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Zena Chiara Masud

Jean Civiale (1792–1867) was a French surgeon and urologist, who, in 1823, invented a surgical instrument (the lithotrite) and performed transurethral lithotripsy, the first known minimally invasive surgery, to crush stones inside the bladder without having to open the abdomen (lithotomy). 

To remove a calculus, Civiale inserted his instrument through the urethra and bored holes in the stone. Afterwards, he crushed it with the same instrument and aspired the resulting fragments or let them flow normally with urine. Civiale founded the first urology service in the world, at the Necker Hospital in Paris.

His book Précis de la Lithotritie is the classic on the topic and stands as one of the more important medical books in urology.

This rare early treatise marked a turning point in the history of urology and surgery, marking one of the first systematic attempts to reduce suffering through endoscopic instruments. 

The volume opens with a detailed introduction on the history of bladder stone treatments and the limitations of previous methods. Civiale carefully describes the anatomy of the urinary tract, the chemistry and formation of calculi, and his own innovative approach to fragmenting stones using specially designed instruments. 

5 large folding plates and one large folding plate at the end. Of special note is the large folding engraved plate, depicting the surgical procedure and instruments in use as " a striking visual reference for early 19th-century operative medicine. The large folding table in the Rapport is: "Tableau Analityque des opérations faites d'après ma méthode." 

Civiale "devoted his entire clinical career to urology and was particularly interested in the removal of bladder stones without having to resort to lithotomy. He worked for a number of years to devise instruments that could be introduced into the bladder transurethrally to crush the stone. Civiale was ultimately successful and in 1824 performed his first human lithotrity. He withstood a bitter controversy over his priority in the operation. The present work is one of his earliest and most important contributions. In it he presents his theories, describes the techniques he employed, and answers the arguments of his critics. At the end of the volume, a report to l'Academie Royale des Sciences by . . . Percy and . . . Chaussier summarizes their investigations into Civiale's claims to priority in lithotrity" (Heirs of Hippocrates 1484). 

See Garrison-Morton 4289 for Civiale's 1826 paper on lithotrity: "[Civiale] invented a lithotriteur for crushing stones inside the bladder and was responsible for putting the operation of lithotrity upon a sound basis." Murphy, History of Urology (pp. 169-71 and figs. 7, 27-29, 33) discusses Civiale's contributions to lithotrity. The explanatory text for Plate IV (illustrated in the photo here) reads: "Elle représente un malade au moment de l'opération; la paroi antérieure de l'abdomen et la vessie étant sup posées transparentes, on voit l'instrument introduit dans la vessie; la pierre, embrassée par la pince, et attaquée par le lithotriteur ; l'appareil entier est fixé et maintenu par la main gauche du chirurgien, placée à la réunion du tour avec l'instrument, et par les deux mains de l'aide placées sur la tige carrée du tour: la main droite du chirurgien tient l'archet. Le sacrum du malade est élevé par un coussin; ses jambes sont légèrement fléchies, sa tête un peu élevée, et ses bras dans leur position ordinaire. On a figuré ici le lit sur lequel je fais les opérations chez moi: on peut se servir d'un lit ordinaire.".

 In 1835, the Academie des Sciences in Paris commissioned a report on the statistical research that had been conducted by him on a wider scale throughout Europe, with the aim of proving that bladder lithotripsy was superior to lithotomy. Civiale used for the first time the method of comparing the relative mortality rates between both groups of patients, and found that the new lithotripsy method had had 7 deaths in 307 operations (2.2%), while the old lithotomy method had 1,024 deaths in 5,443 operations (18.8%). For this study, he received in 1836 the Montyon Prize from the Academy, and one of the members of the committee was none other than famous mathematician Simeon Poisson. 

Opponents of his instrument were labeled by Civiale as "butchers without the necessary delicate touch" who therefore insisted on using the old-fashioned perineal lithotomy. Civiale's instrument was tried in the United States as well, but it did not survive the test of time, as it was difficult to use and even more difficult to repair. Civiale made a generous donation to the Hospital Necker for an allotment of beds and thus founded the world-famous urological clinic at this hospital. A deplorable lecturer, he made up for this lack of skill by his famous books. His long history of successful bladder stone operations was marred only by his failure to crush the stone of King Leopold.

BOOK DETAILS: 

In-8 (203 x 122 mm). Later rebinding in beautiful half-leather, solid and clean although some page have foxing and historical wear.

RARITY AND VALUE:

This book is rare, having sold on six times at auction in the last century (RBH). The last copy sold for 1386 Euros.

Medicin - Antal: 1 - Bog

Docteur Civiale - Précis de la Lithotritie - 1827

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