Surgeons, Stones and Sedentary Lives: Bladder Stones in Pre-Modern England

Le Dran, Surgical instruments for lithotomy, 1730 Wellcome Library, London.

Le Dran, Surgical instruments for lithotomy, 1730
Wellcome Library, London.

King Charles II, some time after 1662, was paying a visit to the races at Newmarket in Suffolk. Upon arriving at his destination, he was told of a bladder stone, or calculus, of great size that had lately been removed from the wife of a local locksmith. It weighed a whopping 964 grams!  Rather than merely making a mental note note of the stone’s existence, he asked for it to be brought straight to him. As the calculus was exhibited to the king, a portion was chipped off, to demonstrate how it had formed. Charles, no doubt amazed by this huge lump, learned that stones form in layers, rather like the trunk of a tree (1). An account written around eighty years later explains that the lady may have kept her ‘monstrous’ stone intact with relatively less nuisance, if not for her eagerness to travel:

She…might probably have lived much longer with it, if she had not thought herself well enough to attempt a journey on horseback; for while she was riding, she was suddenly seized with violent pains, that obliged her to be taken off the horse immediately: after which she could never make water, unless the stone was first moved, and she continued in great agonies till she died (2)

Charles’s wealthy supporters were not exempt from the ailment that caused such the king such fascination. His High Treasurer, Thomas Wriothesley, suffered a grave illness at the end of his life and a post mortem found a large stone in his bladder, as well as an enlarged kidney (3).

Evidence from early modern hospitals show that bladder stones were more common in the seventeenth to nineteenth centuries than they are today, probably due to dietary factors. In areas that were comparatively poor, such as Suffolk’s neighbour, Norfolk, stones were especially rife (4). Norfolk had been a thriving region in the medieval period, but suffered a downturn in later centuries as its textile industries suffered. Records from the Norfolk and Norwich Hospital show that an unusually high rate of admissions were for bladder stone removal. Though the famous stone seen by Charles II was taken from a woman, bladder calculi were, and still are, much more common in men. I’m afraid that the method of extraction for these unlucky men was exceptionally painful – though perhaps preferable to continued suffering from ‘the stone’, which historical sources convey in excruciating detail.

Over at The Chiurgeon’s Apprentice, there is the fascinating, and horrible, account of an eighteenth-century man, who was in such pain from his bladder stone that he (reportedly) drove a nail through his penis and then used a blacksmith’s hammer to break up the stone until it could pass through his urethra (ouch). It’s hard to believe that this is true, but the tale conveys the extreme pain of the condition, and the passion with which a man would want to be rid of his stone! At the Early Modern Medicine blog, there is a grizzly reminder of the pre-modern technique for removing stones: a lithotomy. As the blog states, this involved ‘cutting either the penis or another part of the genital region to allow for the removal of stones with a variety of instruments like the crochet and forceps’.

credit: British Association of Urological Surgeons

Bladder Stones – credit: British Association of Urological Surgeons

But why am I so interested in bladders all of a sudden? This is a question that I have asked myself several times this week as I’ve investigated the intricacies of lithotomy. However, it’s become relevant in the course of my studies of medieval neurological disorder. I’ve been doing some work on the thirteenth-century scribe known as ‘The Tremulous Hand of Worcester’, who clearly experienced some kind of tremor condition. This careful scholar of Anglo-Saxon books drew attention to several remedies in a copy of the Old English Herbarium, or book of herbal remedies. One ailment that interested him, amongst diverse others, was bladder stones. As Christine Franzen and Margaret Pelling told us, in the seminal book on this scribe, bladder stones were prevalent historically, especially amongst those in sedentary occupations (5). The risks of an inactive life for bladder health have been known for some time. A Cyclopaedia of Practical Medicine (1833) stated that ‘Among those beyond middle age, [bladder stone] occurs more frequently in those with sedentary habits than those with active lives’. Interestingly, the author also states that calculi are less common in women, ‘notwithstanding their more sedentary habits’ (!)

What of The Tremulous Hand then, a monk whose devotional writing and scholarship would have required him to sit still for such long hours. Might he have suffered from these painful stones? It’s likely, given the high historical instance and his sedentary activities, coupled his preoccupation with marking out remedies in the Herbarium. Though he showed interest in many different types of herbal remedy – including eyestrain and snakebite –  his large, trembling nota marks appear next to no fewer than six remedies for bladder stones, and eight for inability to urinate.

It is well known that medieval scribes experienced numerous hardships: from bad backs, strained eyes, churning stomachs and demanding masters. Now, might we add burning urethras to the list? Oh, what a life!

(1) A. Batty Shaw, ‘East Anglian Bladder Stone’, Journal of the Royal Society of Medicine, 27; 1979.

(2) Thomas Bennet, The Philosophical Transactions and Collections of the Royal Society of London (1756), p. 1005.

(3) See the entry in the ODNB, here.

(4) A Batty Shaw, The Norfolk School of Lithotomy, Medical History, 14: p. 221-259.

(5) Christine Franzen, The Tremulous Hand of Worcester (Oxford: Clarendon Press, 1991)

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One comment

  1. Interesting it would be interesting indeed to know if he suffered from such a horrible condition.

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