A Remarkable Instance of Four Rough Stones, That Were Discovered in an Human Urinary Bladder, Contrary to the Received Opinion; And Successfully Extracted by the Lateral Method of Cutting for the Stone. By Mr. Joseph Warner, F. R. S. and Surgeon to Guy's-Hospital

LXXVI. A remarkable Instance of Four rough Stones, that were discovered in an human urinary Bladder, contrary to the received Opinion; and successfully extracted by the lateral Method of Cutting for the Stone. By Mr. Joseph Warner, F. R. S. and Surgeon to Guy's-Hospital. Read Feb. 23. 1758. THE favourable reception those few papers have met with from the Royal Society, which I have done myself the honour of addressing to them, encourages me to take the liberty of offering the following account to their consideration: and I am the more immediately induced to submit this paper to their perusal, as the fact hereafter related may possibly be not esteemed a matter of mere curiosity; since it is probable, that the inferences deduced from the history of the subsequent case, when attended to, may prove of the greatest consequence to the future ease and welfare of the patient, as well as be a means of preventing the operator from falling into such errors, as cannot fail of drawing an imputation upon his character, in the practice of one of the most capital and difficult undertakings in his profession. It is a maxim laid down by the most judicious and best received writers upon operations in surgery, that when the surface of a stone, which has been extracted from the bladder, appears to be totally rough, it amounts to a proof of its having been there there alone. But notwithstanding I admit it is from experience found, that the observation is in general well grounded, it may nevertheless appear, from the following case, that this rule is not unexceptionable; for which reason perhaps it may be thought right, that we should not be determined from circumstances only; but, on the contrary, that it is necessary for every surgeon to take such methods during the operation, as will enable him to judge with that degree of certainty, without which he cannot be enabled to do so. The methods I would recommend are these: That after the extraction of a stone from the bladder, tho' the whole of its surface be rough, the operator should nevertheless introduce the forefinger of his left or right hand thro' the wound into the cavity of the bladder; by which means, if the subject be under twelve years of age, he will be enabled to come in contact with every internal part of the bladder with his finger: but if the subject be an adult, and of a corpulent habit of body, the finger, under these circumstances, not being found to be sufficiently long for the purpose, he must have recourse to a female catheter, or some other instrument that is nearly strait, quite smooth and polished, and of about nine or ten inches long; which will serve the purpose equally well, if of a proper form and thickness. This is the method I have made use of upon the like occasions of late years, without giving any great degree of pain to the patient, or considerably retarding the operation. Since I have had the opportunity of making the following observation, as well as a prior observa- tion something similar to this, where two rough stones were extracted by me a few years ago from a young man's bladder of 15 years of age, I cannot help suspecting, that there may have been instances of one or more stones being left behind in the bladder at the time of operating, merely from the operator's putting too great a confidence in this general rule. Which suspicion I am led into from having known people, who have undergone the operation of cutting for the stone, relapse into the like disorder in a short time after the healing of their wounds, attended with such symptoms, as have obliged them to submit to a second operation; when the stone, upon being extracted, has appeared of so considerable a size, as to make it suspicious, that this stone must probably have been of a much longer growth, than the short time betwixt the two operations could admit of. The maxim laid down to us by authors, of a smooth and polished stone in the bladder being never there alone, but always accompanied with one or more stones of the same kind, I know no exception to. But if this phenomenon should ever occur, the strict observance of that rule (delivered to us by judicious writers in surgery) of always searching the bladder under the like appearances, on presumption of one or more stones being left behind, cannot be attended with any future mischief to the patient, when carefully executed by the methods recommended above, and undoubtedly should always be strictly attended to. The smooth and polished appearances of the surfaces of human calculi are universally supposed to arise from their rubbing one against the other; which may with reason be sup- posed to be the case: but I confess this inference is not satisfactory to me; since it is probable, if this was the sole cause of their smoothness, the same effect would probably be always produced, when attended with the same degree of friction. But as this may be considered as a matter of mere speculation, I refer the decision of this point to those of superior abilities. CASE. Mr. William Woodhams, a gentleman farmer, of a corpulent habit of body, in the 46th year of his age, now living in the parish of Udimore, within three miles of Rye in Sussex, was attacked about eight years ago with severe complaints in his loins, accompanied with an incapacity of voiding his urine without the assistance of proper medicines, which were administered to him by a neighbouring apothecary for that purpose. These medicines had the desired effect: they promoted a secretion, and an evacuation of urine; which appeared to be loaded with a considerable quantity of gravelly particles mixed with a mucus of a whitish colour. In the space of three weeks he had perfectly recovered from this attack, and continued well for near five years afterwards, without any return of his complaint, except when he rode hard on horseback, or drank more freely of strong liquors than usual. At the expiration of five years he was seized with an acute fever, of which he recovered in a few weeks. Very soon after his recovery from this illness, he began to complain of excessive pain in voiding his urine, or upon going to stool; which symptoms were were so greatly increased for many months before he submitted to the operation, as to quite disable him from riding, from walking, or from using any kind of exercise. His urine, of late, was continually and involuntarily flowing from him in small quantities. He complained of great pain and soreness in his fundament, attended with a tenesmus. This account he delivered to me on the second day after the operation; and at the same time he very feelingly told me, that he had enjoyed but very few and short intervals of ease for the three last years, till since the operation. On the 30th of January 1758, I cut him, at his own house in Sussex, having first prepared him for the operation in the manner, that is usual upon the like occasion. In the operation, I extracted the four stones, which I now have the honour of laying before the Royal Society. The whole surfaces of these stones appear to be rough, not having the least marks of ever having rubbed against each other during their confinement in the bladder: but yet I conjecture this must frequently have been the case, as there was no difficulty in embracing these calculi with the forceps: for had they been contained in different cells or pouches in the bladder, which sometimes have been observed from dissections, this circumstance would, in all probability, have rendered it impracticable for me to have so immediately got at them, if at all. The forceps was introduced only three times into the bladder for effecting the extraction of the three first stones, and only twice for the extraction of the fourth stone. Besides these four stones, which I have presented to the Society for their inspection, I thought it it not improper to produce, at the same time, some other human calculi, for their further satisfaction, each of which was found single in the urinary bladders of different subjects. The surfaces of these stones may be observed to be much smoother than the surface of either of the four stones, that were extracted from Mr. Woodhams's bladder in the operation I have just now recited; and therefore it was more reasonable to expect to find each of these stones accompanied with one or more stones in the same bladder (according to the received opinion), than it was to find more stones than one in the case of Mr. Woodhams's, which has given rise to these observations. But as the fact before us does of itself shew the impropriety and danger of determining from the surfaces of such extraneous bodies, perhaps it may be thought needless to enlarge upon this subject, to strengthen those precautions so reasonable to be observed in this operation. However, as I have already taken notice of the smooth and polished appearances of the surfaces of such stones, as are probably never found single in the bladder; I have produced two stones of this kind, that were extracted from the same bladder, to shew, that these stones do no more resemble those stones of Mr. Woodhams's, than a piece of polished marble can be said to resemble a rough block of the same species. P. S. I am informed, by a letter from Sussex, dated the 18th instant, that Mr. Woodhams is perfectly well in health; that the whole of his urine had passed through the urethra for the last This Plate is an exact representation of the sizes and external appearances of the four rough stones described in the preceding paper. J. Mynde sc. last five or six days; and that his wound will, in all probability, be soon healed. Hatton-Garden, February 22. 1758. Joseph Warner. LXXVII. Observations on the Limax non cochleata Purpur ferens, The naked Snail producing Purple. By John Andrew Peyssonel, M. D. F. R. S. Translated from the French. Read Feb. 23, 1758. Among the fish we meet with in the seas of the Antilles of America, we find, that this I am going to describe will appear precious, from the beautiful purple colour it produces, in the same manner, that the cuttle-fish produces its ink, if a means could be found to procure this liquor in a sufficient quantity to render it an article of commerce. These fishes are soft, viscous, without shells, scales, or bones; are of the nature of the polypi, and such other kinds, without feet, fins, or any thing to supply their places. Their motion is vermicular; and, like the slugs, they wreath themselves up, and when touched make themselves quite round. They fill up certain membranes of the body with water. Their local motion; antennæ, which they lengthen and contract; and a great many other properties, which they have in common with snails, slugs, and turbinated shell-fish, made me call them naked snails: and altho' they have not the most ef-