Edwin
R Nye reviews Beyond the figleaf
BEYOND THE FIGLEAF
Donald Urquhart-Hay
Steele Roberts, hbk, $39.99
This elegantly produced book brings together the substance of
a series of lectures given by the author to a number of
medical societies in Australia and New Zealand over the
years.
The title defines the theme of the book, but only insofar as
most, but not all, deals with medical progress of the male
problems of the lower urinary tract from the bladder onward.
Many of the early talks describe the evolution of urogenital
surgery from Hippocrates (460-370BC) but particularly from
the 17th century.
That Hippocrates knew about the possibilities about "cutting
for stone", i.e. removing bladder stones, is revealed in his
injunction that this activity is forbidden to physicians and
should be left to "practitioners of the art".
Lithotomists ("stone cutters") practised for hundreds of
years to remove the internally formed stones in the bladder
in men, young and old, that caused suffering and often
blockage of outflow.
Many noted historic figures with the condition are listed,
starting with Samuel Pepys, the famous 17th-century diarist,
with sidelights on his sexual adventures.
Later there was Isaac Newton, Benjamin Franklin, and Napoleon
III of France who at least had the benefit of the then
growing use of chloroform anaesthesia.
The operation, even in the pre-anaesthesia times, consisted
of cutting into the bladder from below which might require
the assistance of four strong men to hold the patient still
while the surgeon cut into the bladder and removed the stone.
Skilled operators might achieve the result in a minute or
less.
Surgically mortality was high, up to 45%, with fees to match.
In fact only the well-off could usually afford the procedure
and some surgeons became wealthy.
A section on circumcision, male and female, touches on the
medical, social and religious dimensions of this procedure.
Other topics in the book include a chapter on Nelson's wounds
and a potted life of Florence Nightingale.
The last emerges as a brilliant woman, she spoke four
languages, with good connections and a flair for organising.
She lifted the status of nursing to that of an honourable
profession for women.
Elsewhere in the book are accounts of the lives of notable
specialists in the field of urology from the 17th century to
the 20th century.
Somewhat out of step with the general tenor of the book are
sections on alcohol and the medical profession, with an
excursion into heraldry as it touches the arms of the
Urological Society of Australasia.
• Ted Nye is a retired physician
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