An Account of a Stone Found in the Stomach of a Lady on Dissection, Another in the Left Kidney, and Some Smaller Ones in the Gall-Bladder. By Mr. William Clerk, Surgeon. Communicated by Dr. Charles Preston

VII. An Account of a Stone found in the Stomach of a Lady on Dissection, another in the left Kidney, and some smaller ones in the Gall-Bladder. By Mr. William Clerk, Surgeon. Communicated by Dr. Charles Preston. In the year 1690, having the Curiosity to visit the Mineral Wells, called Moffet Wells, in the County of Annandale in Scotland, I had there an occasion of Dissecting a Lady who had been drinking of the Waters, by advice of her Physicians, for a Distemper in her Stomach, viz. a continual Vomiting, as also for the Dolor Nephriticus; How long she had been troubled with these Distempers, or what time she continued to drink of the Waters I had no account; only this I know, she dyed in a fit of Vomiting, the reason whereof seems to be plain and obvious; for upon dissecting the Stomach, I found a Stone of the bigness and form as in fig. 1. the corner a. was almost fixed in the Pylorus, so that the passage from the Stomach to the intestines was near quite shut up. The substance of this Stone is a little Spongy, weighing about eight Drams and an half. On Dissection of the left Kidney, I found also a Stone of the same Substance and form, as represented in fig. 2. weighing about five Drams, and in the Gall Bladder I found several Stones, as represented in fig. 3. weighing two Drams. That Stones daily generate in the Vesica Urinaria, Reins and Vesicula jellis, is a thing very ordinary and common; but that Stones should be bred in the Stomach mash of a human Body, is not so very common; However, it seems they have been produced by the same common Cause and petrefying Matter. But I am apt to believe some extraneous body has given origin to that of the Stomach, as it happens frequently even in those extracted from the Vesica Urinaria. Monsieur Tolet in his Treatise of Lithotomy, relates a Story of a Soldier that was cut for the Stone, and an Iron Tag taken out of it, Paræus, lib. 25. chap. 15. reports the like. Hildanus de Lithiæ Ch.3. col.2. writes that a Geneva Man dying after twenty eight years complaint of Gravel, on dissection they found a Stone whereof a Leaden Bullet was the Kernel, which he had received by a Musket Shot. Joseph Cavillart, Obs.viij. relates a parallel Case. Stones generated in the Stomach excite horrid pains, but there are scarce any clear signs by which they can be distinguished from others, except the continuance of the pain; sometimes they are ejected by Vomit; but we have a most notable instance of Stones adherent to the bottom of the Stomach, in Horstius, lib. Inst. p. 142. viz. Religiosus quidam nobilis ordinis Sancti Benedicti & Monasterii campidonensis custos septem circiter annos per Intervalla miris modis conflietatur cum morbis & praeter Ceteras res sapient de dolore circa regionem Cartilaginis ensiformis conquirebatur, post mortem apertus fuit & ventriculo Dissecto plures quam triginta calculos nunc majores nunc minores fundo ac substantiae ventriculi pertinacissime adhaerentes cum maxima adstantium admiratione extraxit. That several extraneous Bodies are oft-times found in the Stomach, being swallowed over, either wilfully or by accident; We have the Authority of Senner. lib. prax. 3. par.2. ser. 1. cap. XV. primo enim compertum est nummos, globulos plumbeos, clavas, mucrones gladiatorum & Cultorum, Secundo varia & monstrosa saepe in ventriculo genita aut quocunque modo producta & vomitu rejecta fuisse observatum est teste Forresto, & alis quamplurimis. Lapidis etiam ovi gallinacei magnitudine ibidem generari Schenk. lib. 3. obs. 9. capillorum veluti glomos, vomitu rejectos fuisse refert Monardes, lib. 3. De Hist. simpl. med. & notabilis, sed certa est Historia de extractione cultri ex ventriculo, & vulnus idonies medicamentis sanatum agerque vivus evasit. And amongst the Rarities in the Anatomy Hall at Leyden, there is preserved a Knife ten Inches in length, which was cut out of a Peasants Stomach, and he lived eight years after. It has been of a long time the received Opinion of Physicians, that Wounds in the Stomach were mortal, but we have also a late instance of the contrary, Philos. Trans. Numb. 219. It were easy to give a number of fresh instances of the swallowing down of Money, &c. and there are some late Accounts in Philos. Trans. but there is a Gentleman one Mr. Cameron, an Episcopal Divine, who some years ago in a frolick swallowed half a Crown, who is alive to this Day, and finds no great Inconveniency thereby. That Stones are not only formed in the Stomach, vesica urinaria, Reins and vesicula fellis, but also in all other parts of the Body, is without all controversy confirmed by manifold Observations and Experience, for Stones in the Brain, vide Philosoph Transact. Numb. 228. Stones cut out of the Kidneys, Numb. 233. Stones in the Ureters and Kidneys, Numb. 233. Stone as big as an Hens Egg in the Gall Bladder, Numb. 233. Stone bred at the root of the Tongue, Numb. 247. Tulpius in his obs. Med. lib. 2. cap. 25. has these words, Calculum ubivis Locorum in homine reperiri certum est. Vedit eum ex utero erumpere Hipp. ex pulmone Galenus, ex capite Hollerius, ab Intestinis Trincavellius ex Liene ac fellis vesicula ut alii, sic nos, ex Lingua ac colli glandulis, sed calculum qui in arteriis Invenerit equidem haec tenus inveni neminem, Paræus, lib. 25. ch. 15. says, he took one from a Man's Knee. Horst. lib. obs. 4. pag. 249. mentions one who voided Two hundred thirty three Stones per Annum, and another that voided One hundred and fifty: Page 150. relates a case where Two hundred were taken out of the Gall Bladder, some quadrangular and of a brown and yellow colour; but that which is more strange is, that Stones should be found even in the Heart itself. Horst. lib. 4. cap. 25. Quodque notatu dignum circa valvulas dextræ ventriculi calculum ex tartaro concretum instar minoris castaneæ nucis compressoris Membranose valvularum substantiae adnatam conspicitur, pag. 253. Historia medico rara & observata haud indigna de calculo, viz. Magnitudine nucis castaneæ minoris, post continuum capitis dolorem è naribus per palatum rejecto. For Stones found in angulis oculorum, vide Platerum, page 906. Ch. xv. aliquando emuntione calculum excrementum vidimus, expuitione cum tuis calculos rejectos fuisset non solum ego sed & alii observarunt; ex ore quoque alii calculi aliquando prodierunt, veluti e Linguae tumore, sicut aliqui notarunt: per annum calculum Scyballi formam experimentem redditum domi quoque asservamus, aliumque qui ex equi alvo prodiit in partu fetum Lapidescentem seu petrosum exclusum à matre se vidisse medicus quidam nostrì seculi clarus mihi narravit, idemque scripto publico testatus est. Cutis poros tophuli exigui innascuntur indeoque eximuntur per aperturas, sponte vel sectione factas, tophi & nodus podagricorum plures sæpenumerò prodierunt. Those Those Stones in the Nerves, are named by Paulus Aeginaeta, *Nodosae nervorum concretiones*. Now that Stones are generated in all parts of the Body, is almost clear to a Demonstration, confirmed by so many observations of credible Persons, but more ordinarily are formed in the Kidneys, and *Vesica Urinaria*, because more properly design'd to separate and contain the serum of the Blood, and for that reason Stones in the Reins, and *vesica urinaria*, are more troublesome to Persons afflicted therewith, than in any other part of the Body; (1.) Because the parts are more sensible; (2.) Because they stop the passage for evacuating the Serum, that is continually separating from the Blood, and by consequence distend the Vessels, and so cause horrid pains. As for the Figures and bigness of those Stones, that is a thing very uncertain, for they are found of all Forms and Shapes, some bigger, some less; some of a prodigious bigness, for which *vide Philosoph. Transact.* Numb. 222. and Tollet's Treatise of Lithotomy. Stones are not only found in Human Bodies, but also in several parts of other Animals, as Bezoar Stone found in the Stomach of a kind of Goat in both Indies, as also in the Stomach of Monkies (which is esteemed the best:) There is also a kind of Bezoar called Cow Bezoar, found in the Stomach of a Cow. *Hippolithus* found in the Stomach of Horses, *Aegagropila*, in the *Capra Alpina*. &c. it were needless to mention any more, these Instances being sufficient. The Writers of the *Materia Medica* ascribe great virtues to these Stones, and particularly the Bezoar, and have wrote large *Encomiums* upon them, to whom I refer. But if Physicians would consider seriously the true worth of them, and virtue in the Cure of Diseases, they would find, that their virtue proceeds more from their being brought from a foreign Country, and a common vogue and esteem they have got in the World, then from any intrinsick virtue they have in the cure of Diseases; and that which seems most to recommend them is their extravagant Price: Whereas we can name twenty Medicines in the Materia Medica, that each of them is as effectual, if not more, in the Cure of Diseases, and to be procured at less Charges. VIII. Part of a Letter from Mr. Bussiere to Dr. Sloane, wherein he gives an Account of the new way of Cutting for the Stone by the Hermit, with his Opinion of it. Here is the Description of the way of performing the Operation, for the extraction of the Stone out of the Bladder, by Brother James an Hermit in France, as I received it from Paris. He maketh use of a Steel Staff, much bigger and shorter than those which are commonly made use of; it is shorter from the top to the bending of it, it bends more than ours, he hath but two, one for Men and another for Children. His Conductor is slender and longer than ours, the point whereof, which goes into the Bladder, being of the Figure of a Lozenge, is wide and open in the extremity. His Forceps have longer branches than ours; but the holds of them are shorter and wider, with many large Teeth within.