History of Medicine

 DINNER AT EIGHT WITH 

         ENGLAND’S FIRST UROLOGIST

 

 

         One of the most painful medical conditions is a bladder stone. Less common today, bladder stones at one time plagued young and old alike, from kings to paupers. Until the early nineteenth century, sufferers had a choice between enduring the pains or resorting to an operation that involved cutting directly into the bladder, usually from below, without anesthesia, to remove the stone. Understandably, the surgeon had to be lightning-fast and precise at the same time. William Cheselden was the leading practitioner of this operation in 18^th century England, accomplishing it within 24 to 60 seconds.

         In the early 1800s a French doctor, Jean Civiale, developed a snare that could be passed through the urethra and grab the stone.

Jean Civiale (Wikipedia)

Another probe, a slender drill, was then threaded through the first instrument. Drilling a few holes in the ensnared stone would usually crumble it enough to allow flow to the outside. Civiale founded probably the world’s first urology service at the Hospital Necker in Paris, relieving many sufferers without surgery. His fame and his practice grew rapidly.

         One of Civiale’s students was a young Englishman named Henry Thompson. Born in 1820, Thompson worked at first in his father’s tallow business, then decided to study medicine. He earned early recognition with a prize essay on urethral stricture and soon thereafter published a book on prostate diseases.

Sir Henry Thompson, photo by Walery 

(Wellcome Library)
       During an educational trip to the continent, he learned the lithotrity technique from Civiale and, seeing a niche, opened a urologic practice in London, the first in England to specialize in urology. He improved the transurethral device making it easier and faster to crush stones. Anesthesia had just been introduced, allowing patients to undergo the transurethral procedure without pain. He published further works on lithotrity, prostate disease, and other topics, wrote numerous articles, gave lectures, traveled to the continent for consultations, and devised new surgical approaches to bladder problems. He earned a knighthood and attracted prominent patients, including Queen Victoria’s physician, Sir James Clark.

         The queen’s uncle, Leopold I, King of Belgium, was a victim of bladder stones and, during a visit to England, consulted Thompson. Thompson referred him to his former teacher, Civiale, but after several tries Civiale was unable to remove the stones. Another surgeon tried and failed, and Thompson, under Sir James Clark’s urging, nervously took on the case. Fortunately, he was able to crush and remove the royal stones, writing to his wife that “no one knows how anxious [I was] but those who are placed in like circumstances.” The grateful king awarded him the equivalent of about $300,000 in today’s money, with an extra bonus on a follow-up visit. 

    Nine years later he treated the Emperor Napoleon III, nephew of Bonaparte, and now exiled in England after losing the Franco-Prussian War. The former emperor had refused treatment for six painful months, passing blood and pus in the urine, but finally

Napoleon III, 1872, a year before death
 (Wikipedia)

allowed Thompson to proceed. Thompson found a stone the size of a date, crushed what he could, and removed some gravel. That evening, Napoleon developed chills, pus and blood in the urine, and passed away two days later. An autopsy showed the remains of the stone and both kidneys nearly destroyed by longstanding obstruction and infection. Thompson accepted only one half of the £2000 fee. Despite this incident, his reputation continued to rise. Over the years, he collected nearly 1000 stones, which he gave to the Royal College of Surgeons. Sadly, the WWII bombing of London obliterated the collection.

         Thompson had boundless energy. As his income grew, he practiced urology only nine months a year and devoted three months to other activities. His wife was the daughter of an artist. Thompson studied art with the help of artist friends and became accomplished enough to exhibit in the Royal Academy and the Paris Salon. He collected Chinese porcelain, studied astronomy and had expensive telescopes made (later donated to the Royal Observatory), ventured into poultry breeding, and later in life wrote two novels, both

Book on Cremation (Wellcome
Library)

popular enough to warrant several reprintings, and he wrote on food and diet. 

        The crusader Edwin Chadwick had reported on the deleterious health effects of overwhelming numbers of burials, often using shallow graves, that were a consequence of overpopulated English cities. To relieve the problem, Thompson  and others founded the Cremation Society of England, organized in 1874 and Thompson served as president for several years. After a long struggle, a Cremation Law was eventually passed legalizing the process.

Thompson loved gourmet food and good company. He instituted the famous “Octaves,” dinners for eight guests (men only), at eight o’clock, serving eight courses and eight wines. A guest of honor might be an extra. His guests included, among others, Conan Doyle, Robert Browning, Dickens, Thackery, the Prince of Wales, Stanley the explorer, and distinguished medical men. An invitation to the renowned dinners was seldom refused. Thompson’s gracious humor and keen intellect rendered the dinners unique experiences. At work, however, he was described as irritable and impatient, as might be expected of someone with his schedule.

Painting of an "Octave" dinner by Solomon J Solomon

Clockwise from the centre background (right of mantelpiece): Ernest Abraham Hart, editor of the British Medical Journal 1866-1898; Sir Thomas Spencer Wells, gynaecological surgeon; Sir Joseph Fayrer, Surgeon-general, Indian medical service; Newman, butler to Sir Henry Thompson; Sir Thomas Lauder Brunton, physician and teacher of pharmacology and therapeutics; Sir William Henry Broadbent, physician; Sir George Anderson Critchett, ophthalmic surgeon; Sir Victor Horsley, surgeon, pathologist and physiologist; Sir Richard Quain, physician; Sir James Paget, surgeon and pathologist; Sir Henry Thompson, urological surgeon, host of the Octaves (behind and slightly to right of left table lamp).

 (Courtesy Wellcome Library)

In later years he became interested in automobiles and bought a Daimler at age 80. Four years later he passed away and, as you might suppose, ordered his body to be cremated. 

He is remembered today for his significant contributions to urologic practice and for his energy, intelligence, and multifaceted talents. A Renaissance man clothed in Victorian garments. 

SOURCES:

Gordetsky, J and Rabinowitz, R, “Sir Henry Thompson: Royal Stones,” Urology 2014; 84: 737-9.

Cope, V Z, “Master Surgeons in Urology: Sir Henry Thompson,” Brit J Urol 1950; 3-5.

Broos, P, “The Death of Napoleon III: Medical Errors at the Sickbed of an Emperor,” Acta Chir Belg, 2007; 107: 588-94.

Jellinek, E H, “Sarcophilia, Cremation, and Sir Henry Thompson,” J Med Biography, 2009; 17: 202-5.

Urquhart-Hay, D, “Sir Henry Thompson BT, the First English Urologist, Brit J Urol 1994; 73: 345-51.

Coues, W P “Jean Civiale – Pioneer French Urologist,” Lancet 1927; Jan 13, 70-71.