Jean Civiale (1792–1867) was a French

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

and

urologist Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organ ...

, who, in 1823,Jean Civiale
Didusch Center for Urologic History invented a

surgical instrument A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...

(the

lithotrite The lithotrite was an early medical device, invented by Al-Zahrawi, an early form of which he called "Michaab". He was able to crush the stone inside the bladder without the need for a surgical incision. It was later modified by Jean Civiale, and ...

) and performed transurethral lithotripsy, the first known

minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition ...

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

, to crush

stone In geology, rock (or stone) is any naturally occurring solid mass or aggregate of minerals or mineraloid matter. It is categorized by the minerals included, its Chemical compound, chemical composition, and the way in which it is formed. Rocks ...

s inside the

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

without having to open the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

(

lithotomy Lithotomy from Greek for "lithos" (stone) and "tomos" (cut), is a surgical method for removal of calculi, stones formed inside certain organs, such as the urinary tract (kidney stones), bladder (bladder stones), and gallbladder (gallstones), tha ...

). To remove a calculus, Civiale inserted his instrument through the

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

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 Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra. Cel ...

. Civiale founded the first urology service in the world, at the

Necker Hospital Necker may refer to: * Necker (surname) * ''Necker'' (ship), several ships * Neckerchief, cloth worn round the neck * Necker cube, optical illusion * Necker Island (Hawaii) * Necker Island (British Virgin Islands) * Necker–Enfants Malades Hospi ...

in Paris. Civiale has been also recently recognized as a pioneer of

evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...

. In 1835, the

Académie des Sciences The French Academy of Sciences (French: ''Académie des sciences'') is a learned society, founded in 1666 by Louis XIV at the suggestion of Jean-Baptiste Colbert, to encourage and protect the spirit of French scientific research. It was at the ...

Paris Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...

commissioned a report on the statistical research that had been conducted by him on a wider scale throughout

Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...

, 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 Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

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 The Montyon Prize (french: Prix Montyon) is a series of prizes awarded annually by the French Academy of Sciences and the Académie française. They are endowed by the French benefactor Baron de Montyon. History Prior to the start of the French R ...

from the Academy; it was published in 1836 as ''Parallèle des divers moyens de traiter les calculeux''. One of the members of the committee was none other than famous mathematician Siméon Poisson; as a consequence, the Academy recommended that the medical uses of

probability Probability is the branch of mathematics concerning numerical descriptions of how likely an Event (probability theory), event is to occur, or how likely it is that a proposition is true. The probability of an event is a number between 0 and ...

should be better studied. Among the many students of Civiale, Sir Henry Thompson, a British surgeon and urologist, took the instrument and the technique to

Great Britain Great Britain is an island in the North Atlantic Ocean off the northwest coast of continental Europe. With an area of , it is the largest of the British Isles, the largest European island and the ninth-largest island in the world. It is ...

and became quite famous with it, after operating on King

Leopold I of Belgium * nl, Leopold Joris Christiaan Frederik * en, Leopold George Christian Frederick , image = NICAISE Leopold ANV.jpg , caption = Portrait by Nicaise de Keyser, 1856 , reign = 21 July 1831 – , predecessor = Erasme Loui ...

. In 1840, he was elected a foreign member of the

Royal Swedish Academy of Sciences The Royal Swedish Academy of Sciences ( sv, Kungliga Vetenskapsakademien) is one of the Swedish Royal Academies, royal academies of Sweden. Founded on 2 June 1739, it is an independent, non-governmental scientific organization that takes special ...

Principal publications

*''De la Lithotritie, ou brolement de la pierre'', (Paris, 1827) *''Lettres sur la Lithotritie, &c.'' (1827) *''Traite pratique et historique de la Lithotritie'' (1847) *''Resultats Cliniques de la Lithotritie pendent les Annes 1860–64'' (1865)

References

* Kiefer JH. Jean Civiale (1792–1867). ''Invest Urol.'' 1968 Jul;6(1):114-7. * Matthews JR
The Paris Academy of Science report on Jean Civiale's statistical research and the 19th century background to evidence-based medicine
''Int J Epidemiol.'' 2001 Dec;30(6):1246-9.
Statistical research on conditions caused by calculi by Doctor Civiale. 1835.
''Int J Epidemiol.'' 2001 Dec;30(6):1246-9. Reprint of the classical report by Poisson, Dulong, Larrey, Double. {{DEFAULTSORT:Civiale, Jean 1792 births 1867 deaths 19th-century French physicians French urologists French surgeons Members of the Royal Swedish Academy of Sciences French medical writers French male non-fiction writers 19th-century French male writers