Hektoen International

A Journal of Medical Humanities

John Douglas of the “high” stone operation

Instruments used by John Douglas for the “high operation.” From Eric Riches, The History of Lithotomy and Lithotrity, January 24, 1967, p. 193.

John Douglas was born in 1675 in Baads near Edinburgh. He had six brothers, the most famous being the anatomist James Douglas, remembered eponymously for describing the Pouch of Douglas (an extension of the peritoneal cavity into the pelvis). Another brother, Walter, served from 1711 to 1714 as governor general of the Leeward Islands, where John Douglas himself became chirurgeon-general in 1712. In 1717, Douglas reportedly worked in Antigua.

On returning to London, Douglas gave anatomy lectures at his house. In 1719 he published a syllabus on what needs to be learned in a Course of Anatomy, Chirurgical Operations, and Bandages. That same year, he secured an appointment to the newly-founded Westminster Infirmary and came to prominence for removing a bladder stone from a sixteen-year-old boy by using the “high” approach. This required reaching the bladder by means of a suprapubic incision, a procedure tried as early as in 1556 in Lausanne but not practiced to any extent in Europe.

Douglas operated on several other patients, mostly young boys who recovered from the surgery within about six weeks. His efforts won him the freedom of the City of London and of the Company of Barber-Surgeons. In 1720 he published his results as Lithotomia Douglassiana, or Account of a New Method of making the High Operation in order to extract the Stone out of the Bladder, invented and successfully performed by J.D. His work went through a much-enlarged second edition with several copper plates in 1723 and was translated into French in 1724 and into German in 1729.

Douglas’s suprapubic operation was superseded in 1726 by William Cheselden’s “lateral” and safer approach through the perineum. This development caused Douglas much bitterness. Although in his publication Cheselden mentioned Douglas for his earlier surgeries, Douglas apparently felt he had not been given enough credit for his work. As a result, Douglas criticized abusively some of Cheselden’s later publications.

Douglas wrote other works. In 1729 he published a monograph titled An Account of Mortifications, and of the surprising Effects of the Bark in putting a Stop to their Progress—a treatise on using salicylic containing willow bark for pain relief. In 1737–39 in A Dissertation on the Venereal Disease, he described the use of purgatives in syphilis. As he also practiced obstetrics, he wrote A Short Account of the State of Midwifery in London and Westminster, which contained a suggested curriculum for better training of female midwives (1736). In this book he opposed the competition from accoucheurs, who increasingly managed the complicated deliveries that in the past had been province of surgeons, “his book largely inspired by spiteful feelings at the successful practice of competing male accouchers.”1

Douglas died on June 25, 1743, remembered as an important surgeon and lithotomist, but notoriously aggressive with those whom he viewed as competitors, becoming “exaggerated into conceit and quarrelsomeness, and being engaged in a number of controversies, out of which he by no means came scatheless.”1


Further reading

  1. Bettany, George Thomas. Douglas, John (d.1743). Dictionary of National Biography, 1885-1900, Volume 15.



GEORGE DUNEA, MD, Editor-in-Chief


Summer 2023  |  Sections  |  Surgery

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