An Abstract out of a Letter from Doctor W. Holbrooke of Manchester, to Dr. W. Cole, Fellow of the College of Physitians in London; Concerning Stones Voided by Stoole. With Dr. Cole's Answer to the Same

V. An Abstract out of a Letter from Doctor W. Holbrooke of Manchester, to Dr. W. Cole, Fellow of the College of Physicians in London; concerning Stones voided by Stoole. With Dr. Cole's Answer to the same. Manchester, September 4. 1700. SIR, I must beg your Patience a while longer, and desire your Thoughts of what I think a remarkable Case. One Crumbleholm came to me sometime ago, and complain'd of a great loss of Appetite, with Scorbutick Itch, and ever and anon severe Convulsive Cholicks below his Navel, all along the Hypogastrium. They last not above a quarter of an Hour, but often return, and raise Tumours the bigness of a large Walnut, which disappear and remove as the Pain shifts. He has been troubled with it some Years, and took Physick of almost every one he met with; but, as far as I can perceive, not in any regular Method, which gave me some hopes, that I might relieve him. Accordingly I began with mild Emollient and Carminative Glysters; purged with Decoct. Sen. Gereon. Syr. de Spin. cervin. & Tinct. Sacr. In the Intervals of the Purges I gave Ethiops Mineral, with bitter Decoctions Alterative, made more Carminative with Rad. Zedoar. and Caflor. He was relieved for that purpose; his Appetite and Complexion mended, but presently was as Ill as ever. Then he show'd me the Stones voided by Stoole, upon a slight Mercurial Purge, which he took last Easter. Upon opening one of them, I found he had swallowed either some Plumb or Apricot Stones, which by their stay in the Intestines were inclos'd in the Excrements, as I take it; and, by the Purge being dislodged from their Sinews, sent forth, as you find. Hoping then that by stronger Evacuations, if I could remove any other that might remain, it might tend to his Cure, I order'd stronger Medicines, of which the Bearer, who is my particular Friend, and was the Apothecary, can give you a more particular Account: However, I could not get any more from him; and he being out of hopes, and uneasy to be kept any longer from his Business, has left off taking any thing. Last Week I saw him, and found him much in the same Condition, tho' somewhat weaker, and sunk more in his Flesh. If you think by communicating this to any of your Friends, or making tryals of the other Stone untouch'd, you may be better satisfy'd in the Young Man's Case, or may think of any thing that may contribute to his Cure, please to signify it by the Bearer, and you will mightily oblige, Your very Humble And Obedient Servant, W. Holbrooke. Dr. Dr. Cole's Answer to the foregoing Letter. Dear Sir, I Received yours by Mr. Harrison, together with your very obliging Present, the two Human Bezoars, (if I may so call them;) but have as yet had little opportunity of having the Opinion of many Physicians here concerning them: One very Ingenious Gentleman, to whom I showed them, was an Acquaintance of yours, Mr Roger Kennion of Cambridge, who went on Monday last for France, who with Dr. Hobart, as also Dr Sloane, admire them. And now, Sir, as to the latter part of your Letter; I look upon these Stones to be not formed of adhering Excrements, as you seem to suppose, but to be made thus. When the Plumb-Stones happen to be included in a fit Glandulous Receptacle, I conceive they may come to be thus coated over by the viscous Liquor secreted out of the Secretory Ducts of those Glandules, which by long-lying there may come to acquire so great a Bulk, by the continual appulse of the same Liquor. This Receptacle I guess to be the Intestinum cæcum, which, tho' small naturally, may be, as other Membranous and Glandulous Parts are, capable of a considerable Extension: So that, when by reason of the Peristaltick Motion of the Intestines above, one of the Plumb-Stones may happen to be, by its pointed Extremity, intruded; the whole may, by the same repeated, tho' slow Motion, dilate the Cavity so, that the whole Body of the Stone may by the same Method be still farther and farther protruded, till it come to the further Extremity; which being closed, must be presumed to detain it there, since 'tis hard to conceive it can quickly get out out again, that Peristaltick Motion being always forward. One of these Stones being thus enter'd, 'tis easy to conceive more may be admitted, since the first cannot but dilate the Passage for another that follows, and so on till the Cavity be full. Whilst these Stones lie there, they must be conceived to offend the part, as having extended it beyond its Natural State: So that the Secretory Ducts of the Gland, of which the inner Coat of that, as well as the rest of the Intestines, is constituted, must be proportionally dilated; whereby an easier way is made for the Liquor, they separate, to be excreted. This being of a viscid and concrecible Nature, must, since it cannot get forth, be presum'd to adhere to the Substratum, the Stones, and so by degrees Incrust them; which Crust by the long confinement must grow so much thicker, for the same reason as it began, the Ducts being kept constantly open, and the Cavity more and more dilated the greater the Incrustation is. So that I conceive the Symptoms are easily accountable for, from the offence given to the part, which being sensible, as all membranous and fibrous Parts are, the Pain must grow greater, the greater the Extension is; and the change of the Posture of the Tumor may very well be conceived to proceed from the different Postures the Intestines put on, by the Chyle or Excrements passing along them, and sometimes filling one part, sometimes another, as they are protruded further and further, their Lubricity on the Surface, length, and confinement obviously favouring that Phenomenon. I am of Opinion, the true Bezoar Stones are form'd in the Beasts, that yield them, in the same manner; but whether their Stomachs or Intestines have other Cavities capable of receiving and retaining them to their full growth, is to be determined by Anatomy. This I think is certain, that all of them have either a Straw, Stick, or other Substance different from the Exterior terior Matter, which we call the Stone, in the middle of them; and thence I conclude the manner of their formation to be the same. From the continuance of his Symptoms, I believe there may be more behind; and cannot think any other Method more likely to extrude them, than by having his Abdomen well anointed with some Emollient Oyles or Liniments, and very well agitated backward and forward as much and as long as he can bear, and this both Morning and Evening: After a little while, that the Stones may be presum'd by this agitation to be somewhat dislodged, some gentle Purgatives I conceive may be of use to be now and then given to carry them downwards, and with all Emollient Glysters to sollicit it gently, &c. W. Cole VI. An Account of the Dissection of a Person, who dy'd of an Ulcer in the Right Kidney. By J. Douglas, M. D. F. R. S. I was desired lately to assist at the opening of a Gentleman, who dy'd the Day before, in the 45th Year of his Age; where I observ'd the following Particulars, relating to the Unusual Structure and Morbid Disposition of the Parts contained in the Cavities of the Thorax and Abdomen. 1. When the Skin with the other Integuments were taken off, I observed that part of the Omentum had thrust itself thro' the Annular Holes of the Abdominal Muscles on the Left Side, and there formed a Epiplocele, or Hernia omentalís, as large as a Walnut. 2. The