Calculi

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 23 of 36)

In reviewing the statistics of vesical calculi, the strangest anomalies in their size and weight have been noticed. Among the older writers the largest weights have been found. Le Cat speaks of a calculus weighing over three pounds, and Morand is accredited with having seen a calculus which weighed six pounds. In his statistics in 1883 Cross collected reports on 704 stones, and remarked that only nine of these weighed above four ounces, and only two above six, and that with the last two the patient succumbed. Of those removed successfully Harmer of Norwich reports one of 15 ounces; Kline, one of 13 ounces 30 grains; Mayo of Winchester, 14 ounces two drams; Cheselden, 12 ounces; and Pare in 1570 removed a calculus weighing nine ounces. Sir Astley Cooper remarks that the largest stone he ever saw weighed four ounces, and that the patient died within four hours after its removal.

Before the Royal Society of London in 1684 Birch reported an account of a calculus weighing five ounces. Fabricius Hildanus mentions calculi weighing 20 and 21 ounces; Camper, 13 ounces; Foschini, 19 ounces six drams; Garmannus, 25 ounces; Greenfield, 19 ounces; Heberden, 32 ounces; Wrisberg, 20 ounces; Launai, 51 ounces; Lemery, 27 ounces; Paget, in Kuhn's Journal, 27 ounces (from a woman); Pauli, 19 ounces; Rudolphi, 28 ounces; Tozzetti, 39 ounces; Threpland, 35 ounces; and there is a record of a calculus weighing over six pounds. There is preserved in Trinity College, Cambridge, a stone weighing 34 ounces taken from the bladder of the wife of Thomas Raisin, by Gutteridge, a surgeon of Norwich. This stone was afterward sent to King Charles II for inspection. In his "Journey to Paris" Dr. Lister said that he saw a stone which weighed 51 ounces; it had been taken from one of the religious brothers in June, 1690, and placed in the Hopital de la Charite. It was said that the monk died after the operation. There is a record of a calculus taken from the bladder of an individual living in Aberdeen. This stone weighed two pounds, three ounces, and six drams. In the Hunterian Museum in London there is a stone weighing 44 ounces, and measuring 16 inches in circumference.

By suprapubic operation Duguise removed a stone weighing 31 ounces from a patient who survived six days. A Belgian surgeon by the name of Uytterhoeven, by the suprapubic method extracted a concretion weighing two pounds and measuring 6 1/2 inches long and four wide. Frere Come performed a high operation on a patient who died the next day after the removal of a 24-ounce calculus. Verduc mentions a calculus weighing three pounds three ounces. It was said that a vesical calculus was seen in a dead boy at St. Edmund's which was as large as the head of a new-born child. It has been remarked that Thomas Adams, Lord Mayor of London, who died at the age of eighty-two, had in his bladder at the time of his death a stone which filled the whole cavity, and which was grooved from the ureters to the urethral opening, thus allowing the passage of urine. Recent records of large calculi are offered: by Holmes, 25 ounces; Hunter, 25 ounces; Cayley, 29 ounces; Humphrys, 33 ounces; Eve, 44 ounces; and Janeway, 51 ounces. Kirby has collected reports ol a number of large vesical calculi.

Barton speaks of stone in the bladder in very young children. There is a record of a stone at one month, and another at three years. Todd describes a stone in the bladder of a child of sixteen months. May removed an enormous stone from a young girl, which had its nucleus in a brass penholder over three inches long.

Multiple Vesical Calculi. Usually the bladder contains a single calculus, but in a few instances a large number of stones have been found to coexist. According to Ashhurst, the most remarkable case on record is that of the aged Chief Justice Marshal, from whose bladder Dr. Physick of Philadelphia is said to have successfully removed by lateral lithotomy more than 1000 calculi. Macgregor mentions a case in which 520 small calculi coexisted with a large one weighing 51 ounces. There is an old record of 32 stones having been removed from a man of eighty-one, a native of Dantzic, 16 of which were as large as a pigeon's egg. Kelly speaks of 228 calculi in the bladder of a man of seventy-three, 12 being removed before death. The largest weighed 111 grains. Goodrich took 96 small stones from the bladder of a lad. Among the older records of numerous calculi Burnett mentions 70; Desault, over 200; the Ephemerides, 120; Weickman, over 100; Fabricius Hildanus, 2000 in two years; and there is a remarkable case of 10,000 in all issuing from a young girl. Greenhow mentions 60 stones removed from the bladder. An older issue of The Lancet contains an account of lithotrity performed on the same patient 48 times.

Occasionally the calculi are discharged spontaneously. Trioen mentions the issue of a calculus through a perineal aperture, and there are many similar cases on record. There is an old record of a stone weighing five ounces being passed by the penis. Schenck mentions a calculus perforating the bladder and lodging in the groin. Simmons reports a case in which a calculus passed through a fistulous sore in the loins without any concomitant passage of urine through the same passage. Vosberg mentions a calculus in a patent urachus; and calculi have occasionally been known to pass from the umbilicus. Gourges mentions the spontaneous excretion of a five-ounce calculus; and Thompson speaks of the discharge of two calculi of enormous size.

Of the extravesical calculi some are true calculi, while others are simply the result of calcareous or osseous degeneration. Renal and biliary calculi are too common to need mention here. There are some extraordinary calculi taken from a patient at St. Bartholomew's Hospital and deposited in the museum of that institution. The patient was a man of thirty-eight. In the right kidney were found a calculus weighing 36 1/2 ounces, about 1000 small calculi, and a quantity of calcareous dust. In the left kidney there was a calculus weighing 9 3/4 ounces, besides a quantity of calcareous dust. The calculi in this case consisted chiefly of phosphate of magnesium and ammonium. Cordier of Kansas City, Mo., successfully removed a renal calculus weighing over three ounces from a woman of forty-two. The accompanying illustration shows the actual size of the calculus.

At the University College Hospital, London, there are exhibited 485 gall-stones that were found postmortem in a gall-bladder. Vanzetti reports the removal of a preputial calculus weighing 224 grams. Phillipe mentions the removal of a calculus weighing 50 grams from the prepuce of an Arab boy of seven. Croft gives an account of some preputial calculi removed from two natives of the Solomon Islands by an emigrant medical officer in Fiji. In one case 22 small stones were removed, and in the other a single calculus weighing one ounce 110 grains. Congenital phimosis is said to be very common among the natives of Solomon Islands.