j£ro ^ '^   (?. /-^ J
REPORT
OF THE
COMMITTEE ON THE
STATISTICS OF CALCULOUS DISEASE
IN OHIO, MADE TO THE
OHIO STATE MEDICAL SOCIETY,
AT THE ANNUAL MEETING,
HELD IN COLUMBUS, JUNE, 1850.
BY E. H. DAVIS, M. D.
    COLUMBUS:
STEAM PRESS OF S. MEDARY
       1850.
 
 
REPORT
OF THE
COMMITTEE ON THE
STATISTICS OF CALCULOUS DISEASE
IN OHIO, MADE TO THE
OHIO STATE MEDICAL  SOCIETY,
AT THE ANNUAL MEETING,
HELD IN COLUMBUS, JUJfE, 1850.
     COLUMBUS:
STEAM PRESS OF S. MEDARY.
         1860. 
  The Author  being  absent at  the time of publication, the proof
sheets were not submitted to his inspection, and consequently many
errors occur in  this Report. 
REPORT OF THE COMMITTEE  ON THE STATISTICS OF
             CALCULOUS DISEASE IN OHIO.
   Your committee, in pursuance of the resolutions passed by the late
 meeting of the Ohio State Medical Society, beg leave to report, that
 they entered upon their duty in January last, by collecting the statis-
 tics  within  their own counties; and, also, by issuing the following
 circular,  propounding certain questions, and asking the co-operation
 of the Medical Faculty throughout the State.

                           CIRCULAR.

   The question being under discussion, whether geological formations
 have  any influence  in the production of certain  diseases, such as
 cholera, gravel,  goitre, <fcc, the following resolutions were offered,
 by Dr. Davis:

 Whereas, the question is unsettled whether geological formations have
   any influence in the formation or modification of calculous disease,
   and as the State of Ohio is considered favorable for collecting statis-
   tics on this subject, her territory being  nearly equally divided be-
   tween the limestone and coal, or freestone formations; therefore,
   Resolved,  That  this Society consider the subject of sufficient im-
 portance to recommend the medical profession in each  county of this
 State  to  collect all the statistics  in reference to calculous disease in
 their  respective  counties, and forward the same to a  committee ap-
 pointed by this Society.
   Resolved,  That a  committee of  three be appointed  to collect and
 arrange the statistics upon this  subject, and  report the same to the
 next annual meeting of this Society.
                              E. HAMILTON DAVIS, M. D.,
                              Prof. J. P. KIRTLAND. M. D.,
                              Prof. R. D. MUSSEY, M. D.
                                                     Committee.

                                  Chillicothe, February, 1850.

   Dear Sm—Will you be kind enough to collect the statistics in
reference  to  calculous disease in your county, in accordance with the
wish of the  State Medical Society, and  forward  the same to me in
time to incorporate the facts into a report for the next annual meeting,
to be held in the first week in June next.   Due credit will be given
for all facts furnished.
   To facilitate  and simplify the matter, it  would be well to  arrange
the facts in the  following order, viz : 
4
   1.  The number of cases of calculous disease that have  occurred
in your county for the past ten or twenty years.
   2.  The number of cases operated on, and by whom.
   3.  The number of cases determined by post  mortem examina-
tion.
   4.  The number of cases passing sand or gravel per urethra.
   5.  The number of cases determined by sounding, and not other-
wise.
   The age and  sex of the subject; his native country ; length  of
residence in the  locality where  disease was developed; the number
and character of the calculi; the kind of water prevailing, and rocks,
in your county, are facts very much desired wherever they can be
furnished.   Have you ever known any of  the domesticated animals
afflicted with this disease?   Have you  any specimens of calculi ana-
lyzed, or that you would like to have analyzed?
   It is hoped that all who desire to increase the the number of medi-
cal facts, to aid and promote the profession, and increase its usefulness,
will attend to these statistics, and forward the results as soon as prac-
ticable.   By so doing, they will  place  the  committee, as  well as the
profession at large, under lasting obligations.
                           Most respectfully yours,
                                      E.  H. DAVIS, Chairman.

   About two hundred copies of this  circular were  sent to the profes-
sion throughout the State,  and  we regret  to  say that not more than
thirty replies have been  received.  Notwithstanding this partial at-
tention to the subject, a considerable amount of valuable knowledge
has been  collected, sufficient to  increase greatly our  interest  in the
subject, and  to  awaken a  desire for  like  information from  the re-
mainder of the State.
   It is with this view that  your chairman  consents  to lay before the
Society  the few  facts  already obtained, hoping they may serve  to
stimulate the profession in the parts of the State not yet heard from,
to attend  to  the request of the  Society,  by sending forward their
statistics during the coming year, so as to enable your committee to
make a full and complete report upon this subject at their next meet-
ing.
   We think  it unnecessary to  introduce any argument to prove the
importance of collecting such  medical statistics:  for  it must be ob-
vious to every thinking mind that this is the only true mode of arriving
at distinct  views or accurate conclusions upon most subjects.  This is
more especially the case when applied to  the branches of public hy-
giene and etiology of disease.   It is  in  this way only that  we can
demonstrate the  existence  or  comparative  frequency of disease  in
different countries.  It enables  us  to  determine  the success of the
various measures resorted  to for the purpose of removing the  causes
or relieving the evils attendant upon disease.  They  may also become
useful as a means of estimating the comparative value of the different
systems of medical practice.  But in the  present  investigation our 
5
object is to determine whether calculous disease is  more frequent in
limestone than coal districts; and, also, whether the chemical charac-
ter of the calculi are the same in the two geological  formations.
   According  to  some  medical  philosophers, "man is  the fair ex-
ponent of the principles contained in the soil on  which he  lives."
Without assenting wholly to this proposition, we can readily conceive
how  many substances may be introduced into the  human system in
the  water we drink — particularly that obtained from  springs  and
wells.  This  water first  perculates through  the soil, collecting car-
bonic acid, which enables it to dissolve and hold in solution the various
salts of lime,  magnesia, and other substances.  This is evidently the
case throughout  the limestone region: for when the water becomes
exposed to the atmosphere, or to  the boiling temperature, the carbonic
acid passes off, causing a deposit of earthy salts in a solid form, such
as the stalactites and incrustations of caverns, and the hard calcareous
coating on the inside of tea kettles used in those districts.
   The analyses of  the water  in  different parts of the State have not
been brought to that state of completeness to justify  their introduction
here ; yet' we may mention some of the  general results.  From an
examination of the water in Muskingum, Trumbull, and Washington
counties, situated in the coal measures, made by Drs. Holston, Nichols,
and  Hildreth, we find the  carbonate of lime, magnesia, and the
chloride of sodium, to be in much smaller proportion, when compared
with the results from the limestone water, whilst the sulphates of iron,
soda, magnesia, lime, alumina, and potassa, are in much greater pro-
portion.   We find, on  evaporating  an ounce of water from wells in
this  vicinity,  there is  left from   10 to 35-100ths of a  grain of solid
matter, which proves to be mostly carbonates of lime and magnesia.
This very nearly agrees with the examination made by Prof. Peter
on the limestone water of Lexington, Ky.   He remarks in his valuable
paper on Urinary Calculi: " If we suppose only two-tenths of a grain
of these earthy carbonates are contained in an ounce of water, we
have 3.2 grains to the pint; and  if a person drinks half a gallon of it
in a day, he takes into his system at the same time  12.8 grains of car-
bonate of lime and magnesia, which will unite with any of the acids
of the animal  economy, and thus tend to neutralise those fluids,  se-
cretions or excretions, which are naturally in an  acid  condition."
Now if these  various salts are introduced into the  fluids in excess, it
is quite evident, the only way the  system has of  relieving itself of
such substances is by passing them off in  excretions from the kid-
ney.
   This sudb.  being the state of facts, we might suppose, a priori—that
water contaminated with  such impurities would not only increase the
number of calculous affections, but also give character  to the calculi
themselves.  In justice to your committee, it may be well to remark
here, that they are not wedded to any preconceived opinions, or de-
fenders of any particular theory, but only seekers after truth, desiring
the facts to speak for themselves  ; we therefore proceed immediately
to them. 
6
   The State of Ohio, as you will perceive by the accompanying cut,
is nearly equally divided between the geological formations, denomi-
nated the blue and cliff limestone on the west, and  the sandstone, or
coal bearing series on the east.   True, there are circumstances that
may modify or change the effects of these formations to some extent.
For instance, portions of our State  are  covered, to a  considerable
depth, by drift, which may  exert some influence on the character of
the water in those parts.  On the other hand, some  of our rivers take
their rise in  the limestone formation, (the Scioto for instance,)  and
then pass down through the shale and sandstone series, bearing in their
waters a solution of the salts of lime  and magnesia, and  depositing
the lime pebble in all their  alluvions.   There  are also a  few thin
strata of lime scattered throughout the coal measures.   But these cir-
cumstances are  not  considered sufficient to vary much the general
results.
  We have received from twenty-two counties tolerably full reports,
and partial ones  from eighteen more;  making  forty out of eighty-
four, the whole  number in the State.  The  counties heard  from,
although not half  in number, yet contain rather  more  than half
the population of the State.   In this number the reports show the ex- 
7
istence of calculous disease in thirty-five, and that there has not been
a case observed in the other five tor the past twenty years.
  We have been struck with  the remark made by most of our cor-
respondents, that this disease is by no means frequent in their county.
Yet we  think, by comparing  our statistics with those of other coun-
tries,  we will find they stand quite high on the list.
  In order to condense most of the facts  into as small a compass as
possible, we have arranged ie the following table.    By doing so, we
lay the whole matter, with our authorities, before the  profession, hoping
they will correct any mistakes that have  been made in time for the
next report.
   1.  The county.  2.  The initial letter standing  for the  geological
formation.   3.  Number of years observed.   4.  The whole  number
of cases.  5. Number of operations.  6. Number determined by post
mortem examination.  7.  Nnmber passing sand or gravel.  8. The
sex.   9. The surgeon operating.  10. By whom reported. 
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6 
10
    We do not claim that our reports are full or entirely complete, ex-
  cept in a few counties.   Taking their returns as data, we feel justified
  in stating that not more than \ of the cases that have occurred in the
  40 counties within the average period of observation, (15 years) have
  been returned.   We, therefore, think it proper to add the supposed
  deficit of 25 per cent, to the number reported, in making an estimate
  for the State.  The time for which the statistics are collected varies in
  the different counties  from five to twenty years.    The population of
  the 40 counties, by the census of  1840, was about 900,000, or three
  fiths of the whole State.   The number of cases reported  as operated
  on are  74.   Number determined by  post mortem examination 13.
  Number passing sand or gravel 64.   If we are  correct in adding 25
  per cent, for  the supposed deficiency in the returns, we will have the
  following results  for the  whole State.    Average  population of the
  State for the past 14 years 1,600,000—average number of cases ope-
  rated on per annum, adding those  determined by post mortem exami-
 nation  12, making about one operation per annum for 135,000 inhabi-
 tants.
   But when we compare the results taken from the  counties situated
 in the two geological formations, we find them presenting the follow-
 ing difference.  In 18 counties  situated in the limestone  region, in-
 cluding those  along the Scioto valley, with a population of 394,000—
 average time  of observation 12 years, we have reported 46  cases by
 operation, and 10 by postmortem examination   Adding one fourth to
 complete the returns, it then shows  the proportion  to be  1 case per
 annum to about 60,000  inhabitants, whilst on the other hand, 22
 counties in the sandstone and coal series, with a population of 552,000
 —with an average  time of observation of 16 years,  report 28 opera-
 tions—2 cases by post mortem examination.  By adding  one fourth
 as  above, we have 1 case  per annum to 238,000 population—show-
 ing this disease as represented by the operations and post mortem ex-
 amination, to be nearly 4 times  more frequent in the limestone forma-
 tions than in the coal series.
   The question very naturally presents itself here,  whether the blue
 or cliff  limestone  favors  most the  formation of these concretions ?
 We would remark that our reports  have not been sufficiently numer-
 ous to draw any positive conclusions, but  so  far as they go, they fa-
 vor the idea, that such cases are most numerous in the blue limestone.
 We will give here the comparative frequency of the  disease, from the
 reports  in a few localities in this State,  and then compare them with
those of other counties.
  Brown county----------------------1 case per annum in  20,000
  City  of Dayton--------------------1 case per annum in  25,000
  City  of  Columbus__________________1 case per annum in  30,000
  City of Cincinnati----------________1 case per annum in  80,000
  To account for the great difference exhibited between Cincinnati and
 the other points mentioned, we find a sufficient reason in the fac.t,  that
most of the water used in that city is taken from the Ohio river, which
is but slightly contaminated by calcareous impurities. 
11
  From Dr. Peter's paper alluded to above, it is evident that calcu-
lous affections are more frequent in Kentucky than in any other part
of the world in which inquiries regarding this subject have been insti-
tuted.   This inference is confirmed by the fact, that Dr. Dudley, the
distinguished  Surgeon of that State, is said to have performed the
operation of lithotomy some 200 times.  Lexington, from whence Dr,
P. draws his facts, is situated on the blue limestone, which formation
extends into Ohio as far north as Dayton.
  We here subjoin a table  showing the relative  frequency of this di-
sease in different countries :
Countries.
Ireland,  (the pauper population)______
     "   City of Cork........_______
Bohemia____________________________
Islands of Malta_____________________
Cornwall and Devonshire. (England) __
Glasgow____________________________
Ionian Islands____________,.__________
Bristol, (England)___________________
Lombardy__________________________
London_____________________________
County of Norfolk___________________
Copenhagen________________________
City of Norwich_____________________
City of Lexington_________.__________

   This fact must be kept in  view in comparing these tables, that those
of Ohio  and  Kentucky  represent the whole number of cases, while
the rest represent those only in hospital practice.
   Your  committee would further state, that of the 74 operations re-
ported, 72 were by cutting  and 2 by crushing.  In all this  number,
but 6 are reported as unsuccessful, and 2 that required a second ope-
ration. This success compares favorably with like statistics from other
countries.
   * In the Pennsylvania Hospital, 83 cases have undergone the ope-
ration  with the following result: 72 cured,  10 died and 1 is set down
as relieved,   f Dr. Smith,  of  Bristol,  England, furnishes  a table of
354 operations in that country, which shows the  following  figures:
275 cured, and 79 deaths;  or when compared, thus—
  *Report of the committee on Surgery—Trans, of the Am. Med. Ass. 1848.
  tStatistical inquiry into the frequency of Stone in the bladder in Great Bri-
tain and Ireland.
No. of cases per
    annum.
in 875,000
in 800,000
in 347,000
in 300,000
in 293,000
in 77,000
in 60,000
in 41,000
in 38,500
in 38,000
in 34,000
in 22,000
in 21,000
in 16,000
Authority.
r.  Yelloby
'   Civiale
Smith
Yelloby
Civiale
Yelloby
Civiale
Yelloby

Civiale
Yelloby
Peter 
12
  Dr. Smith's table  for  England and Ireland—354 operations, 79
deaths, or 1 in 4^.                                   #
  Pennsylvania Hospital, 82 operations, 10 deaths,  or 1 in 85.
  Ohio Report, 72 operations, 6 deaths, or 1 in 12.
  With  regard to the sex and  age of the subjects  operated on, we
have the  following exhibit:  In 71  cases in which the  sex is reported,
66 are males and 5 females, or about 7 per cent, females.  In 45 cases
reporting the age, it stands thus :
  Between  4 and 10 years of age--------......   14 cases.
    do      10 and 20       do      -----........-   10  do
    do      20 and 30       do      ---------------    6  do
    do     30 and 50       do      .....-------    8  do
    do     50 and 70       do      .....---------    5  do
    do      70 and 84       do      .....---------    2  do
  The oldest patient operated on being 84—the operation performed
by Dr. Acklby,  of Cleveland.
  The number of calculi in seven instances, are reported to be from
2 to 5.  In the Lexington collection 31 were taken from one patient.
Dr. Bird, in his paper on the calculi of Guy's  Hospital, remarks that
142 were removed from a single person.  In the case  of the late Chief
Justice Marshall, the number was said to amount  to 1,000.  In two
post mortem examinations  made in Ross county,  by Dr. Scott and
myself, there were found in  one case 127  calculi, and 81 in the other,
varying in size from a mustard seed to that of a hickory nut.

              CHEMICAL  CHARACTER OF THE CALCULI.

  We have not  been  able to collect  calculi  from  a  large number of
subjects.   Most  persons afflicted with this disease being desirous of
retaining  the  object which  was the source of  so much pain.  Many
other specimens  have found their way into the  cabinets of Medical
Colleges,  the proper place for them, provided the faculty of the insti-
tutions would  collect their true history, and furnish  it, together with
an accurate analysis, to the profession.  We have over 200 specimens
of calculi taken from 12 human subjects, and 11 from domestic ani-
mals, viz :  the horse, cow, sheep, hog  and dog.   As yet, we have not
completed the  analysis of all the  specimens, but we  will  give the re-
sults of an examination made by my friend Prof. Peter, of Ky., on a
few specimens sent him, together with those made by others of this
State.  Dr. P. returns the following statements :
   Calculi marked No. 1, part of  127  taken from Mr. L. of Ross co.,
Ohio, post mortem, contained a nucleus composed of  nearly pure uric
acid—the exterior layers contain a little  urate of ammonia and some
oxalate of lime, with  traces of phosphates.
   Calculi No.  2,  part of 81  taken from Mr. O, Ross co., A. D., 1845,
was principally what is called fusible  calculi, or a mixture of phosus-
pkate of lime, with the ammonio-phospkate of magnesia, and a trace of
uric acid. 
13
  Dr.  Holston,  of Muskingum county, sends the following account
of a stone removed and examined by himself:  "Stone large and ex-
ceedingly hard—weight, 7g. 33., externally grayish brown, internally
pure white, of lamellated structure.  A fragment heated to redness in
a platinum crucible,  blackened without swelling, then became white
externally ; but on being reduced to powder its color was gray.  Di-
lute nitric  acid  dissolved it.   Under the most intense heat produced
with the mouth blow-pipe,  a small fragment exhibited signs of fusion
at the corners ; on analysing 8 gr. it was found to consist of

     Phosphate of lime-------------   87.50>  minonarts
     Animal matter not analysed____   12.50$        ^
   Drs.  Mtjssey, Howard,  and other surgeons of this State, have re-
marked that their collections  principally consist of phosphates  of
lime and  magnesia, with but  few specimens of pure uric  acid, and
mulberry varieties.
   It is evident, from the few results already obtained from examina-
tion of calculi in Ohio, that they possess most of the peculiarities of
those in the Kentucky collection.   For the purpose of understanding
more fully these peculiarities, we copy some of the results of an ex-
amination made  by Prof.  Peter on 78 human calculi found in the
Medical Museum of Lexington, Ky., which is  undoubtedly the most
extensive and authentic of any yet made in the Mississippi Valley.
   He found the Nuclei to consist as follows :

Out of  78—
         Uric acid      mainly  in...................   32
         Urate of ammonia do     ...................   26
         Oxalate of lime   do     ...................    7
         Phosphates       do     ...................    7
         Foreign substances do     ...................    4
         Cystine           do     ...................    2

           The  Bodies are composed as follows :
         Of Uric acid.........................-----   34
         Of Urate of ammonia, <fec,.................    2
         Of Oxalate of  lime........................   16
         Of Mixed phosphates.......................   16
         Of Triple phosphates.......................    4
         Of  Cystine...............................    2

In addition—
          Uric acid exists in  notable proportion in......    4
          Urate of ammonia   do       do       ......   24
          Oxalate of lime      do       do       ......    9
          Mixed phosphates   do      do       ......   12
          Phosphate of  lime   do      do       ......    5 
14
The Cortex, or outer layer, was of Uric acid in..........   37
           Of Urate of ammonia with phosphates in----    2
           Of Oxalate of lime......................    9
           Of Mixed phosphates.....................   37
           Of Triple phosphates......,..............    2
           Of Cystine.............................    2

  The peculiarities presented by the Lexington collection as compared
with others whose history is known,  are as follows :
  A.  As regards the Nuclei.
  1.  A great deficiency in the proportion of  uric acid.
  2.  A great excess in the proportion of nuclei of urate of ammonia,
and of the earthy phosphates.
  B. In relation to t/ieir general composition.
  The same peculiarities pointed  above, in regard to nuclei, with the
additional one:
  3.  An excess in the proportion of the mulberry, or oxalate of lime,
calculus.
  From a careful review of the  chemical nature of the food and water
of this district, Dr. Peter arrives at the  following  conclusions, which
are  also applicable to a large  portion of  Ohio :
  " It appears,  therefore, highly probable that the use of  the lime-
stone water, and a corn and bacon  diet,  may be the principal cause
of the great excess in the  earthy phosphates  and oxalate of lime in
the  calculi of this region ; that  the earthy carbonates in the water, by
neutralizing to some extent the natural acidity  of some of  the animal
fluids may  be the cause of the very small proportion of pure uric acid,
and the great proportion of urate of ammonia to be found in them; and
that both these causes acting together with, and superadded  to all the
other circumstances predisposing to urinary deposits to be found every
where occasion the great increase in the proportion of calculous  dis-
ease which is presented in this country."

                     general observations.

  From the foregoing  facts, the question may arise, how shall the evils
growing  out of the use  of well and spring water be averted ?   We
would recommend those afflicted with this disease to use  rain water,
which may be collected in deep cisterns, where it will remain sweet
and pure for  any length of time.  But  when  it is not  practicable to
procure this, we advise boiling the water  before using, as this will de-
posit most of the salts.
  The large number of cases determined by post mortem examination,
would seem to indicate  the lack of a proper diagnosis on the part of
the  profession.   But we presume most of these cases  have refused to
be operated on.   We  would earnestly recommend the early use of the
sound, in all cases where there is the least suspicion of stone in the
bladder, as the only means of  arriving at correct conclusions.   As a 
15
proof of the great importance of detecting these concretions at an early
period, so as to adopt measures for promoting their discharge per ure-
thram,  we copy Dr. Holston's third case :
  " Mr. Bradford—set 40.—On sounding, detected a small calcu-
lous—urethra very large and dilatable.  Directed 20 drops of wine of
tobacco three times a day, which  was increased on the third day to 40
drops, with copious draughts of flax seed tea.   He was forbidden to
urinate  for 24 hours.   For 20 hours he endured  the ordeal of nausea
and urinary tormina, aided  during the last seven or eight by a broad
ligature  around the  penis.   On  removing the tape, the urine gushed
forth as thick as his  finger, and with it the calculus, the size and shape
of an almond.  Ten years have since elapsed without a return of the
difficulty."
  We would suggest, as another valuable  means  of enabling us to
form a correct diagnosis in diseases of this kind, to make  ourselves
familiar with  the peculiar  forms of crystals belonging to the various
salts which may be contained in the  urine—then by evaporating a few
drops on glass, and  placing it under a microscope, it will reveal the
character of  substance  held in solution.   In this way we have been
able to detect two or three salts in the same drop.
   Before closing  this subject, we  would recommend the profession
throughout the entire Valley of the Mississippi, as well as in Ohio,  to
keep register of this and other important  diseases, and then collect the
stat sties at least once in ten years.  In this  way we might  learn the
influence that a change of manners, customs and habits of a people
may have on the diseases which afflict them.   For there are portions
of this  great Valley  that undergo, in a single  age, all the transitions
from a log hut residence, and corn and bacon diet,  and ardent spirits as
a beverage, to fine houses, luxurious living, with  the free use  of wine
and  fermented liquors !
                           E. HAMILTON  DAVIS, Chairman.
  Note.—"We would ask the  attention and co-operation of all who receive
this paper in collecting the statistics of this disease and forwarding them to
the Chairman in the City of New York. 
 
 
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