Name: Talking Sense
Location: Wellcome Collection

Rob Bidder is an artist based in south-east London and a Visitor Experience Assistant at Wellcome Collection. He also plays music in a ramshackle manner. He is a Gemini with a Libra ascendant.

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Rob Bidder

@robertbidder

Artist

Comic

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Strike, Rob Bidder

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No Body Squabbles today. Consider shouting in the city centre instead.

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Sport

Body Squabbles

Strike

Before a young Parisian doctor developed a treatment for bladder stones in 1824, dealing with them was a dangerous and often deadly business. Find out how Jean Civiale refined and demonstrated his groundbreaking technique. 

In 1782 a wealthy French expatriate in India, Colonel Claude Martin, began to suffer from a bladder stone. It was an uncomfortable complaint that made it difficult to urinate, and the retired army officer was soon forced to give up horse riding and many of his favourite foods. But it was also worse than a mere inconvenience: left untreated, the condition might well kill him.

Colonel Martin was told that the only possible cure was a painful and dangerous operation. Understandably, he was not enthusiastic about this prospect, so the resourceful Frenchman set about finding an alternative. 

His solution was a homemade surgical instrument fashioned from a knitting needle. He inserted this implement up his own urethra and into his bladder, filing small fragments off the stone to break it down. He repeated this eye-watering procedure three times a day for six months, after which he reported that the stone had completely gone. And he had become one of the few people to operate on their own body.

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Treacherous treatment for a painful problem 

Bladder stones, hard masses that crystallise from minerals in the urine, have afflicted humans for thousands of years. Ancient Indian and Egyptian surgeons invented procedures for removing them, which are documented in some of the earliest surviving medical texts. Substantial improvements were made to the operation, known as lithotomy, between the 16th and 18th centuries, but all entailed a large incision, which inevitably damaged delicate tissues and brought the risk of infection. 

In an age before anaesthetics it was excruciatingly painful, and the danger was enormous: a large proportion of patients died, and many more were permanently affected by incontinence, persistent wounds, and (for men) erectile dysfunction. Small wonder that Colonel Martin was keen to avoid this ordeal. 

Surgical removal of a stone from the bladder from ‘Précis iconographique de médecine opératoire et d’anatomie chirurgicale’ by Claude Bernard, 1848.

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During the 18th century physicians started to look for a gentler way of treating bladder stones. Some tried to develop medicines that would disperse them naturally. In 1738 a certain Joanna Stephens claimed that she had devised an infallible cure for the complaint, and the British government paid her the enormous sum of £5,000 (around £600,000 now) to disclose her secret recipe. Its ingredients included soap, snails and burnt eggshells, and – like every such concoction dreamed up to treat the condition – it turned out to be entirely useless. Other researchers attempted to dissolve the stones by injecting special solutions into the bladder, but this was no more successful.

When the breakthrough finally came, it was strikingly similar to Colonel Martin’s approach. In the space of a few years, several researchers hit upon the idea of using delicate instruments to remove bladder stones via the urethra – doing away with the need for an incision. In 1813 the Bavarian physician Franz von Paula Gruithuisen unveiled a series of instruments he had invented, and which offered a variety of ways to break down the stone in situ. 

This was an uncomfortable experience for the patient, but infinitely preferable to the agonies of surgery.

One employed a powerful jet of water to dissolve the object; another used the heat from an electric current; a third had a tiny drill bit at its tip. But Gruithuisen’s most promising idea was also the simplest: a slender pair of forceps that could grab the stone and crush it to smithereens.

Gruithuisen proved the technique was feasible by successfully passing a metal tube into his own bladder, but never used it to treat a patient. Several researchers developed similar devices in succeeding years, but the first to put one to clinical use was a young doctor from Paris. Jean Civiale was still a medical student when he became interested in the problem of bladder stones, and in 1818 he applied to the French government for a grant to fund his work.

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Jean Civiale

After numerous prototypes he finally designed an instrument he called the lithotriteur – from the Greek words for ‘stone’ and ‘rub’. It consisted of a long, thin metal tube with three grasping arms, like a tiny claw, at the end. This was used to seize the stone inside the bladder; then a drill was passed through the tube to break it up. Catching the stone – which of course the surgeon could not see – required great dexterity. Civiale practised the technique by walking around town with lithotriteur in hand, using it to pick up nuts inside his coat pocket. 

Civiale first employed his invention on 13 January 1824, demonstrating it in front of a large audience of eminent medics. The operation took place at his home, and the patient was Monsieur Gentil, a 32-year-old who had suffered from a large bladder stone since the age of four. After removing his trousers and undergarments, Gentil sat down on a small bed. 

Civiale then lubricated his lithotriteur with wax and oil, inserted it through the tip of the man’s penis and manipulated it into his bladder. This was an uncomfortable experience for the patient, but infinitely preferable to the agonies of surgery.

An illustration of Civiale’s lithotriteur in action.

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Civiale had no difficulty in grasping the stone with his pincers, and then attacked it with the drill, which struck the stone with a sharp crack that was audible to the spectators. After 40 minutes the job was done, and Civiale flushed the man’s bladder with warm water. When M. Gentil urinated a few minutes later, both surgeon and patient were gratified to find that his urine contained numerous small fragments that had come away from the stone – the instrument had worked. 

Two more sessions were necessary to complete the treatment, but three weeks later the object had disappeared, and M. Gentil was cured. “This young man, sick and miserable for so long, became the healthiest and happiest soul alive,” as one witness put it.

The new operation, known as lithotrity or lithotripsy, revolutionised the treatment of bladder stones: within a few decades it became the preferred option for most patients. Other practitioners improved Civiale’s equipment, and it soon became normal to crush the stone rather than drill into it. 

Illustration of Jean Civiale’s instruments from ‘Lettres sur la lithotritie’, c.1827. 

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There were many sceptics, however, and Civiale realised that he needed to prove the superiority of his method over traditional surgery. He painstakingly collated all the data he could find on conventional lithotomies performed all over Europe – more than 5,000 of them. Of these patients almost 20 per cent had died, compared with just 2.3 per cent who had undergone Civiale’s new operation. 

His analysis was not particularly rigorous by contemporary standards, but his use of statistics to determine which was the better mode of treatment was far ahead of its time. It foreshadowed today’s evidence-based medicine, in which therapeutic decision-making is influenced more by hard data than by personal experience.

Lithotrity was also the first minimally invasive procedure, representing a new approach to surgery that was less traumatic for the patient, did away with the need for large incisions and involved little or no blood. It was the conceptual ancestor of today’s keyhole operations or the astonishing catheter procedures that now allow cardiologists to operate on the inside of the heart without even putting the patient to sleep. 

When Jean Civiale relieved Monsieur Gentil of his bladder stone in 1824, he was not merely demonstrating an ingenious new technique, but also a radically different surgical paradigm.

Thomas Morris is author of ‘The Matter of the Heart’ and more recently ‘The Mystery of the Exploding Teeth and Other Curiosities from the History of Medicine’. He has worked as a radio producer for the BBC on such programmes as ‘Front Row’, ‘Open Book’ and Melvyn Bragg’s ‘In Our Time’, and his journalism has appeared in publications including the Lancet and the Times.

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Thomas Morris

Author

Emily Evans is a medical illustrator and anatomist. After her role as a senior demonstrator of anatomy at Cambridge University, alongside her career illustrating medical and surgical books for over a decade, she now writes and publishes books about anatomy and art, such as ‘Anatomy in Black’, while running her brand, Anatomy Boutique.

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Emily Evans

Illustrator

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The Bladder

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Among those vying to find alternatives to major surgery for bladder stones, young doctor Jean Civiale stood out, painstakingly honing a method that was to become the norm.

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The extraction of the excruciating bladder stones

The blight of the ballooning blood vessels

The case of the cancerous stomach

The mystery of the malignant brain

The problem of the punctured heart

The tale of the toxic kidneys

Revolutions in Surgery

With today’s understanding of how viruses spread, it would be reasonable to assume the terrifying death toll of the Spanish flu pandemic could never occur again. But we still need to factor in the poisonous part fake news is likely to play.

In the final year of the First World War a deadly pandemic spread rapidly around the world. The Spanish flu pandemic of 1918–19 infected up to a third of the world’s population and killed up to 100 million people. 

Health authorities and doctors were largely powerless – they had little idea what this malady was or how to cure it. The only measure that helped was quarantine, and governments implored each other to keep the pandemic out at all costs. In November 1918, for example, New Zealand’s government warned Australia that “mortality is appalling… [the] only effective measure your side will be to prevent introduction of epidemic pneumonia into Australia”.

It’s hardly surprising that rumour and misinformation were rife. The Spanish flu hit at a time when bacteriologists had enjoyed the acclaim of decades of successful discoveries, including the pathogens responsible for various high-profile diseases like tuberculosis and cholera. But the pathogen responsible for Spanish flu remained a mystery and, with little helpful guidance available from the medical community, the world was ripe for the proliferation of ‘fake news’. 

Biologists beg a fantastical winged pathogen: “Come on, precious, tell us who you are!”

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Biólogos y el microbio de la gripe española

Popular culture sought to understand the pathogen in creative ways, often portraying it as some kind of insect or devil. 

Conspiracy theories abounded and blamed the pandemic on the war – often, unsurprisingly, on the enemy. In Rio de Janeiro, the newspaper A Careta reported that the pandemic had been purposely spread around the world by German submarines, with innocent people “falling victim to the Germans’ treacherous bacteriological creation”.

Conspiracy theories abounded and blamed the pandemic on the war – often, unsurprisingly, on the enemy

Artist Jordan Baseman delved into newspaper archives to find traces of peoples’ everyday experiences of the pandemic while researching for ‘Radio Influenza’, a digital artwork marking the centenary of the Spanish flu. Baseman encountered many examples of fake news and misinformation, particularly about the way that the pathogen spread. 

He found that: “The flu was blamed on foreigners (anywhere in the world, not just the UK), on Jewish people, on dancing, on jazz music, on the bombing of the soil as a result of the war, and on pretty much anything else you could think of.” 

The significant death tolls did not reflect well on governments or public health authorities. Baseman’s research found that authorities were almost “universally presented as useless and slow… bumbling officials” who pontificated without providing “any real support or assistance”. 

A Brazilian newspaper cartoon shows a German submarine using Spanish flu as a weapon of war. 

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Some people took full advantage of the chaos and confusion. One of the most dramatic features of the Spanish flu virus was the psychosis that accompanied infection for many victims – from mild hallucinations to severe delirium, and even extreme violence. Baseman found that this known symptom was used by some as ‘fake news’ to try to hoodwink those in authority:

“Influenza was often used as a reason by people as an excuse to carry out crimes. The flu took the blame for… bad behaviour, of a less severe variety: petty theft, truancy, irrational behaviours and any out-of-character and impulsive acts. Sometimes the flu was a genuine and valid reason for some calamity, but often times, the flu seems to be used as a dodge.” 

More: A yellow fever epidemic in New Orleans is blamed on an influx of new immigrants.

One hundred years on, the Spanish flu is a cautionary tale of the devastation that new infectious diseases can cause. Although we now have some vaccines, they are not universally applicable to all flu strains. 

A new vaccine would take at least six months to develop, and in today’s ever more interconnected world and the technology of intercontinental flight, we are vulnerable to such an outbreak. Recent modelling for a similar virus today suggests a global toll of over 30 million deaths.

Professor Heidi Larson, an anthropologist and Director of the Vaccine Confidence Project, has pointed out the dangers of scientific evidence and governmental advice being drowned out by ‘fake news’ in the modern digital world. And in the last few years rising levels of death from measles and other preventable diseases have been linked to false rumours spread on social media. 

If we face another deadly pandemic, this spread of misinformation could have a potentially catastrophic effect on our ability to contain the outbreak. 

Hannah Mawdsley is a historian of memory, and her PhD thesis focused on the evolving memory of the Spanish Flu over the past century. She now works for the National Trust in London.

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Hannah Mawdsley

Thomas is a London-based photographer working for Wellcome. He thrives when collaborating on projects and visual stories. He hails from Italy via the North-east of England.  

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Thomas SG Farnetti

Thomas S G Farnetti

Photographer

Essay

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Fake news and the Flu

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Why the 1918 Spanish flu defied both memory and imagination

Discover what causes some pandemics to be forgotten and others to be remembered.

Research primary source material on public health and preventive medicine.

Being Human

Explore our exhibition on what it means to be human in the 21st century.

Discover how history shows that fake news could play a deadly role – by generating potentially lethal misinformation during a future pandemic.

Fake news and the flu

Artist Sam Falconer’s portraits highlight the achievements of fascinating figures in medicine, whose contributions range from discovering the causative agent of syphilis to advancing techniques for the study of living cells. 

Sam Falconer is an illustrator and artist with a particular interest in science and deep time. He has illustrated content for publications including National Geographic, Scientific American and New Scientist.

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Sam Falconer

Sam’s website

Image gallery

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Faces from the archive banner

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Meet some of the lesser-known but no less extraordinary figures in the history of medicine, through a series of original portraits.

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Woodblock: Ambrosia altera

Explore stories inspired by the objects, manuscripts and more in our archives.

Stories inspired by the objects, manuscripts and more in our archives.

Inside Our Collections

Faces from the archives

Hear from Joanna Cannon about her experiences of being a junior doctor on a hospital ward, as told in her powerful new memoir ‘Breaking & Mending’. Listen to stories of compassion, burnout, kindness and heartbreak, then join the conversation. 

Joanna Cannon is the author of the Sunday Times bestsellers, ‘The Trouble with Goats and Sheep’, which was published in 15 languages, and ‘Three Things About Elsie’, longlisted for the Women’s Prize for Fiction 2018. Her novels have sold over half a million copies in the UK alone. Her love of narrative had always drawn her to psychiatry, but it wasn’t until her thirties that she decided to go to back to university to study medicine. Before specialising in psychiatry, she rotated through a series of hospital jobs, from A&E to palliative care.

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Joanna Cannon

Speaker

Hannah Beckerman is an author, journalist and broadcaster. She is a book critic and features writer for the Observer, the Guardian and the FT Weekend magazine, and was the book pundit on the Sara Cox Show on BBC Radio 2. She is a regular chair at festivals and events across the UK and has judged numerous book prizes. Her second novel, ‘If Only I Could Tell You’, is published by Orion.

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Hannah Beckerman

Hannah’s website

Facilitator

Discussion

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Portrait of Joanna Cannon

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We’ll be in the Forum. To get there, take the lift or stairs up to level 1 and then follow the signs through the ‘Being Human’ gallery.

The Forum

Booking a ticket for a free event does not guarantee a place on the day. Doors usually open 15 minutes before an event starts and we advise arriving before the scheduled start time to claim a place. We hold some spaces for people with access requirements. If you have any access requests or requirements, email us at access@wellcomecollection.org or call 020 7611 2222.

First come, first served

Hear Joanna Cannon in conversation about her experiences as a junior doctor and her new book ‘Breaking & Mending’.

Stories of Compassion and Burnout

Discover the works of Jo Spence and Oreet Ashery in this audio-described tour of the Misbehaving Bodies exhibition. Through photography and video, these artists explore the politics of the body, living with chronic illness, and alternative medicine. 

Your tour guide, Rob Bidder, is trained in audio description by VocalEyes and has designed his tour for visitors who are blind or partially sighted.

Everyone will meet at the information point on Level 0 before the tour in Gallery 2.

Guide

Gallery tour

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Access tour at Wellcome Collection

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This event will be audio described for visitors who are blind or partially sighted. Places are free but very limited. If you would like to come along, email access@wellcomecollection.org or call 020 7611 2222.

This event is audio described for visitors who are blind or partially sighted. For any assistance, please email us at access@wellcomecollection.org or call 020 7611 2222.

Audio described

We’ll meet at the Information Point, which is on level 0, directly in front of you as you enter Wellcome Collection.

Information Point

Discover the works of Jo Spence and Oreet Ashery in this audio-described tour of the Misbehaving Bodies exhibition.

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We regularly run tours of our exhibitions for visitors with access needs: British Sign Language (BSL) interpreted, audio described (AD) and speech-to-text (STT) tours.

Access Tours and Discussions

AD Tour of Misbehaving Bodies

Come along to an afternoon of live action role play (larp) inspired by the exhibition Play Well. Join artist Adam James to let loose your inner child or pretend to be a grown-up at Crumbles Castle Playground, as adults and children temporarily swap roles. 

Set in the 1980s, this afternoon of games, workshops and role play will have you remembering playmates and silly games, and get you thinking about barriers to play. You don’t need any previous experience of larping to join in. This event is suited to all fitness levels and we will provide refreshments.

This event is open to adults and children aged eight or over, and any children need to be accompanied by an adult. When you book, we will send you an email with important information about the event. 

Workshop

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Event in a children's playground

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Crumbles Castle Playground is located on Pembroke Street, London N1 0DP.

Crumbles Castle Playground

Where do the children play? Larp

50-years on from the first moon landing, space tourism and missions to Mars are once again on the agenda. Join space psychologist Iya Whiteley to hear how we can prepare individuals for the immense mental challenges of these journeys and how her research could benefit us here on planet earth.

Dr Iya Whiteley is Director of the Centre for Space Medicine at Mullard Space Science Laboratory, UCL. She recently directed the European Space Agency’s (ESA) study on the development of technology and techniques for the psychological support of crews in preparation for exploration missions to Mars and the Moon, and currently leads the ESA-funded study on using technology to assess fatigue levels.

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Iya Whiteley

Researcher

Join space psychologist Iya Whiteley to find out how people can prepare for the mental challenges of space travel, and how this research could help improve working conditions on Earth.

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