historyWellcome Collection1824 · Paris, France
In 1824 Jean Civiale crushed a bladder stone through the urethra, sparing patients major surgery
Bladder stones were once removed by cutting into the body, a procedure that was agonising before anaesthetics and often fatal. Gruithuisen had proposed instruments to break stones inside the bladder in 1813, but Jean Civiale was the first to use one on a patient. His lithotriteur had grasping arms to seize the stone and a drill to break it. On 13 January 1824 he treated Monsieur Gentil, who was cured after three weeks and a few sessions. Civiale's comparison of records found a death rate near 20 per cent for conventional lithotomy against 2.3 per cent for his method.
The lithotriteur was a thin metal tube passed through the urethra into the bladder, with three arms at the tip that grabbed the stone. A drill or crusher then broke it into fragments small enough to be flushed out in urine. Because no incision was made, the infection and tissue damage of older surgery were largely avoided.
Lithotrity became the preferred treatment within decades and is an early example of a minimally invasive procedure, the ancestor of today's keyhole and catheter techniques. Civiale's use of numbers to compare treatments also foreshadowed evidence-based medicine.
Civiale practised handling his instrument by using it to pick up nuts from his coat pocket while walking around town.
Wellcome Collection · CC BY 4.0
Illustrative photo · Unknown author, CC BY 4.0, via Wikimedia Commons
