. He became professor of surgery at the College and later dean of the school. A medical colleague, while praising his surgical talent, added that “he was original and bold almost to recklessness.” He served with distinction in the Civil War, read widely, and served one term as a State Senator. He published a report of his innovative operation in 1869 and died in the following year.

     There appear to be no further cholecystotomies until 1878, ten years later. In that year his old schoolmate, J.Marion Sims, unaware

J Marion Sims (from Meine
Lebensgescgichte, Hathi Trust)

of Bobbs’ report in an obscure journal, performed a similar operation in Paris. The patient was a 45-year-old woman with pain and a palpable mass, complicated by jaundice and severe itching. Sims aspirated the tender mass, removing 32 ounces of dark fluid. This relieved the pain and itching, temporarily. When symptoms recurred, Sims opened the abdomen, employing the new Lister technique of carbolic acid washes and sprays. He removed 24 ounces of dark fluid and 60 gallstones from the gallbladder and sewed the edges of the empty sac to the abdominal wall. The patient did well for five days, then began to ooze blood from the wound, gums, and intestinal tract, dying of internal hemorrhage. (Possibly a clotting disorder?) At autopsy the wound was intact and the gallbladder was not distended. Sims concluded that the operation probably had a future as a remedy for painful gallbladder distension and possibly liver abscesses and hydatid cysts. He coined the word “cholecystotomy”, a mixture of Greek words for gall, bladder, and incision. 

     The following year, the English surgeon, Lawson Tait, reported another case of cholecystotomy to the Royal Medical and Chirurgical

   Lawson Tait  (from biography    
by McKay, Hathi Trust)

Society. This patient survived the surgery. In 1889 Tait reported on an extended experience with 55 cases, seven of whom died. Of interest, Tait, like Sims, was primarily a gynecological surgeon. 

     The first actual removal of the gallbladder was done by Carl Langenbuch, in Berlin. In 1882, after trial operations on animals, he removed the organ from a man whose chronic pain over years had reduced him to morphine addiction and a skeletal appearance. The day after surgery the man was reported to be pain-free and smoking a cigar. Modern gallbladder surgery was born.

 

SOURCES:

Brayton, A W. “John S. Bobbs of Indianapolis: The Father of Cholecystotomy.” 1905; Indiana Med J 24: 21-37.

Tinkere, M B. “The First Nephrectomy and the First Cholecystotomy, with a Sketch of the Lives of Doctors Erastus B. Wolcott and John S. Dobbs.” 1901; Johns Hopkins Hosp Bull 12: 247-51.

Bobbs, J S. “Case of Lithotomy of the Gall Bladder.” 1868; Trans Indiana State Med Soc 18: 68-73.

Sims, J M. “Cholecystotomy in Dropsy of the Gallbladder.” 1878; Brit Med J June 8, pp 811-15

Tait, L. “Case of Cholecystotomy Performed for Dropsy of the Gallbladder.” 1879; Proc Royal Med Chirurg Soc 9: 435-7.

McKay, W J S. Lawson Tait: His Life and Work. 1922; William Wood and Co.

Thorwald, Jurgen. The Triumph of Surgery. 1957; Pantheon Books.