Today (March 26) in London History – Surgery without Anesthesia

Samuel Pepys was “cut for the stone” – had a bladder stone removed without benefit of anaesthesia – on March 26, 1658. This Today in London History episode tells the tale.


First, the Today in London recommendation. Again, it’s a no brainer. Make sure you pay a visit to the Old Operating Theatre. It’s the only Georgian operating theatre extant. Fascinating place. 

And why have I recommended it today? Here’s why.

Today in London History. 

I wonder.

Wonder if any of these podcasts are ever like a flung stone skipping across the surface of a pond or lake. As opposed to just sinking where they indent the water.

By skipping stones I mean is there anybody out there listening who occasionally repeats the essence of one of these. As in, “hey guess what this day’s the anniversary of in London?”

“Did you know that it was 49 years ago today – March 26th, 1973 – that women broke the barrier, crashed the party, got to work on the London Stock Exchange?” It’s just a neat piece of trivia. And sort of impressive to know that – and of course it was a significant milestone for equal rights, equal opportunities for women – helps us map that long and still not yet completed march.

But that’s not the one I’m doing today. We’re going to fan back through more than 300 March 26ths – we’re going back to March 26th, 1658. 

What happened – in London – on March 26th, 1658?

Here’s a clue: it was as big as a tennis ball.

Got it? No, I didn’t think so. 

Ok, that’s enough of a teaser.

It was a bladder stone.

Samuel Pepys’ bladder stone. 

On this day, March 26th, 1658, Samuel Pepys was cut open – without anaesthetic – and separated from his bladder stone.

The event was so remarkable – so memorable – he celebrated it on every March 26th for the rest of his life.

Now I’m going to get into Pepys – so to speak – in a minute. But first let’s take a close look, a professional look at that operation. 

And look, I’m a doctor – but I’m not a doctor of medicine, not a surgeon. I’m a PhD, a doctor of philosophy. In English Lit, as it happens. And Samuel Pepys is an important figure in the history of English Literature. But I make no claim of an even a smidgeon of medical expertise. So I’m going to get us into the operating room, get us looking on, get us watching Pepys’ entire body, restrained though it was, heave with the agonising, unbearable pain that experiencing. Get us watching him grimace. Getting us hearing the gasps and groans and muffled screams coming from his voice box – I’m going to do that by drafting in Beth Wilkey, from the Royal College of Physicians. Here’s what she says about that operation.

The operation is called Lithotomy. It’s the surgical method of removing stones – calculi to use the scientific term – from the bladder and the kidneys. Take the word lithotomy apart, we get lithos, which is Greek for stone. And otomy, which implies cutting. Discectomy, for example. Or lobotomy. Or appendectomy. The operation has been carried out since antiquity. Trenchantly Beth Wilkey says, “thankfully, methods have drastically improved.”

She says, “when Pepys had his operation the procedure was notoriously risky. Without anaesthesia – this will come as no shock – patients were at risk of going into shock with the pain. It gets worse, without knowledge of infection, a patient’s tools were often a hotbed of bacteria.

Patients would lie on a table or a specially designed chair, and the surgeon would get the show on the road by inserting a thin silver instrument, the itinerarium, through the penis into the bladder to help position the stone.

Once the stone was positioned he made a small incision (about three inches) – I’m sorry but a three-inch incision doesn’t sound small to me – anyway, a three-inch incision was made at the neck of the bladder – I’m practically fainting just thinking about that – ok, steady, let’s have at it again, a three-inch incision was made at the neck of the bladder by going through the perineum. The perineum – for anyone who doesn’t know – I’m not sure you want to know – is the area between the anus and the genitals. It extends from either the vaginal opening to the anus or the scrotum to the anus.

To put it into modern parlance, basically the surgeon, Thomas Hollier, ripped Pepys a new one. Ripped it with the help of a scalpel and all kinds of ropes and strong men to hold Pepys down. 

Forceps were then inserted to grasp and remove the stone. Or, depending on the call, the surgeon could use a fun tool called a scoop extractor. It was worse than any nightmare. It was butchery. Now look, we should be on our knees tonight, thanking the good lord – or at the very least modern science – for sending up anaesthesia. 

Now how about pre-op and post-op.
Pre-op, Pepys will have had a warm bath the day before the operation. That will have been a novel experience. Almost no one in the England of Pepys’ day will have had so much as one warm bath over the course of their entire life.

The morning of the operation he will have been given a cordial drink into which the whites of 15 eggs will have been stirred.

And then, strapped down, tied down, held down – the straps will have been round his neck, arms and legs – Pepys will have been cut open – as described above – the stone probed for, position, and extracted, though ripped out is probably a more accurate description. Speed was of the essence. The best surgeon in the land could usually get the job done in about a minute. 

Aftercare? No, it wasn’t stitches. One small mercy, eh. 17th-century surgeons opted for letting the wound heal naturally with just a dressing to protect it. Pepys will have been confined to bed for about a week. Full recovery will have taken 30 to 40 days. Pepys was par for the course. He’d fully recovered by May 1st – 36 days after the operation.

What else? Well, normally, a surgeon would wash his hands and his tools after the last operation of the day. 

Pepys caught a break. He was the first person operated on that day. And the tools were new. So they were clean. He got off infection-free. The normal fatality rate for being cut for the stone – that’s Pepys’ phrase – was about ten per cent. A ten per cent fatality rate today and a surgeon would be stripped of his license. But ten per cent was regarded as very good in Pepys’ day.

Anything else? 

Yes, both the ducts from Pepys’ testicles were so cut or damaged from the operation he was rendered sterile. Not impotent, but infertile. 

Now, finally, that tennis ball. It was the surgeon who said the stone was as big as a tennis ball. But we should bear in mind that our game of tennis didn’t exist in the 17th century. So the size of the stone would have been more like the dimensions of a billiard ball. Pepys kept it as a memento. Kept it in a specially made box – like a little jewel box. And every year, on the anniversary, when he celebrated having survived the operation and having the stone in a box on his mantlepiece rather than in his bladder causing him no end of agony, the stone would be given pride of place at the festive dinner. 

But let’s hear from Pepys himself. Here’s how he describes the operation in his diary entry for March 26th, 1660. “This day it is two years since it pleased God that I was cut of the stone at Mrs Turner’s in Salisbury Court. And I did resolve while I live to keep it a festival, as I did the last year at my house, and forever to have Mrs Turner and her company with me. But now it pleases God that i am where I am and so am prevented to do it openly; only, within my soul I can and do rejoice and bless God, being at this time, blessed be his Holy name, in as good health as ever I was in my life.”

Closing remarks. Why do we read Pepys? Why is it the greatest diary in the history of English literature? Well, one important thing was the timing. He kept it in the 1660s. And what a decade that was. Crammed into those ten years were three of the most important events in the history of this country and of London. The Restoration. The Great Plague. The Fire of London. To that you can add that Pepys was well connected, he knew everybody who was worth knowing. And the work he was doing was hugely important. He was Secretary of the Admiralty. The way it’s often put is, Samuel Pepys forged the scabbard that held the sword that Nelson used.

And finally, he’s just so engagingly frank and honest about everything. About his ambitions and his fears and his everyday life and how people lived in the 17th century and the merry chase he led his long-suffering wife – he was a bottom pincher par excellence. And it’s all there, in the diary. It’s a window on a fascinating time and place. 

And on that note, good night from that same (but changed) fascinating place in our day, good night from London, See ya tomorrow. 

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