The Case of a Patient Voiding Stones Through a Fistulous Sore in the Loins, without Any Concomitant Discharge of Urine by the Same Passage: In a Letter to Dr. Maty, from Mr. S. F. Simmons

XII. The Case of a Patient voiding Stones through a fistulous Sore in the Loins, without any concomitant Discharge of Urine by the same Passage: In a Letter to Dr. Maty, from Mr. S. F. Simmons. Redde, Dec. 23, 1774. I have taken the liberty of addressing this letter to you, because, from your situation as Secretary to the Royal Society, and the reputation, you have acquired, in the literary world, I have no doubt of your being very ready to receive it favourably. If you think it sufficiently interesting, you will be pleased to communicate it to the Royal Society; but if you think, that it has neither enough of novelty, or utility, to merit a place in their Transactions, I beg the favour of you, to let it rest with you. ELEANOR PILCHER, the subject of it, is about 52 years of age, and lives at Littlebourn in Kent. About twenty-five years ago she first began to complain of pain in her back, of a difficulty in making water, and of other nephritic symptoms, which gradually increased. Soon after this she began to void gravel with her urine, and to pass several very small stones; and these symptoms continued to return very frequently, and with much much severity. About ten years after the first appearance of these complaints, a swelling came on in the left lumbar region, which, after having been very painful, for a considerable time, suppurred. This wound, which very soon became fistulous, has continued open ever since, and has constantly afforded an ichorous discharge. It was not till December 1772, fifteen years from the appearance of the tumour, that this discharge began to abate, and that the wound, from being perfectly easy, became painful and inflamed. During all this time the nephritic symptoms had continued to return, without any variation, the urine had constantly afforded a gravelly sediment, and several small stones had passed through the meatus urinarius; but these concretions were now about to take a different course. The pain in the back, which had commonly affected the left side, became much more intense than usual, but was not attended by any of the other symptoms, which had been the usual forerunners of a fit of the gravel. The discharge, from the wound, was suddenly diminished, and the pain and inflammation exceedingly increased, though the urine continued to pass in a healthy quantity, and without difficulty. These complaints continued, during eight days, and then a round and smooth calculus, weighing about twelve grains, was extracted, with some difficulty, from the wound. Since that time no gravel has been voided with the urine, though no urine ever passes through the wound; and six other paroxysms, like that I have described, have taken place, in which the same symptoms have occurred, and and which have terminated in a similar manner, so that seven calculi have passed through the wound, only two of which have been preserved, and the least of them weighs six grains. During the intervals of these paroxysms, the patient enjoys a state of ease and health; and the orifice, of the wound, soon after the exclusion of a calculus, returns to its usual size, admitting with difficulty a common probe. This case, of which I have endeavoured to give you an accurate history, appears to be a great proof of the powers of nature. The right kidney does not seem to be affected, and as no urine ever passes through the wound, it should seem, as if the secretion, by the left kidney, is destroyed; for, as no gravel is now voided with the urine, the left ureter is probably closed. The case however, though a very interesting one, is not perfectly singular, for Delechampius relates, that he saw a man who passed several stones, through an abscess of the loins, that had become fistulous. And Tulpius, in the fourth book of his Observationes Medicae, gives the history of a patient, who after undergoing much pain, from a nephritic complaint which he inherited from his father, at length passed a stone, from the kidneys, externally through the loins, which occasioned a callous ulcer, through which pus and urine were perpetually flowing. Neither time, or any of the remedies employed, afforded him any relief, but, the passage through the loins closing, and the matter taking a different course, an acute fever was at length brought on, of which the patient died. And the late Mr. Cheselden observes, that he had three patients, from from whom he had extracted small stones, which had made their way from the kidneys to the integuments, and there occasioned an imposthumation. But cases like these, though not perfectly new, seem to deserve to be recorded, as very rare ones, especially when they afford more interesting circumstances, than seem hitherto to have occurred. You will do me much honour, by acknowledging the receipt of this letter. I shall be very ready, to give any necessary information, you may wish to receive, on the subject. And am very respectfully, Sir, Your most obedient humble Servant, Wingham in Kent, Nov. 7, 1773. SAMUEL FOART SIMMONS.