Biography Sir Henry Thompson: Royal Stones Jennifer Gordetsky and Ronald Rabinowitz “Sir, you have a stone in the bladder,” said Thompson with a great deal of certainty. “That is impossible” retorted the patient, “I have been assured by a very rising surgeon that there is nothing of the kind present.” Thompson looked at the patient and said simply, “Sir, I have risen.”1 Henry Thompson (Fig. 1), born in 1820 in Framlingham, Suffolk, was the son of a strict preacher. Despite his father’s objections, Henry pursued a career in medicine. He graduated from University College Hospital in 1850 and became a house surgeon.2
SPECIALIZATION IN UROLOGY After a short period of general practice, Thompson decided to pursue a career in surgery and especially urology. The Royal College of Surgeons awarded him the Jacksonian Prize twice; in 1852 for his essay on urethral stricture and in 1860 for his work on prostatic disease.3,4 In his 1861 book, “The Diseases of the Prostate: Their Pathology and Treatment,” Thompson proposed that enlargement of the prostate was secondary to aging and not venereal disease, venous stasis, sexual excess, gout, or stricture.4 In 1857 Thompson was accepted into the Societe de la Chirurgie de Paris. While in Paris to accept this honor, he met Jean Civiale, a lithotrite expert. Civiale trained Thompson in “bloodless” and “almost painless” transurethral lithotripsy. By 1862, Thompson was the leading specialist of the lower genitourinary tract in Britain. His reputation brought him prestigious patients including Queen Victoria’s physician Sir James Clark.
ROYAL STONES Leopold I, King of Belgium from 1831 until 1865, had intermittent bladder stone symptoms for 3-4 years before his 1862 visit to his niece, Queen Victoria. During his return trip home, Leopold had a recurrent attack and at the recommendation of Sir James Clark, Thompson was consulted. Thompson deferred management to his mentor Civiale. Between March and July 1862, Civiale performed 13 litholapaxies. Despite Civiale’s best efforts, Leopold’s Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD; the Department of Urology, University of Rochester Medical Center, Rochester, NY; and the Department of Pediatrics, University of Rochester Medical Center, Rochester, NY Reprint requests: Jennifer Gordetsky, M.D., The Weinberg Building, Room 2242, 410 North Broadway Street, Baltimore, MD 21231. E-mail: [email protected] Submitted: April 22, 2014, accepted (with revisions): June 24, 2014
ª 2014 Elsevier Inc. All Rights Reserved
symptoms continued to worsen. In December, Bernhard von Langenbeck was consulted and he performed more procedures in attempts to relieve the King of his bladder stone. After Langenbeck’s efforts were also unsuccessful, Thompson was again consulted. Thompson brought a new set of lithotripsy instruments to Brussels in May 1863. Leopold, now 73, was greatly troubled by the pain and sleeplessness caused by his bladder stone. The King was also anxious after the past failed attempts at treatment and the recurrent postoperative fevers he had suffered. The King was not the only one who expressed anxiety. In a letter Thompson wrote to his wife, he stated, “I slept only one and a half hours last night, between 5 and 6 and a half a.m. I took too much coffee and could not sleep, and then I got to thinking about my case and I got horribly anxious about it in the night. No one knows how anxious, but those who are placed in like circumstances.”2 In June, Thompson sounded the King’s bladder, found a stone, and crushed it. Per his report, “We saw the King at nine. I injected him with water at H.M.’s wish, having drawn off the urine. I then introduced very carefully the sound and turning it to the left, instantly found the hard body. I struck it hard and got again the dull note. I withdrew the sound, introduced a lithotrite with plane blades and turned to the left. I found nothing, to the floor, found nothing but grazed it in the middle line first position and caught it by short diameter crushing it twice. My blades were full, I screwed home tight and withdrew them full with good quantity of phosphatic debris. After waiting 15 minutes. I injected again at his wish, withdrawing first the water—no blood and introduced again the same lithotrite in the same position and with the same result. A good quantity is now removed. It is what would be an excellent result in any case. Slight trace of blood this time. Pain not much.” One additional litholapaxy was performed 4 days later from which the King made a rapid recovery. No anesthetic was used during any of the procedures. Henry Thompson gained much acclaim at the Belgian court and returned home £3000 ($292,730 in today’s money) richer. A year later, Thompson returned for a follow-up visit of a week’s duration and was given an additional £1000. In a humble gesture, Thompson sent a letter to Civiale, acknowledging the debt he owed to his former master. Civiale responded by saying, “I regret my failure but I have succeeded at the hands of my pupil.” In 1867, Queen Victoria bestowed the honor of Knighthood on Thompson.2 Years later, once antiseptic technique had been well established, Thompson realized that by using new http://dx.doi.org/10.1016/j.urology.2014.06.031 UROLOGY 84: 737e739, 2014 0090-4295/14
737
Figure 1. Sir Henry Thompson, F.R.C.S. Barraud and Jerrard, photographers. The Medical profession in all countries containing photographic portraits from life v. 1, no. 18. London: J. & A. Churchill, 1873.
instruments on Leopold, he had used an uncontaminated lithotrite and thereby avoided postoperative sepsis. In contrast, the instruments used by Civiale and Langenbeck had been previously contaminated by hundreds of French and German urethras. In Thompson’s own words, “Hence unwittingly these new instruments were absolutely free from any trace of bacterial taint through previous use for other patients. At this time our instruments were always washed of course every time they were used, but mere washing is wholly inadequate to prevent the transmission of bacterial infection. It was to this happy incident that my success was greatly attributable.”2 Nine years after his success with Leopold, Thompson was called upon to treat Charles, the nephew of Napoleon Bonaparte. Charles became Emperor Napoleon III of France after a coup d’etat in 1852, the same time he became symptomatic with bladder stones. His symptoms increased in frequency, and by 1870, he was almost never free of dysuria, hematuria, and pyuria. On several occasions, the Emperor required catheterization. His physicians felt surgical intervention was necessary, but the Franco-Prussian war intervened. Traveling to the front greatly aggravated the Emperor’s condition; he was now being catheterized twice daily and suffered episodes of rigors. His face was described as pale with puffy eyelids. On September 2, Napoleon and his army, 738
surrounded by a quarter of a million German troops at Sedan, surrendered.2 Napoleon was sent to live in exile in Britain. On July 19, 1872, Sir Henry Thompson was consulted on the Emperor’s condition. Napoleon permitted a rectal exam, which identified a normal prostate, but he refused bladder sounding. The pain worsened over the next few months to the point where the Emperor was unable to ambulate. For almost 6 months, the Emperor continued to refuse care, despite severe pain, hematuria, and pyuria. Napoleon finally agreed to treatment and Thompson was consulted for a second time. He arrived on Christmas Eve and on December 26, the Emperor underwent bladder sounding. The Emperor was provided with chloroform anesthesia by Dr. Joseph Clover, the most experienced chloroformist of the day. A stone the size of a date was found and litholapaxy was recommended. Surgery was finally preformed by Henry Thompson on January 2, 1873, 21 years after the Emperor’s first symptoms of bladder stones. The stone was crushed using a flat-bladed lithotrite and as much debris as possible was removed from the bladder. That night Napoleon suffered rigors, bleeding, and significant postoperative pain. Over the next 2 days, he continued to have pain, bleeding, rigors, and urinary frequency. A residual stone fragment was suspected and the Emperor underwent a second procedure on January 6. A stone fragment was in fact identified in the membranous urethra and subsequently dislodged and crushed. Over the next 2 days, the Emperor became progressively somnolent and incoherent. There was still evidence of obstruction and so a third procedure was planned for January 9. However, at 10:25 AM January 9, 1873, Emperor Napoleon III lapsed into a coma and died 20 minutes later. An autopsy the following day showed gross pyonephrosis and within the bladder was a portion of calculus measuring 1.25 inches and weighing 3/4 of an ounce. The cause of death was reported as “failure of the circulation and was attributable to the general constitutional state of the patient.”2 The pathologist then went on to proclaim that “The disease of the kidneys, of which this state was the expression, was of such a nature and so advanced that it would in any case shortly determined a fatal result.”2 Thompson was later presented with his promised fee of £2000, of which he only accepted half, stating that he had been hired for a full month and only worked half of that time. Despite this poor outcome, Thompson’s career continued to strengthen, and by the end of his life, he presented a collection of nearly a thousand stones to the Royal College of Surgeons. Unfortunately, this collection was destroyed in the Nazi bombing of 1941. Given his specialization of the lower genitourinary tract, Sir Henry Thompson has been called the first British urologist.5-7
RENAISSANCE MAN Sir Henry Thompson was considered a high-strung man and suffered from a psychosomatic nervous disorder, for UROLOGY 84 (4), 2014
which he received electric shock treatment from his personal physician, Edward Jenner. Thompson’s assistant, George Buckston Browne, described his employer as testy, impatient, rude, and grudging in his complements. Thompson was also known to be eternally busy, selfconfident, and impatient of having his views contradicted. However, despite being a serious person with little sense of humor, he could at times be quite charming.1 In 1851, Thompson married Kate Loder, a talented pianist, and they had 3 daughters. Thompson remained devoted to his wife for their entire marriage, even after she suffered paralysis.2,5 Aside from surgery, Thompson pursued many other interests. He was a strong advocate of cremation stating that it was “a necessary sanitary precaution against the propagation of disease among a population rapidly increasing, and daily growing larger in relation to the area it occupies.”8,9 In 1874, he helped to organize the Cremation Society of England and became its first president. This was a bold stand in a time when cremation was seen as anti-Christian and was not sanctioned by the law. Thompson was also quite a socialite and held extravagant dinners every Thursday night at his country estate near London. The dinners, “Octaves,” were based around the number 8, which came from Thompson’s love of music. Eight guests were invited, each one representing a note within the scale of C major. Guests were selected based on their achievements in art, literature, politics, and medicine. Only men were considered for invitation. Dinner began at 8-o’clock and 8 courses were served. Notable guests included the Prince of Wales, Robert Browning, Arthur Conan Doyle, and Charles Dickens. Thompson also perused oil painting and sketching, and because of this interest, his texts were superbly illustrated. His work as an artist was exhibited multiple times at the Royal Academy. Other interests included collecting Nanking porcelain, poultry farming, gardening, photography, and astronomy.
UROLOGY 84 (4), 2014
In his later years he became very interested in the automobile. He took his first ride at the age of 80 and bought a Daimler the following year. In addition to his 20 publications in the field of medicine, he wrote a book titled “Food and Feeding” and 2 best selling novels, “All But” and “Charley Kingston’s Aunt.”10-12 Sir Henry Thompson, described as “Britain’s first urologist” and “a truly versatile Victorian,” died in 1904 at the age of 83 and was cremated at Golders Green, London. References 1. Cope Z. The Versatile Victorian. London: Harvey & Blythe, Ltd.; 1951. 2. Ellis H. A History of Bladder Stone. Oxford: Blackwell Scientific; 1969. 3. Thompson H. The Pathology and Treatment of Stricture of the Urethra, Both in the Male and Female; Being the Treatise for Which the Jacksonian Prize for the Year 1852 Was Awarded by the College of Surgeons of England. London: John Churchill; 1854. 4. Thompson H. The Diseases of the Prostate, Their Pathology and Treatment; Comprising the Second Edition of “The Enlarged Prostate,” and a Dissertation “On the Healthy and Morbid Anatomy of the Prostate Gland,” to Which the Jacksonian Prize for the Year 1860, Was Awarded by the Royal College of Surgeons of England. London: John Churchill; 1861. 5. Dunsmuir WD, Kirby RS. Sir Henry Thompson: the first British urologist (1820-1904). J Med Biogr. 1995;3:187-191. 6. Resnick MI. Sir Henry Thompson (1820-1904). Invest Urol. 1973; 11:263-264. 7. Urquhart-Hay D. Sir Henry Thompson BT, the First English Urologist. Br J Urol. 1994;73:345-351. 8. Moxon RK. Sir Henry Thompson (1820e1904)—cremationist, artist and host extraordinary. N Engl J Med. 1962;1:927-929. 9. Thompson H. Modern Cremation: Cremation; Its History and Practice to the Present Date with Information Relating to All Recently Improved Arrangements Made by the Cremation Society of England. London: K. Paul, Trench & Co.; 1889. 10. Thompson H. Food and Feeding. London: F. Warne; 1899. 11. Thompson H. “All but;” a Chronicle of Laxenford Life. London: Kegan Paul, Trench; 1886. 12. Thompson H. Charley Kingston’s Aunt. London: Macmillan; 1885.
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SPECIALIZATION IN UROLOGY After a short period of general practice, Thompson decided to pursue a career in surgery and especially urology. The Royal College of Surgeons awarded him the Jacksonian Prize twice; in 1852 for his essay on urethral stricture and in 1860 for his work on prostatic disease.3,4 In his 1861 book, “The Diseases of the Prostate: Their Pathology and Treatment,” Thompson proposed that enlargement of the prostate was secondary to aging and not venereal disease, venous stasis, sexual excess, gout, or stricture.4 In 1857 Thompson was accepted into the Societe de la Chirurgie de Paris. While in Paris to accept this honor, he met Jean Civiale, a lithotrite expert. Civiale trained Thompson in “bloodless” and “almost painless” transurethral lithotripsy. By 1862, Thompson was the leading specialist of the lower genitourinary tract in Britain. His reputation brought him prestigious patients including Queen Victoria’s physician Sir James Clark.
ROYAL STONES Leopold I, King of Belgium from 1831 until 1865, had intermittent bladder stone symptoms for 3-4 years before his 1862 visit to his niece, Queen Victoria. During his return trip home, Leopold had a recurrent attack and at the recommendation of Sir James Clark, Thompson was consulted. Thompson deferred management to his mentor Civiale. Between March and July 1862, Civiale performed 13 litholapaxies. Despite Civiale’s best efforts, Leopold’s Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD; the Department of Urology, University of Rochester Medical Center, Rochester, NY; and the Department of Pediatrics, University of Rochester Medical Center, Rochester, NY Reprint requests: Jennifer Gordetsky, M.D., The Weinberg Building, Room 2242, 410 North Broadway Street, Baltimore, MD 21231. E-mail: [email protected] Submitted: April 22, 2014, accepted (with revisions): June 24, 2014
ª 2014 Elsevier Inc. All Rights Reserved
symptoms continued to worsen. In December, Bernhard von Langenbeck was consulted and he performed more procedures in attempts to relieve the King of his bladder stone. After Langenbeck’s efforts were also unsuccessful, Thompson was again consulted. Thompson brought a new set of lithotripsy instruments to Brussels in May 1863. Leopold, now 73, was greatly troubled by the pain and sleeplessness caused by his bladder stone. The King was also anxious after the past failed attempts at treatment and the recurrent postoperative fevers he had suffered. The King was not the only one who expressed anxiety. In a letter Thompson wrote to his wife, he stated, “I slept only one and a half hours last night, between 5 and 6 and a half a.m. I took too much coffee and could not sleep, and then I got to thinking about my case and I got horribly anxious about it in the night. No one knows how anxious, but those who are placed in like circumstances.”2 In June, Thompson sounded the King’s bladder, found a stone, and crushed it. Per his report, “We saw the King at nine. I injected him with water at H.M.’s wish, having drawn off the urine. I then introduced very carefully the sound and turning it to the left, instantly found the hard body. I struck it hard and got again the dull note. I withdrew the sound, introduced a lithotrite with plane blades and turned to the left. I found nothing, to the floor, found nothing but grazed it in the middle line first position and caught it by short diameter crushing it twice. My blades were full, I screwed home tight and withdrew them full with good quantity of phosphatic debris. After waiting 15 minutes. I injected again at his wish, withdrawing first the water—no blood and introduced again the same lithotrite in the same position and with the same result. A good quantity is now removed. It is what would be an excellent result in any case. Slight trace of blood this time. Pain not much.” One additional litholapaxy was performed 4 days later from which the King made a rapid recovery. No anesthetic was used during any of the procedures. Henry Thompson gained much acclaim at the Belgian court and returned home £3000 ($292,730 in today’s money) richer. A year later, Thompson returned for a follow-up visit of a week’s duration and was given an additional £1000. In a humble gesture, Thompson sent a letter to Civiale, acknowledging the debt he owed to his former master. Civiale responded by saying, “I regret my failure but I have succeeded at the hands of my pupil.” In 1867, Queen Victoria bestowed the honor of Knighthood on Thompson.2 Years later, once antiseptic technique had been well established, Thompson realized that by using new http://dx.doi.org/10.1016/j.urology.2014.06.031 UROLOGY 84: 737e739, 2014 0090-4295/14
737
Figure 1. Sir Henry Thompson, F.R.C.S. Barraud and Jerrard, photographers. The Medical profession in all countries containing photographic portraits from life v. 1, no. 18. London: J. & A. Churchill, 1873.
instruments on Leopold, he had used an uncontaminated lithotrite and thereby avoided postoperative sepsis. In contrast, the instruments used by Civiale and Langenbeck had been previously contaminated by hundreds of French and German urethras. In Thompson’s own words, “Hence unwittingly these new instruments were absolutely free from any trace of bacterial taint through previous use for other patients. At this time our instruments were always washed of course every time they were used, but mere washing is wholly inadequate to prevent the transmission of bacterial infection. It was to this happy incident that my success was greatly attributable.”2 Nine years after his success with Leopold, Thompson was called upon to treat Charles, the nephew of Napoleon Bonaparte. Charles became Emperor Napoleon III of France after a coup d’etat in 1852, the same time he became symptomatic with bladder stones. His symptoms increased in frequency, and by 1870, he was almost never free of dysuria, hematuria, and pyuria. On several occasions, the Emperor required catheterization. His physicians felt surgical intervention was necessary, but the Franco-Prussian war intervened. Traveling to the front greatly aggravated the Emperor’s condition; he was now being catheterized twice daily and suffered episodes of rigors. His face was described as pale with puffy eyelids. On September 2, Napoleon and his army, 738
surrounded by a quarter of a million German troops at Sedan, surrendered.2 Napoleon was sent to live in exile in Britain. On July 19, 1872, Sir Henry Thompson was consulted on the Emperor’s condition. Napoleon permitted a rectal exam, which identified a normal prostate, but he refused bladder sounding. The pain worsened over the next few months to the point where the Emperor was unable to ambulate. For almost 6 months, the Emperor continued to refuse care, despite severe pain, hematuria, and pyuria. Napoleon finally agreed to treatment and Thompson was consulted for a second time. He arrived on Christmas Eve and on December 26, the Emperor underwent bladder sounding. The Emperor was provided with chloroform anesthesia by Dr. Joseph Clover, the most experienced chloroformist of the day. A stone the size of a date was found and litholapaxy was recommended. Surgery was finally preformed by Henry Thompson on January 2, 1873, 21 years after the Emperor’s first symptoms of bladder stones. The stone was crushed using a flat-bladed lithotrite and as much debris as possible was removed from the bladder. That night Napoleon suffered rigors, bleeding, and significant postoperative pain. Over the next 2 days, he continued to have pain, bleeding, rigors, and urinary frequency. A residual stone fragment was suspected and the Emperor underwent a second procedure on January 6. A stone fragment was in fact identified in the membranous urethra and subsequently dislodged and crushed. Over the next 2 days, the Emperor became progressively somnolent and incoherent. There was still evidence of obstruction and so a third procedure was planned for January 9. However, at 10:25 AM January 9, 1873, Emperor Napoleon III lapsed into a coma and died 20 minutes later. An autopsy the following day showed gross pyonephrosis and within the bladder was a portion of calculus measuring 1.25 inches and weighing 3/4 of an ounce. The cause of death was reported as “failure of the circulation and was attributable to the general constitutional state of the patient.”2 The pathologist then went on to proclaim that “The disease of the kidneys, of which this state was the expression, was of such a nature and so advanced that it would in any case shortly determined a fatal result.”2 Thompson was later presented with his promised fee of £2000, of which he only accepted half, stating that he had been hired for a full month and only worked half of that time. Despite this poor outcome, Thompson’s career continued to strengthen, and by the end of his life, he presented a collection of nearly a thousand stones to the Royal College of Surgeons. Unfortunately, this collection was destroyed in the Nazi bombing of 1941. Given his specialization of the lower genitourinary tract, Sir Henry Thompson has been called the first British urologist.5-7
RENAISSANCE MAN Sir Henry Thompson was considered a high-strung man and suffered from a psychosomatic nervous disorder, for UROLOGY 84 (4), 2014
which he received electric shock treatment from his personal physician, Edward Jenner. Thompson’s assistant, George Buckston Browne, described his employer as testy, impatient, rude, and grudging in his complements. Thompson was also known to be eternally busy, selfconfident, and impatient of having his views contradicted. However, despite being a serious person with little sense of humor, he could at times be quite charming.1 In 1851, Thompson married Kate Loder, a talented pianist, and they had 3 daughters. Thompson remained devoted to his wife for their entire marriage, even after she suffered paralysis.2,5 Aside from surgery, Thompson pursued many other interests. He was a strong advocate of cremation stating that it was “a necessary sanitary precaution against the propagation of disease among a population rapidly increasing, and daily growing larger in relation to the area it occupies.”8,9 In 1874, he helped to organize the Cremation Society of England and became its first president. This was a bold stand in a time when cremation was seen as anti-Christian and was not sanctioned by the law. Thompson was also quite a socialite and held extravagant dinners every Thursday night at his country estate near London. The dinners, “Octaves,” were based around the number 8, which came from Thompson’s love of music. Eight guests were invited, each one representing a note within the scale of C major. Guests were selected based on their achievements in art, literature, politics, and medicine. Only men were considered for invitation. Dinner began at 8-o’clock and 8 courses were served. Notable guests included the Prince of Wales, Robert Browning, Arthur Conan Doyle, and Charles Dickens. Thompson also perused oil painting and sketching, and because of this interest, his texts were superbly illustrated. His work as an artist was exhibited multiple times at the Royal Academy. Other interests included collecting Nanking porcelain, poultry farming, gardening, photography, and astronomy.
UROLOGY 84 (4), 2014
In his later years he became very interested in the automobile. He took his first ride at the age of 80 and bought a Daimler the following year. In addition to his 20 publications in the field of medicine, he wrote a book titled “Food and Feeding” and 2 best selling novels, “All But” and “Charley Kingston’s Aunt.”10-12 Sir Henry Thompson, described as “Britain’s first urologist” and “a truly versatile Victorian,” died in 1904 at the age of 83 and was cremated at Golders Green, London. References 1. Cope Z. The Versatile Victorian. London: Harvey & Blythe, Ltd.; 1951. 2. Ellis H. A History of Bladder Stone. Oxford: Blackwell Scientific; 1969. 3. Thompson H. The Pathology and Treatment of Stricture of the Urethra, Both in the Male and Female; Being the Treatise for Which the Jacksonian Prize for the Year 1852 Was Awarded by the College of Surgeons of England. London: John Churchill; 1854. 4. Thompson H. The Diseases of the Prostate, Their Pathology and Treatment; Comprising the Second Edition of “The Enlarged Prostate,” and a Dissertation “On the Healthy and Morbid Anatomy of the Prostate Gland,” to Which the Jacksonian Prize for the Year 1860, Was Awarded by the Royal College of Surgeons of England. London: John Churchill; 1861. 5. Dunsmuir WD, Kirby RS. Sir Henry Thompson: the first British urologist (1820-1904). J Med Biogr. 1995;3:187-191. 6. Resnick MI. Sir Henry Thompson (1820-1904). Invest Urol. 1973; 11:263-264. 7. Urquhart-Hay D. Sir Henry Thompson BT, the First English Urologist. Br J Urol. 1994;73:345-351. 8. Moxon RK. Sir Henry Thompson (1820e1904)—cremationist, artist and host extraordinary. N Engl J Med. 1962;1:927-929. 9. Thompson H. Modern Cremation: Cremation; Its History and Practice to the Present Date with Information Relating to All Recently Improved Arrangements Made by the Cremation Society of England. London: K. Paul, Trench & Co.; 1889. 10. Thompson H. Food and Feeding. London: F. Warne; 1899. 11. Thompson H. “All but;” a Chronicle of Laxenford Life. London: Kegan Paul, Trench; 1886. 12. Thompson H. Charley Kingston’s Aunt. London: Macmillan; 1885.
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