Dr. Mullineux His Account of a Stone of an Extraordinary Bigness, Spontaneously Uoided Through the Urethra by a Woman in Dublin

III. Dr. Mullineux his Account of a Stone of an extraordinary bigness, spontaneously voided through the Urethra by a Woman in Dublin. Women are made by Nature of a more nice Composition, and weaker Frame than Men, and are therefore liable to many Infirmities that Men are not the least subject to. Yet in one of the most painful that afflicts the Body, the Stone in the Bladder, they have much the advantage, and are more rarely troubled with it than Men. For among the two vast Collections of Stones, that amount at least to several Thousands, kept together in the Hospitals at Paris l'Hotel Dieu and la Charité, cut out only of such as come thither to be cured, not one in an Hundred, I might safely say more, is taken out of a Woman. This remarkable difference must certainly proceed from the Urinary Passage in this Sex, being shorter, larger, and more apt to dilate; so that for the most part, when Gravel, or a sort of viscous clay matter, which I take to be the chief Cause of the Generation of the Stone, falls into the Bladder, 'tis suddenly and easily discharged, e're it can cohere together and form a Stone of any large Bulk, which cannot so frequently happen in Men, by reason of the narrowness, crookedness, and length of the Passage of the Urethra. However it sometimes comes to pass, that even in Women, either from a more depending, or less elevated Posture than usual in their Bladder, or that the matter forming the Stone adheres to some part of its Membranes, so that it cannot fall in the Urinary Passage, till its own Bigness or Gravity forceth it thither, Stones of a very considerable Bulk are generated. Of this we have lately had here in Dublin a very remarkable Example: One Margaret Plunket alias Weldon, to give her her Maiden Name according to the Irish way, the Mother of Five or Six Children, Cozengerman by her Mothers side, who was the Lord Netherfield's Sister, to my Lord Tirconnell, born in the County of Meath, about Sixty Years of Age, now living in Church-street, Dublin, on May 29, 1691. voided through her Urinary Passage, by the help of Nature alone, without the use of Remedies, or any forcible means whatever, V. Fig. I. a Stone of this Shape and Size, somewhat resembling a hard Pear a little press'd or flatted. Its Circumference measured the longest way is 7 Inches and \( \frac{1}{4} \), round about where it was largest 5 Inches \( \frac{3}{4} \); its Weight at present, according to Troy Pound, \( \frac{3}{4} \) lb, \( \frac{3}{4} \) lb, \( \frac{3}{4} \) gr. 6. for it has lost considerably both of its first Bulk and Weight by many little Fragments breaking off from the smaller end A, where 'tis much softer, smoother, whiter, its parts more porous, and so incoherent, that the least force severs them: Whereas the bigger end B, as far as the Stroke \( \infty \) passes, is of a very different Texture, much more close and compact, covered with a yellowish shining Crust, ruff, granulated, and as hard as the best Portland Stone. This different Texture of Parts in one and the same Stone, observable in most of this kind if they be of a large Size, proceeds, I am apt to think, from the same constant Bed or settled posture of the Stone in the Bladder, whereby some parts of it are more exposed to imbibe the Moisture of the Urine as it falls or settles in the Bladder than others; and by this sort of Maceration are kept soft, whilst those parts that lie higher towards the upper Region of the Bladder remain dry, harder, and gather a sort of gritty Crust, as we find most soft Stones do, do, that are dug out of the moist Earth, when exposed a while to the dry Air. It seems to me very probable, that Stones when they come to be of a large size, keep much one and the same posture in the Bladder at all times, there not being room in so pliant and membranous a Body, that always contracts itself to the least Dimensions it can, to allow a Stone of any considerable Bulk; for the Case is different in those that are small, to tumble or change its Situation very much. But however this Conjecture may prove true or false, 'tis undeniable, that some Stones from their way of Generation must of necessity remain fixt and immovable in the Bladder; being closely joined and united to the very substance of its Membrane, of which sort there are several Examples recorded by Scenkius, and other Collectors of Observations: And I'm perswaded this Stone I am now describing may be reckon'd among them: For about the larger end, where 'tis marked $ddd$, there still closely adheres several thin Films and carious Filaments, which manifestly shew it was formerly united by this part to the membranous Substance of the Bladder, and that lately by its own Weight, or some other Accident, it was torn away, and fell into the Urethra, through which 'twas voided; and hence it was that this Woman, as she her self told me, never suspected her self, till very lately, at all troubled with the Stone. For these Three Months past, whilst 'twas sticking in the Urinary Passage and coming away, she has suffered great Pains, and a perpetual Strangury, or an involuntary dropping of her Water from her; and this Infirmity still continues, by reason the largeness of the Stone has over-stretch'd the Fibres that compose the Sphincter of the Bladder in its Passage through it, whence their Tone is so relaxt, they have lost all power of Retention: And for this Reason, I find all Women that void Stones this way, way, of any considerable bigness, are constantly attended with this Weakness. But this Trouble is fully recompens'd by the Remission of her Pains, which, since the Stone came away, are so abated, that she can walk about, and is now able to come abroad. 'Tis very extraordinary that so large a Stone should be naturally voided by the Bladder; and I have read but of very few that come nigh the bigness of this, which I have now in my Possession, and keep among some other natural Productions, as a curious Rarity. Thomas Bartholine in his Centuria Ia Hist. Anat. Observat. 71. sets down the Description and Figure of a very large Stone as he thought, though he says 'twas but Ovi Gallinacei magnitudine, that came from a Woman as this did. And Daniel Angelus in the Miscellan. Physico-Medic. Germanic. An. 1676. Observat. 195. gives the Figure of another Stone, much of the same size with Bartholine's, spontaneously discharged the same way. Likewise Petrus Borellus Centuriae Secundae Observ. 22. mentions a Stone, but gives no Figure of it, voided by a Girl through her Urinary Passage, Ovi Anserini magnitudinis, as his own Words are, which I suppose was much of the same size with this of ours. But Nicolaus Tulpius in his more elaborate Observ. Lib. 3. cap. 7. gives an Account of a Woman 89 Years of Age, that voided a Stone, of which he gives you an accurate Figure, full as broad, somewhat longer, and almost 3j heavier than this I have describ'd; yet she lived after it, and was so well as to walk abroad. I mention these several Examples, not only to illustrate and confirm the Truth of our present Story, even to the most incredulous; but as so many Arguments, from whence I think, one may reasonably infer, That no Woman need be obliged ever to undergo the painful and hazardous hazardous Section of the Stone; though some among the Ancients describe the particular manner how the Operation is to be perform'd in this Sex; as Ælius Tetr. 4. Sermon 4. cap. 99. And among the Moderns, Monsieur Tolet Traitè de la Lithotomie, Chapit. 15. pag. 122. For since Nature by her own Power, without the Assistance of any Help or Remedies, could disburthen herself, and force away such large Stones as these here describ'd, why may we not probably conclude, That even those still of a larger, if there be any such bred in Women, as one may well question, since all those Accounts of Stones of prodigious Bulk bred in the Bladder, are related of Men only; as if Nature kept somewhat the same Rule of Proportion in these sort of Productions, as she observes generally in the Stature of Men and Women: I say, why may not they be brought away, by putting the Body into a convenient Posture, and so by the Hand and Fingers forcing the Stone into the Urinary Passage, which by Application of relaxing and strongly emollient Remedies, may be so dilated, as to give a free Passage to the Stone without any forceable Section? But this I leave to be determin'd by such, who lighting upon proper Subjects, may have occasion hereafter to try the Success of this Practice, which if found to answer Expectation, may be of solid and real use. July 14. An. 1691. Since my writing the foregoing Account, Mr. Thom. Proby, an ingenious Chyrurgion of this Town, has lately in two Instances of Fact, successfully demonstrated the Practicableness of what I then proposed only with Probability, touching the Extraction of Stones bred in the Bladders of the Female Sex without any Incision, as well those of a large, as those of a smaller Magnitude. The first Instance is the more remarkable, as well for the Girls being very young, and by consequence the Passage of her Vrethra strait and small, as that the Stone was extraordinary long, and considerably large for one of her Years. The annext Figure expresses exactly enough both its Shape and Bignels. The Child's Name was Sarah Cooke, about Six Years old; for some Years past she had been so miserably afflicted with the Stone, and a perpetual Incontinency of her Urine, that her Parents at any Hazard were willing to attempt relieving her of so violent a Pain, and so foul a Distemper. Whereupon, June the 8th, 1693, the Child being placed in a convenient Posture in a Man's Lap sitting across a Table, with her Arms tied down to her Legs by a sort of Bandage usual in these Cases, the Chyrurgeon first past his Catheter into the Neck of the Bladder, that it might empty itself of all Urine, before he inserted his Dilatory Instrument, or his Speculum Vesicae as one may call it, with which he extended the Vrethra as much as possibly he might with safety, and without putting the Child to extraordinary Pain; afterwards by help of a Directory and Forceps gently thrust into the Bladder, he brought away the Stone without any manner of Incision in about 3 or 4 Minutes time from the passing in of his first Instrument, and put the Patient to so little Pain during the Operation, that when it was over, and she laid quietly a-bed, she slept without any Opiate 7 or 8 Hours together, as she had not done in many Months before, and is now perfectly well and at ease. Whether hereafter the Sphincter of the Bladder may restore itself, and become so strong, that she shall not be liable to a Stillicidium Urinae as heretofore, the only Inconvenience that may be feared at any time can attend this sort of Operation, is uncertain as yet, since 'tis so lately perform'd; but being so young a Child, and the constant Cause of the Relaxation of the Sphincter, the Stone in the Bladder being ing now wholly removed, 'tis probable she may recover it, and not be subject to this Weakness as heretofore. The other Instance is a Child something elder, about 10 Years of Age, her Name Elizabeth Mortimer, who has been troubled with an Involuntary distilling of her Urine, and other painful Symptoms of the Stone for these three or four years past; but on June the 12th, 1693, was happily relieved by the extraction of a large Stone near as big as a Pigeons Egg, after the same manner and method as before describ'd, and with as good Success, though not altogether with as quick Expedition. From these Examples one may reasonably conclude, That those of intermediate Years as well as Childhood and Old Age, are capable of undergoing this Operation of Extraction of the Stone with Safety: And I make no great doubt to assert, That 'tis the only proper and secure way of freeing the Female Sex from the Stone in the Bladder, and that such should never be persuad'd to undergo the Section upon any account, since the Stone, if it be not of an immoderate bigness, may be extracted by dilating only the Neck of the Bladder; and if it be of so large a Bulk; (as I have reason to think it never, or very rarely is in this Sex) as that it cannot be drawn out this way; then the Section, if the Chyrurgeon be so bold as to venture on it, must be made so wide, as wholly to cut through the short Neck of the Bladder, and to divide likewise some part of its thin membranous Substance, which is known to be of the most dangerous consequence in cutting the Stone, and to be avoided as certain Death to the Patient. I have added the Figures of the Three Stones I have here mention'd, all express'd as big as the Life. That Mark Fig. 1. is the Stone spontaneously voided by the Old Woman. Fig. 2. was taken out of the Child Six Years Years Old. And Fig. 3. was brought away from the Child Ten Years Old; both these without any Section. IV. An Account of the Tubera Terræ, or Truffles found at Rushton in Northamptonshire; with some Remarks thereon. By Tancred Robinson, M.D. and R.S.S. SIR, THE Tubera Terræ (which you was pleas'd to send me, together with a Draught of them drawn with your own Pencil) observ'd lately at Rushton in Northamptonshire, by that curious and learned Gentleman Mr. Hatton, are indeed the true French Truffles, the Italian Tartufi or Tartuffole, and the Spanish Turmas de Tiera, which are not noted by Mr Ray to be found in our British Soyl. I have seen them thrice as large at Florence, Rome and Naples, where they eat them as a delicious and luxurious piece of Dainty, either fry'd in slices with Butter or Oil, Salt and Pepper; or else out of Pickle, and often boil'd in their Soup. Of these there are three or four Species mentioned by Matthiolus, Imperati, J. Bauhine and Mentzelius. These observ'd in England are all included in a studded Bark or Coat, the Tubercules resembling the Capsules or Seed-Vessels of some Mallows and Alcea's; the inward substance is of the consistence of the fleshy part in a young Chestnut, of a paste Colour, of a rank or hircine Odour, and unfavourly, streaked with many white Veins or Threds, as in some Animals Testicles; the whole is of a globose Figure, though unequal and chinky.