For the Medically Knowledgeable-A question

[Michael W Richards]

In what medical procedure(s) do surgeons remove both the uterus and the bladder as a common practice?

Thanks in advance,
Best regards

[Jon Guy]

Hi Michael

An in-grown toenail?

[Michael W Richards]

Hi Michael

An in-grown toenail?

As thread starter am I obligated to address every inane comment? Ok...seriously, I believe that in certain cases Hysterectomies involve the removal of the bladder as well as the ovaries and fallopian tubes. Ive read recently that the vast majority of Medical Students of the mid 19th century would have been expected to have performed some similar surgeries...meaning, specific excisions of the female reproductive organs. There was a focus on Reproduction and Reproductive Organs through medical colleges during those mid 1800's in particular, and interestingly, I recently re-read a Ripper book that was a failure as it was intended but had interesting medical reflections in it, and one of them concerned a physician who performed the extractions I asked about while in London on Sept 30th, 1888, doing a hysterectomy. The patient apparently dies.

That re-read plus some other instigators made me wonder if there are other situations that might involve similar measures.

Obviously, my thinking is that based on the first 2 murders Inquests I believe its quite possible that a medical student or someone with similar training did those murders. Is it possible that the taking of the uterus and bladder might be instinctive to such a person after so much training in that regard, and would it then be less likely to see such a man later substitute an organ he chose to go through the victim, from the front, to get?

Would the fact that understanding and/or performing these extractions became so familiar to such students that they could do them...in the dark?

Cheers Jon

[Errata]

That is not a standard medical procedure. Even if a uterus is disposable, a bladder is not. The only way that surgery happens is if there is MASSIVE pelvic trauma, like getting shot in the pubic bone or something. If both organs were destroyed, you have probably lost a good portion of the lower intestine and bowel as well.

You can remove the organs, but a substitute has to be found for the bladder. In the modern era transplants are possible, or barring a lack of any other option I suppose a graft could be put in creating an essentially very long urethra. But that person would be incontinent. Which doesn't matter that much since they would likely also have a colostomy bag and artificial bowel. But back in 1888 there was only one option. Death. Without a way to dispose of urine, or by forcing a wound to remain open in order to provide a portal to remove the urine from the kidneys, a woman dies horribly and slowly. Taking a week or two to die of kidney or liver failure.

[Prosector]

As a surgeon perhaps I can add something here. The uterus and bladder can today be removed in one operation for advanced cancer that has affected both organs, such a procedure being known as a pelvic clearance. However, abdominal surgery was in its infancy in 1888 and that operation was many years away at that time. Hysterectomy was performed then, although much more rarely than it is now. If there had been significant pelvis sepsis (for instance from a sexually transmitted disease) the uterus might be attached to the posterior wall of the bladder by adhesions in which case the surgeon would perhaps take a portion of the bladder together with the uterus and then repair the remaining bladder with one or two layers of sutures. However, as I said, that sort of major surgery was extremely rare in 1888. Most doctors would not have witnessed such a thing. Don't forget, the first appendicectomy in Britain was performed by Frederick Treves at the London Hospital in June of 1888 and that was considered pioneering stuff.

Prosector

[Michael W Richards]

As a surgeon perhaps I can add something here. The uterus and bladder can today be removed in one operation for advanced cancer that has affected both organs, such a procedure being known as a pelvic clearance. However, abdominal surgery was in its infancy in 1888 and that operation was many years away at that time. Hysterectomy was performed then, although much more rarely than it is now. If there had been significant pelvis sepsis (for instance from a sexually transmitted disease) the uterus might be attached to the posterior wall of the bladder by adhesions in which case the surgeon would perhaps take a portion of the bladder together with the uterus and then repair the remaining bladder with one or two layers of sutures. However, as I said, that sort of major surgery was extremely rare in 1888. Most doctors would not have witnessed such a thing. Don't forget, the first appendicectomy in Britain was performed by Frederick Treves at the London Hospital in June of 1888 and that was considered pioneering stuff.

Prosector

Hi Prosector,

Thanks for the professional overview. Though it doesnt agree with what Ive read. The reference I made to a surgery performed on the 30th of September was one of two such incidents, the first one being earlier in the month. The statement alleges that the surgeon, a member of the surgeons College and an Obstetrician, who later gets intimately connected with the royal Family through his care of Beatrice, performed 2 such operations in September that year, although they were not specifically categorized as Hysterectomies in his notes.

Perhaps the sexual disease angle might explain that? Maybe these were both "working" women. Interestingly his notes also indicate he gave an abortion to a Mary Ann Nichols in London in 1885.

Best regards

[Errata]

Hi Prosector,

Thanks for the professional overview. Though it doesnt agree with what Ive read. The reference I made to a surgery performed on the 30th of September was one of two such incidents, the first one being earlier in the month. The statement alleges that the surgeon, a member of the surgeons College and an Obstetrician, who later gets intimately connected with the royal Family through his care of Beatrice, performed 2 such operations in September that year, although they were not specifically categorized as Hysterectomies in his notes.

Perhaps the sexual disease angle might explain that? Maybe these were both "working" women. Interestingly his notes also indicate he gave an abortion to a Mary Ann Nichols in London in 1885.

Best regards

A surgeon might have performed the procedure, but he was killing those women. And it may have been one of those damned if you do, damned if you don't situations. If whatever was wrong with these women was killing them, surgery may have been performed to buy time to think of a solution, or even to prevent a terrible death from sepsis, which really is one of the worst ways to go. But hysterectomies had a high fatality rate as it was, and the removal of the bladder was fatal.

Does this reference give any clues as to why these surgeries were performed, or the disposition of the patients?

And it's not considered a hysterectomy unless the surgery is performed to cure female hysteria. Otherwise it is simply a removal of a diseased organ. I don't know why. As best I can tell the surgical technique didn't vary.

[Ginger]

I have trouble believing that a medical man committed these crimes. What seems to me to have motivated the Ripper was the desire to poke around in dead women, to open their bellies, and see what was inside. The killing seems kind of incidental, done in a quick businesslike way so that he could get on with the part that really interested him. A doctor, a medical student, or even a morgue attendant would have much safer ways to gain access to dead women, and to have indulged himself in a much more leisurely manner.

[Robert]

Hi Prosector

Could I ask you a quick question? What would cause adhesions or old firm adhesions in relation to the lung?

"On opening the thorax it was found that the right lung was minimally adherent by old firm adhesions. The lower part of the lung was broken & torn away.

The left lung was intact: it was adherent at the apex & there were a few adhesions over the side. In the substaces of the lung were several nodules of consolidation." (From Dr Bond's post mortem on Mary Kelly)

[Prosector]

Hi Robert

Adhesions result from any form of previous inflammation. In 1888 by far the most likely cause of pleural adhesions (adhesions between the lung and the inside of the chest cavity) would have been tuberculosis. It was not necessary to have had full blown consumption but just a minor exposure in childhood due to drinking milk containing the tuberculosis bacillus. Pasteurisation of milk was first proposed in 1886 and didn't come into common use until much later so Mary Jane, like most children, was probably exposed to the organism in childhood.

And Michael, in answer to your comment, I did not mean to say that abdominal (as opposed to vaginal) hysterectomy was not performed in 1888, just that it wasn't very common and certainly total excision of the bladder at the same time as hysterectomy (pelvic clearance) had never been done at that time. It was first performed by the American surgeon Alexander Brunschwig in 1948 and is still known as Brunschwig's operation.

By 1888 the concept that a wandering uterus was the source of hysteria had certainly been abandoned in mainstream medicine and the term hysterectomy was in common use for removal of the uterus by either the abdominal or vaginal route.

Prosector

[Robert]

Hi Prosector

Thanks very much for that.