Wednesday, May 10, 2006 05/10/06-Surgery in 1658

In today's excerpt, renowned London diarist Samuel Pepys (1633-1703) elects to undergo surgery for a stone in his urinary tract in March of 1658. He is 25 years old:

Surgery was not an easy choice. It was known to be a hideously unpleasant procedure and a gamble besides. 'In this great and danger­ous Operation, life and death doe so wrastle together, that no man can tell which will have the victory,' warned one treatise for surgeons, and patients were recommended to make their peace with God before undergoing it. Yet, in spite of the risk, the operation was always in demand, because of the 'scarce credible' pain caused by the stone.

The operation was performed in the patient's bedroom. On the day of the surgery a lightly boiled egg was recommended, and a talk with a religious adviser. (Sam) had a last Bath, was dried, after this he was asked to position himself on a table, possibly covered with a straw-filled bag into which he could be settled while the process of binding him up began. Some surgeons thought it wise to say a few reassuring words at this point, because the binding was terrifying to many patients. They were trussed like chickens, their legs up, a web of long linen strips wound around legs, neck and arms that was intended to hold them still and keep their limbs out of the surgeon's way, the patient was further bound to the table. He was shaved around his privy parts, arid a number of strong men were positioned to hold him fast: 'two whereof may hold him by the knees, and feet, and two by the Arm-holes, and hands. The hands are also sometimes tyed to the knees, with a particular rowler, of the knees by themselves, by the help of a pulley fastened into the table. There were no anesthetics, and alcohol was certainly not allowed to a patient undergoing surgery to the bladder.

The surgeon got to work. First he inserted a thin silver instrument, the itinerarium, through the p***s into the bladder to help position the stone. Then he made the incision, about three inches long and a finger's breadth from the line running between s*****m and a**s, and into the neck of the bladder, or just below it. The patients face was sponged as the incision was made. The stone was sought, found and grasped with pincers; the more speedily it could be got out the better. Once out, the wound was not stitched - it was thought best to let it drain and cicatrize itself.

Pepys, no doubt by now fainting with shock and pain, was unbound and moved to his warmed bed. A cold syrup of lemon juice, radishes and marshmallow was ready for him to drink. The first dressing was left for twelve hours, and the thighs were kept tied to help the wound ­heal naturally. Recovery, for those who did not succumb to secondary infection, was expected to take thirty to forty days. Pepys made it in thirty-five. It was a triumph, especially considering the size of Pepys's stone was about 2 1/4 inches.

Clair Tomalin, Samuel Pepys, The Unequalled Self, 2002, p. 61

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