HISTORY 'W6-'— 
*t*t ■M 
& 
PHOSPHATIC CALCULUS 
. SPONTANEOUSLY EXPELLED THROUGH THE VAGINA 
FROM A 
CYST OF THE ANTERIOR VAGINAL WALL. 
READ BEFORE 
THE ORLEANS PARISH MEDICAL SOCIETY, 
On the 24th June. 1878, 
By THOMAS LAYTON, M. D. P. 
Reprinted from 
The New Orleans Medical and Surgical Journal 
For August, 1878. HISTORY 
OF A 
Phosphatic Calculus 
SPONTANEOUSLY EXPELLED THROUGH THE VAGINA, 
From a Cyst of the anterior Vaginal Wall. 
(Head before the Orleans Tarish Medical Society on the 24th June, 1878,) 
By THOMAS LAYTON, M. D. P. 
Reprinted from the New Orleans Medical and Surgical Journal 
Ou the 9th April, 1878,1 was called to see Mrs. S., residing 
on Seventh street, near Constance, and was subsequently made 
acquainted with the following history : Mrs. S., is a native of 
New Orleans; she is now forty-nine years of age. She has 
been a widow since 1861. She bore nine living children in 
rapid succession, and had no miscarriages; she nursed all her 
children. She is a tall, larged limbed woman, of swarthy 
complexion, with dark hair and eyes. She is intelligent and a 
type of the Spanish Creole. Until lately, she was fleshy. Her 
menstruation has always been perfectly regular until three 
years ago. During her menstrual life, the flow was copious, 
lasting six or seven days every month. Up to about the time 
when this history begins, she had never suffered from any 
uterine or other disorder, with a single exception to be men* 2 
tioued later, and, in a word, she considered herself a remarkably 
healthy person. 
Towards the commencement of 1875, the interval between her 
menstrual periods began to lengthen, and the quantity of blood 
lost each time lessened perceptibly. This altered condition of 
meustruation was deemed natural both by herself and her 
friends, especially as it was attended neither by inconvenience 
nor sexual malady, and a year and a half ago, the menopause 
appeared to have been safely reached. 
In the summer of 1875, she contracted intermittent fever, for 
which she was treated by a physician, with but indifferent suc- 
cess, for three months, at the expiration of which, she was 
counselled by her medical attendant to visit the sea shore, 
whence, after a stay of some duration, she returned cured of 
her malarial troubles. 
Her health remained good, until the month of January of 
this year, when she began to suffer intensely from a pain in 
the left side, in the inferior costal region. 
The physician, who had attended her in 1875, having died 
in the meanwhile, another professional gentleman saw her, and, 
according to her statement, diagnosed malarial enlargement of 
the spleen, for which, according to her statement again, she 
was blistered and purged, with the result of relieving the pain 
in about three weeks time, when the physician discontinued 
his services. 
From this moment however, she began to lose flesh, 
and her friends noticed that her complexion was becoming 
pallid. The loss of flesh, although general, was more particu- 
larly visible about the abdomen and hips, which, from a con- 
dition of previous fullness and firmness, became shrunken and 
flaccid. 
During the month of February, she felt pains in the abdomen, 
which frequently became enlarged, and at the same time, she 
experienced a sensation of weight in the pelvis, whilst in the 
act of walking. The abdominal pain was referable to the 
inferior portions of the cavity, with perhaps a tendency to 
localization over the site of the right ovary. With regard to 3 
this last point however, her recollections are not absolutely 
positive. 
Acting upon the advice of her friends, she concluded to 
visit a midwife living in the Second District of this city, 
because it was suggested that her condition might be due to 
uterine cancer. The midwife examined her with a speculum, 
on the 11th of March, and assured her of the non-existence of 
cancer, but affirmed the existence of inflammation and ex- 
tensive uterine ulceration, whose curation was declared to be 
quite feasible, under a course of cauterization. This, Mrs S. 
consented to, and visited her nine times, being cauterized 
twice a week. The cauterizations were severe and followed 
by pain, loss of blood and the passage of a substance compared 
to pieces of flesh or skin. 
Mrs. S. and her niece, an intelligent lady, who was present 
at these cauterizations, say they were informed by the mid- 
wife, that nitrate of silver (probably in stick form) was the 
caustic employed. The remainder of the treatment consisted 
in baths and vaginal injections with a decoction of poppy 
heads. 
After the ninth visit to the midwife, and after the eighth 
cauterization, Mrs. S. was seized with an attack of acute 
dysentery which confined her to bed, and compelled her to 
suspend the treatment detailed above. I was sent for on the 
9th April, to attend the lady in her attack of dysentery, 
which proved tractable, yielding readily to the therapeutic 
measures adopted. Upon becoming convalescent, the patient 
apprized me of the foregoing facts in her history, and desired 
me to make an examination of her womb. I declined doing 
this, because she was under the charge of the midwife, and 
withdrew. 
Shortly after, I was again sent for, and informed that the 
midwife’s further services had been dispensed with, and upon 
renewed solicitation, I decided upon making a digital examina- 
tion, as I had come unprovided with instruments. 
On introducing the finger, instead of meeting with a cervix, 
more or less conical, and projecting to a greater or less extent 
into the vagina, I found a cavity with sharp, wiry edges, 4 
not unlike the condition frequently offered by the os during 
labor. Iu a word, the infra-vaginal portion of the cervix had 
entirely disappeared, and the sharp, wiry edges mentioned 
above were formed by the junction of the vagina and uterine 
substance. The diameter of the orifice of the cervical cavity 
was about equal to that of a twenty-five cent piece. The index 
penetrated for some distance into this cavity, which was 
conical, and whose walls were rugous, or lined with granu- 
lations breaking down easily under the finger. The body of 
the womb was enlarged and in a moderate state of antever- 
sion, still it did not appear to have contracted adhesions, as 
the entire organ was mobile. The uterus was judged to have 
attained an enlargement corresponding to the growth noticed 
after three mouths of pregnancy, because the fundus could be 
distinctly felt above the symphysis pubis. 
On withdrawing the finger from the cervical cavity just 
described, for the purpose of carefully exploring the vagina, 
a number of indurated spots were discovered apparently infil- 
trated into the vaginal walls and forming an interrupted circle 
around the vagina at a point estimated to be probably not 
less than half an inch, and not more than three-quarters of an 
inch below the vaginal insertion. This broken, nodulated 
circle appeared to be upon an oblique plane, the anterior 
segment of the circle being perhaps a little lower than the 
posterior. The indurated spots produced a sensation of thicken- 
ing; they were flat, and did not seem to offer a greater 
diameter than that of a pea, except upon the posterior and 
anterior walls, as will be described, and the interrupted 
circle alluded to was formed of perhaps six or eight of these 
nodes. The induration upon the posterior wall was diffuse 
and seemed to extend upwards to the cervix, with whose sub- 
stance it became fused. 
The induration upon the anterior wall of the vagina was the 
most prominent of all, its projection into the vagina being of 
about the size of a green pea. 
Upon the withdrawal of the finger, no odor was detected, 
but it was found to be bathed in a sanious fluid, which also 
rickled from the vulva. • 5 
The patient’s attention being called to this discharge, she 
stated that from about the time the midwife had begun to 
cauterize her, she had observed her linen to be stained by a 
liquid, whose appearance she likened to that of water, in which 
raw meat had been washed. 
The day following; I returned to Mrs. S.’s residenee, taking 
with me different specula. 
Upon applying Sim’s instrument, I was struck with the pen- 
dulous, flaccid condition of the abdominal tissues, which hung 
down in folds, like the skin of a rhinoceros. This flaccid ity 
had not escaped the notice of the sufferer, who reiterated her 
previous statement, concerning its recent occurrence. 
I obtained a good view of the parts, and saw what my finger 
had detected the day before. 
The indurated spot upon the anterior vaginal wall was dis- 
tinctly visible, resembling a teat of flesh or conical granula- 
tion, whose apex, directed towards the vaginal cavity, was 
ulcerated, as though denuded of epithelium. The vagina 
below the zone of indurated spots was of a delicate pink hue, 
and furnished no secretion, being in contrast with the cavity 
described as existing in the cervix, from which a small quantity 
of the sanious fluid, already alluded to, was trickling. The 
diagnosis did not seem to admit of much doubt, the age of the 
patient, the destruction of the cervix, and the sanious fluid 
noticed, as well as the existence of the indurations of the 
vaginal wall, apparently pointing to cancer. 
The prognosis was however held in reserve, and a guarded 
opinion expressed, because, iu the first place, the repeated 
cauterizations, the lady had undergone, were recent, and al- 
though it was hardly possible that the destruction and indura- 
tions were the result of injudicious action on the part of the 
midwife, still such a result might have followed the employ- 
ment of caustics by her, and in this event, time would prove 
an important factor in bringing about a solution of the difficulty. 
Iu the second place, careful inquiry into hereditary influences 
in the family of the patient failed to develop any history of 
cancer or gout. (It is useful to say in this place, by way of 6 
parenthesis, that the mention of gout is in trod uced, with the 
view of subserving future purposes.) 
Mrs. S., was the ninth child, and was a few months old, when 
she lost her mother, who died, at the age of forty seven years, 
according to family tradition, from the rupture of an internal 
abscess due to an injury received whilst lifting a heavy tub. 
Her father died suddenly in his eighty-first year. 
For obvious reasons, the treatment recommended was ex- 
pectant, and generous diet was insisted upon. 
I did not see the case again for several days, when upon in- 
troducing the finger, the condition of the parts was found to 
have undergone no material change, except, that the teat of 
flesh, which has been described as being situated high up on 
the anterior vaginal wall, was noticed to have become enlarged, 
and to have attained fully the size of a red bean. Careful ex- 
ploration with the finger revealed the fact, that a hard sub- 
stance, upon which the nail grated, and which was mobile, ap- 
peared to be working its way through the apex of the teat, 
coming into the vagina, from the direction of the bladder. 
Being muck surprised at this unexpected event, I inserted a 
Sim’s speculum, and the increased size of the teat was plainly 
visible, and a dark colored body wTas also distinctly seen pro- 
truding from the apex into the vagina, perhaps to the extent 
of a quarter of an inch. (The mensuration is however, of course, 
only approximative.) 
Not being provided with a female dressing forceps, the 
speculum was withdrawn, and an attempt was made to 
enucleate this strange product with the finger. Although 
mobile, it could not be dislodged, and the endeavor was aban- 
doned, owing to an annoying hemorrhage which occured. 
The patient and her niece were informed that something in 
the shape of a hard body might pass through the vulva, and 
they were instructed to be on the look out, and carefully pre. 
serve it, in the event of its transit. 
Circumstances prevented my seeing the patient for nearly a 
week, when I received a visit from her niece, who informed me, 
that, on Friday, May 17th, on the second day after my last visit, 
Mrs. S., whilst using the vessel had felt something pass through 7 
the labia, and had heard the noise produced by its tall upon 
the bottom of the vase. 
The ladies at once examined the urine and removed the 
stout1, for such it was, which I received from my visitor. 
1 iuquired, if there had been, at any time since its passage, 
dribbling of urine through the vagina, and was given a nega- 
tive reply. 
I examined the stone carefully. It was regularly ovoid, and 
presented somewhat the appearance and shape of a large 
Spanish olive. 
Its length was one inch, and its greatest diameter was sixty- 
eight one hundredths ({£,) of one inch. (I will say here, by 
anticipation, that the above mensuration was kiudly made by 
Professor Joseph Jones.) 
I weighed the stone, and found its weight to be seventy-six 
(7G) grains Apothecaries’ weight. 
It was of a dark color, and, in spots, its surface resembled 
that of a mulberry. 
No odor was detected. 
At the smaller of its extremities, a circular portion of the 
outer layer or crust had been fractured, apparently as the 
result of its fall upon the bottom of the vessel. Inspection of 
the fractured spot showed an external layer of whiteish huo? 
which in places was very thin, and elsewhere measured from 
i* to of an inch in thickness. This external layer could be 
compared to a cement destined to fill up interstices, and give 
the stone its generally regular ovoid shape. 
The same external layer, too, was enveloped in a thin coating 
of dried animal matter and clotted blood, which doubtless 
caused the dark color of the outer surface mentioned above. 
The whiteish substance just described was friable and 
excentric to another and more deeply shaded stratum plainly 
visible at the bottom of the fracture. 
I visited Mrs. S. at the earliest opportunity. Examination 
showed that the parts had undergone no change of condition, 
except that the teat upon the anterior wall, through which the 
stone had passed, was lessening in size. 
1 passed a catheter into the bladder, in which careful explora- 8 
tion failed to reveal the presence of any concretion. An 
attempt was then made, with the finger in the vagina to 
establish communication, through the teat, with the catheter 
in the bladder. No success attended this endeavor. 
I purposely refrained from having a chemical analysis made, 
before presenting the calculus for inspection to the members of 
the Orleans Parish Medical Society, which I did at the 
meeting held on the 27th May, 1878, on which occasion I re- 
ported the case orally. It was then decided to commission me 
to submit a written report, which would form a subject for dis- 
cussion at the next regular meeting of the society. 
This paper is the desired written report, which I supplement 
with a statement of the results furnished by a chemical analysis 
of the product, kindly made in my presence, in his laboratory, 
by Professor Joseph Jones, to whose courtesy and valuable as- 
sistance I wish publicly to render thanks. 
The remaining history of the case, to date, may be briefly 
summed up as follows: May 31st; the patient has had 
fever and pain in the lower part of the abdomen since 
yesterday. Green matter vomited to-day. Bowels loose. The 
os still presents the same wiry condition : the uterus is hard 
and heavy, the vaginal nodes are less marked. The lady’s 
garments show pinkish stains. 
June 3d: Fever; vomiting of grassy green matter continues, 
June 5th: This morning, whilst urinating, there occured a 
sudden gush of blood referred to the vagina. 
June 7th : Grassy green matter vomited again. No repeti- 
tion of the hemorrhage. Vaginal exploration reveals two small 
liquid cysts on the anterior lip of the os. The nodules have 
almost entirely disappeared, and the anterior elevation, through 
which the calculus escaped, has completely subsided, leaving 
no perceptible induration. On the posterior vaginal wall 
there exists a hard baud, conveying the impression of cicatri- 
cial tissue, which runs up to and is finally lost within the 
cervical cavity. The uterus is anteverted and the os directed 
towards the concavity of the sacrum. The mouth of the womb 
is puckered. The cavity of the cervix appears to have become 9 
smaller. It is certainly less fungous. There is no odor, aud 
the finger is withdrawn without any traces of blood. Tho 
edges of the os have still the same sharp feel, and the inferior 
segment of the uterus is perceptibly indurated. The abdomen 
is tender at night, but there are no lancinating pains. Mrs. S., 
generally rests well under the influence of an opiate. She is 
feeble and complains of want of appetite. 
June 18th : Fever for three days past: pain in region of 
spleen and lower part of abdomen, spleen not enlarged. Pink- 
ish stains upon garments: little or no appetite, nausea. Ex- 
amination by speculum reveals an ulceration of about the size 
of a pea, on the anterior lip and extending into the cavity of 
the cervix. The os is softer and more oedematous, and the 
cervical cavity seems smaller and smoother. From the ulcera- 
tion on the anterior lip, a thin stream of blood flows down into 
the vagina. The uterus is anteverted. The sound passes 
readily to a depth of at least three inches. The vaginal nodes 
have all disappeared, but the posterior cicatricial band, already 
described, is still to be felt. The souud, on being withdrawn 
from the cavity of the uterus, was noticed to be covered with 
a sanious liquid. The vagina contains a mucous, viscid secre- 
tiou. The removal of the speculum is followed by the appear* 
ance of a citrine fluid at the vulva. 
REMARKS. 
Although this case, iu its original features, presents a good 
field for a differential diagnosis between uteriue cancer and 
destructive lesions, which may have been produced by a mid- 
wife, and although the discussion of these points is interesting, 
yet my intention is to pass by, unnoticed, this aspect of the 
history related in the preceding pages, in order to take up the 
study of the strange body, whose unexpected appearance ex- 
cites a more absorbing curiosity, as a matter of scientific rarity. 
A stone is observed to make its way through the vaginal 
wall into the vagina, coming apparently from the bladder. 
Whence did it originate ? 
Three suppositions might be entertained. 
First: this stone is an ordinary vesical calculus. 10 
Second: it is due to some foreign substance introduced for 
various purposes. Let me say at once, for the sake of brevity, 
that the facts in this case allow no room for entertaining this 
second supposition, which may therefore be dropped from 
further consideration. 
Third: the production under examination has originated in 
a cyst of the vaginal wall. 
To return then to the idea first enumerated. The thought 
would naturally arise, that the calculus had worked its way 
from the bladder to the vagina. 
Here are the reasons, for which this supposition must be laid 
aside, as untenable. 
It will be remembered, that no gouty antecedents were 
discovered in the family history of Mrs. S. Of course, it will 
be understood, that, for obvious reasons, very little stress is 
laid upon this absence of any known hereditary influence. 
Stronger negative grounds can be brought forward. 
It will be remembered too, that with the finger in the vagina 
and the catheter in the bladder, no communication between 
these parts could be detected. 
There has never been any flow or dribbling of urine through 
the vagina. This of itself is a very strong argument. 
T. Gaillard Thomas says (1) at page 154: “An involuntary 
“ flow of urine usually announces the existence of a fistula 
“ within three or four days after delivery, though when it is 
“ the result of injury inflicted by instruments employed in 
“ delivery, it may occur immediately. On the other hand, 
“ the separation of the slough may not take take place 
“ until much later ” 
He then relates instances in which the sypmtoms of fistula 
were not manifested until after a month, on the twenty-second 
day, after twenty-nine days, and on the twenty-first day. 
In the case now being considered, the longest of these limit- 
ing periods has been exceeded, and the urine has never passed, 
except through its natural channel. 
In Fleetwood Churchill’s Practical Treatise of the Diseases of 
(1) Thomas on tho Diseases of Women. 11 
Women (2), I find the following at page 881, which I render 
into English, from the French translation of Wielaud and Du 
brisay, not possessing a copy of Churchill’s work in the original 
“ English: “The signs of vesical fistulce are not numerous, for 
“ besides the physical signs of the lesion, the only rational 
“ symptom consists in the flowing of urine, not through the 
“ urethra, but through the vagina.” 
It is not deemed necessary to adduce additional authorities 
upon this point. 
Finally, the analysis of the stone enables me to state posi- 
tively that it did not come from the bladder. 
The calculus was analyzed in my presence by Professor 
Joseph Jones on the 6th June. 
It was very hard in its central parts, and considerable time 
was required to saw through its mass. 
Prof. Jones kindly wrote me a letter, of which I give a copy, 
detailing the results of the analysis. 
“Medical Department University of La., 
June 6th, 1878. 
Thomas Layton, D. M. P. 
“ Dear Sir—In reply to your request, I have made a section 
“ and chemical analysis of the small calculus which you extract- 
ed from the anterior vaginal wall of Mrs. S., now under your 
“ care. The calculus has a central nucleus with surrounding 
“ rings. The central portion is firm, cutting with difficulty by 
“ means of the metacarpal saw. 
“Chemical examination: soluble in nitric acid; ammonia 
“ throws down small flocculent deposits of magnesian phosphate. 
“ Molybdate of ammonia, heavy yellow deposit showing presence 
“ of phosphoric acid. Solution of acetate of soda in acetic acid 
“ with perchloride of iron, heavy deposit of phosphate of iron. 
“ Oxalate of ammonia, heavy deposit of oxalate of lime. 
“ Tests for uric acid with nitric acid and ammonia gave no 
“ reaction characteristic of uric acid. N~o murexide present. 
“ All the tests as well as the appearance of the calculus aud 
“ its physical properties indicate that it is nothing more nor less 
(2) Traite Pratique des maladies des femmes par Fleetwood Cliurchill. Traduction de 
Wieland et Dubrisav ; Paris, 1860. 12 
“Mum the phosphate ol‘ lime. In my opinion, it is analogous 
“ to prostatic and salivary calculi. 
“ Respectfully, 
“ Your obedient servent, 
“(Signed) , Joseph Jones, M. D. 
“Professor Chemistry and Clinical Medicine.” 
I take pleasure in showing you three different specimens of 
the calculus. 
The powder is the remainder of the dust obtained by sawing 
through the stone. 
A part of this powder was employed by Dr. Jones in making 
the chemical analysis detailed above, because it was considered, 
that this dust, obtained by sawing through the calculus, repre- 
sented a fair average of its composition. 
A portion of the calculus has been preserved in its original 
condition, as obtained by me from Mrs. S. 
Owing to the hardness of the centre and its disposition in 
concentric layers, I took this third specimen to Messrs. Griswold 
& Co., who had the courtesy to have it polished, with the 
result, which is submitted for your inspection to-night. The 
polished portion of the calculus represents an irregular, 
truncated, six sided pyramid. Examined with a magnifying 
glass, a regular mosaic is revealed, the mass being formed of 
a number of stones of different sizes, closely grouped together, 
aud firmly imbedded in a kind of mortar or cement, which 
infiltrates itself into all the chinks and interstices between the 
small stones, and is composed of the same external layer of 
whiteish hue already described as giving the calculus its 
generally regular ovoid shape. Examined isolatedly with the 
each of these smaller stones is found to otter one or 
more nuclei encircled by concentric wavy strata similar to the 
rings in the trunk of a tree. Uuder the glass too, these 
smaller stones very much resemble the thin horizontal sections 
of grape vine stems, which are prepared as specimens for the 
microscope. 
Viewed by the base of the pyramid, the polished portion of 
the calculus appears to be formed by a number of vertical 
bundles wedged together and held fast by the ubiquitous 13 
cement which lias been described. An idea of the disposition 
of these calculous bundles may be conveyed, by saying that 
the manner in which they are grouped together is not unlike 
the appearance of bundles of muscular fibre seen under the 
microscope. 
A decision having thefore been reached, that this stone did 
not come from the bladder, the process of elimination or ex- 
clusion, adopted at the beginning of this study, leaves but 
one gate open, viz: “the production under examination has 
“ originated in a cyst of the vaginal wall.” 
Let me say at once, that careful research into the special 
literature of the subject developed but meagre results. No 
where, among the—it is true—relatively speaking limited 
facilities at my disposal, have I been able to find any mention 
made of a calcareous production obtained from a cyst of the 
vagina, which appears itself to be of rare occurrence. 
True, Van Swieteu, in his Commentaries, has at page 1S3, 
Vol. V, a chapter on “ Calculus/’ (3) in which he says (trans- 
lation mine); “There is scarcely any part of the body, as will 
“ appear from the following pages, in which a calculus has not 
“ sometimes been found : whence it appears, that the material, 
“ from which the calculus grows, is present in the whole body, 
“ or at least, that it is conveyed throughout the entire body.” 
In the same volume, lower down, we find the following, at 
page 193. (4) “ The engendering of a calculus is successive, 
“ not taking place all at once, as Helmontius claimed, who 
“ believed, that, in one instant, a calculus, and a large one 
“ too, might be formed by a certain petrifying spirit pervading 
“ the whole system, which might produce the same effect, as that 
“ which has furnished the poets with the fable of Medusa’s 
“ head.” 
Still further on, in the same volume, at page 203, Van 
“ (3) GerardiVan Swietou. Med. Doct. Commentaria in Hermanui Boerliaave apliorismos 
“ &.c. Parisiis MDCCLXXIII, “ vix ullus, ut patebit in sequentibus, locus corporis est. 
“ ubi non fait inventus aliquando calculus: unde videtur materia, ex qua calculus 
“ concrescit in toto corpore adesse, vel saltern per totum corpus deiVrri.” Tomus Quintus. 
• p. 183. 
(4) “Ibid: p 193. “ Successiva ergo est calculi generatio non momentanea uti Helmon- 
“ tius voluit, qui credebat, nno momento calculum, ac magnum quidem, formari posse a 
“ spiritu quodam petrifico pervadente omnia, quique eumdem efl'ectum pi oduceret, ac de 
'• Medusa:.capite Poetic fabulati sunt.” 14 
Swieten relates that Hippocrates meutious a stone, which 
was expelled from the uterine cavity of a woman sixty years of 
age. 
He also states that Louis had collected the histories of 
several cases of uterine calculi. 
It would seem as though Louis was rather sceptical concern- 
ing Hippocrates’ story, told in brief above, aud whilst not 
venturing to openly impugn that hoary and venerable authority, 
still he, with a certain degree of timidity, doubtless consequent 
upon a sense of his audacity, undertakes to hint that the stone 
in question may have come from the bladder aud not from 
the womb. 
Van Swieteu however, shocked at the temerity displayed by 
doubting any assertion made by the Father of Medicine, clings 
to the Hippocratic version, because, as he gravely asserts, 
Louis does not seem to have based his opinion upon very sub- 
stantial arguments, aud with this dignifiedly withering rebuke, 
unlucky Louis’ dissenting interpretation is dismissed as un- 
worthy of further consideration. 
Next in order, the great commentator quotes a case communi- 
cated by the “ very celebrated Gaubius ” to a society at 
Haarlem in Holland, in which a virgin, aged twenty-eight 
years, suffering from falling of the womb, passed a large num- 
ber of uterine calculi in the space of a few years. These 
calculi, according to Gaubius, were like chalk. 
Van Swieten then alludes to calculi found in the uterine 
annexes, and concludes by saying, at page 204 (fi): “ I believe 
“ that these instances are evidently sufficient to demonstrate 
“ that scarcely any spot can be found in the human body, in 
“ which a calculus has not sometimes been discovered. I 
“ might easily enumerate additional facts: (for Medical History 
“ abounds in such), Stones, forsooth, have been found in the 
“ mouth, the tongue, the nostrils, the ears, the liver, the spleen 
&c., but lest I should dilate too lengthily upon all these, it 
“ will suffice to have pointed them out summarily.” 
(5) Ibid, p. 204. “HaeC puto suflicere, nt constct, vix loca in corpore humano leperiri, 
“in quibus non fuerit aliqufludo inventus calculus. Plura facile recensere potuisseni; 
‘‘ (Historia enim Medics in bis dives est.) Fuerunt enim calculi inventi in ore, lingua, 
auribns, hepate, liene, etc., sed ne bitnis in his longus sim, suminatirn baec tnnnuisse 
snfficiet” 15 
The existence of vaginal cysts being admitted, perhaps on 
account of self-evident analogy, it may be useful to recall an 
observation of Sir Astley Cooper (6) who says that he once 
saw an atheromatous or melicerous cyst which had undergone 
ossification. 
Dr. A. B. Miles, Assistant House Surgeon of the Charity 
Hospital in this city, has kindly taken an interest in the history 
of the case presented to you this evening, and he informs me 
that at page 170 of Green’s Pathological and Morbid Anatomy, 
under the head of secondary changes in cysts, it is said that: 
“calcification and ossification of the wall may also occur 
“ Calcification of the contents is also common.” 
Dr. Miles also called my attention to the fact, that iu Gross’ 
System of Surgery, Yol. II, p. 947, an account of vaginal 
cysts is given. The contents were liquid however. 
Dr. Miles, to whom I am indebted for the foregoing authori- 
ties, also undertook to examine a file of the Transactions of 
the London Obstetrical Society. 
He mentions finding in Yol. IX for 1807, the history of a 
cyst of the anterior vaginal wall, with fluid contents. The case 
was reported by J. Hall Davis, M.D., F.R.C.P. Dr. Davis 
states that on two occasions Dr. West met with vaginal cysts 
containing fluid, aud that Scanzoni also opened a vaginal cyst, 
whose contents were liquid. 
It is needless, for present purposes, to call attention to the 
fact, that all the books allude to Nabothian cysts and to those 
of Bartholin’s glands. 
The fact that purely vaginal cysts are uncommon is patent 
from the number of authors, who, in their writings omit even 
mentioning the existence of such tumors. For instance, 
neither Marion Sims nor T. Gaillard Thomas appears to con- 
sider the matter worthy of the slightest attention. 
Some of the medical dictionaries also, such as Nysten and 
Dunglison, do not devote a passing allusion to the subject. 
Broca iu his “ Traite des Tumeurs,” (7) Yol. II, p. 115, 
(6) (EuvresChirurgicales completes de Sir Astloy Cooper. Traduction de Cliassaignac et 
Richelot. Paris, 1837, page 590. A copy Of the English edition is not in my possession. 
(7) Traite des Tumours par Paul Broca, Paris, 1869, 16 
speaking of cysts formed around inert and solid bodies, says 
(translation mine): “ Such cysts may be compared to those 
“ which sometimes surround certain concretions formed in the 
“ tissues, and due to the deposit of non-orgauized matter (cre- 
“ taceous tubercles, stony concretions, etc). Besides, as these 
“ concretions are always deposited very slowly, they are very 
“often deprived of a cystic envelope, and they are directly in 
“ contact, or even in continuity with the surrounding tissues ; 
“ whence arose the ancient idea, that they were due to the 
“ petrifaction of such tissues.’7 
In a number of works upon obstetrics, we read of cysts of 
the vagina which impeded labor. All the accounts of such 
cysts, which I have bad occasion to examine, refer to tumors, 
whose contents were fluid. 
Churchill (8), in his treatise of the diseases of women, 
already quoted, writes as follows, page 141: “ Encysted tumors 
“ of the vagina. I have never met, in the books, with any 
“ description of this disease, I do not believe it to be very 
“ common. I will therefore be the more excusable in giving 
“ details here concerning the four cases which I have seen.” 
All four were cysts with fluid contents. 
In Graily Hewitt’s work (9) on the “ Diseases of Women,” 
at page 192, I find the following : “ Dr. West relates a case, 
“in which a cyst of the vagina, the size of an egg, projected 
“ from betweeu the vulva, and had just the appearance prc- 
“ sented by a prolapsed bladder. By the use of the catheter, how 
“ ever, the nature of the tumour was made evident.” Lower down’ 
at page 194, Graily Hewitt remarks that: “These cysts 
“ (vaginal) are not common ; they could hardly be confounded 
“ with any thiug else they probably consist of enlarge- 
“ ments of the mucous follicles. It is more difficult, 
“ to distinguish the next series of cases,—those in which a 
“ hard fibrous tumour of the vagina is found growing external 
“ to the canal, but projecting partly into it—from some other 
“ conditions. Occasionally fibrous tumours, resembling the 
(8) Traite pratique des maladies des femmes, par Fleetvrood Churchill. Traduit par 
Wieland et Dubrisay, Paris, 1866. 
(9) The Diagnosis and Treatment of Diseases of Women, by Graily Hewitt, M.D/ 
Lond. M. R. C. P. London, 1863. 17 
“ fibrous tumours of the uterus, grow in the vaginal wall, 
“ originating primarily in the uterus according to Kiwisch, 
“ but sometimes also primarily in the vaginal wall itself, ac- 
“ cording to Scanzoni.” 
In a short paragraph, at page 1036, entitled : “ Kystes et 
Polypes du Vagin,” (10) Professor Courty of Montpellier, writes 
the following, which I translate: “Cysts are only exceptiou- 
“ ally observed in the vagina. Those of the superior and 
“ inferior parts are furnished by the uterus and the vulva, 
“ and offer the appearance of follicular cysts. Those of the 
“ middle region, or of the vagina properly speaking are due to 
“ the development of serous bursfe, or to the formation of cysts, 
“ whose primitive location is in the peri-vaginal cellular tissue 
“ (Rokitansky), and whose development gradually, although 
“ often very slowly, causes the cyst to project into the vagina, 
“ that is to say, towards the point were the least obstacle is 
“ offered to the growth of the tumor. Incision of the cyst, 
“ evacuation of its serous contents and cauterization of 
“ its cavity are sufficient to obtain a cure.” 
Nelaton, in his Surgical Pathology (11), Vol. V, page 823, 
treating of deep follicular cysts of the vagina, writes as follows 
(translation mine): “They are observed in the upper half of 
“ the vagina and in the neighborhood of the cervix uteri; they 
“generally occupy the anterior wall of the vulvo-uteriue canal. 
“ Two cysts of this kind are seldom found in the same patient; 
“ The matter contained in these pouches is viscous, 
“ropy and reminds one of mucilage ” 
The most satisfactory contribution to the literature of vagi- 
nal cysts, I have met with, is to be found in the report of a 
case related to the New York Obstetrical Society, by Dr. Paul 
F. Muude, editor of the “American Journal of Obstetrics.” 
The history of Dr. Munde’s case is published in the American 
Journal of Obstetrics for October, 1877. (12) The patient, a 
(10) Traite pratique (lea maladies de l'uteius et de sea annexes, par A. Courty, Paris 1806 
(11) Elements de Pathologie Chirurgicale, par A. Nelaton, Paris, 1859. 
(12) Transactions of the New York Obstetrical Society, in American Journal of Obstet- 
ics, October, 1877, p. 673, et seq. 18 
Mrs. B. McD. had a cyst of * the anterior wall of the vagina, 
with “ clear glutinous contents.” Dr. Mund4’s report on this 
occasion is supplemented by the following interesting remarks 
which I transcribe: “The uumber of cysts of the vagina 
“ reported in literature is by no meaus so great, that the 
“ publication of a new case may be considered superfluous. 
“ Up to the appearance in 1871 (Arch, fur Gyuakologie, II) of a 
“ paper on this subject by Wiuckel of Dresden, in which the 
“ first full account of the literature, etiology, pathology and 
“ treatment of these growths was given, only fifty cases ot 
“ true vaginal cyst had been reported, including four related 
“ by Wiuckel in that paper. Since then only two papers have 
“ appeared, one by Kaltenbach of Freiburg (Arch. f. Gyn., V., 
“ 1873), chiefly the report of a case, and the other by Von 
“ Preusehen, (Centralbl., 40, 1874} who found glands in the 
“ vagina, and attributes the cysts to the occlusion aud dilata- 
“ tion of these glands. (13). 
“One case has also been reported (Am. Jour. Obst., Vol 
“ IX, 1876) by the late Dr. Braiuard Iluut of this city. 
“ Doubtless other cases have been observed and reported, but 
“ have escaped my notice in the superficial review 1 have been 
“ able to give of the matter. T. Gaillard Thomas does not 
“ mention the disease at all in the latest edition of his book, 
“ and Shroeder devotes but two pages to its very imperfect 
“ description. In view of this scarcity of literature, aud the 
“comparative rarity of the affection, it may not seem inappro- 
“ priate to refer briefly to the conclusions arrived atby Winckel. 
“ He found that the cysts generally occur singly (in 82 per cent.), 
“ more rarely two (12 per cent.), aud still less frequently, three 
“ cysts (4 per cent.), are found at a time. Kiwisch found five in 
“ one case. As a rule, the cysts are located on the anterior 
“(11) cases), or posterior (14) wall, more rarely laterally (5). 
“ On the anterior wall, the lower third and junction of middle 
“ and upper third are the favorite seats ; on the posterior wall 
“ the lower and middle thirds. In two-thirds of the cases, the 
(13) It may not be out of place here, to mention that Robin and Littre, in their lthl 
edition, p. 1484, denied the existence either of glands or of follicular orifices in the vaginal 
mucous membrane. X, L. 19 
t* cysts occurred in the lower half of the vagina. The size of 
“ the cysts varied from that of a pea or uut (25.5 per cent.) to 
“ that of a hen’s egg or pear, or larger (34.09 per cent.), the 
“ larger proportion being of medium size, pigeon’s egg (40.4 
“ per cent.). The contents of the cysts varied greatly, being 
“ reddish, brown, green, slimy, glutinous, albuminous, but 
“ generally of clear yellow color and serous consistency. An 
“ analysis shows albumen, salts and water, epithelia, granulated 
“ cells, fat globules, and, in those with colored contents, pig- 
“ ment and blood corpuscles. 
“There are four varieties of vaginal cysts, differing in origin 
“ and constitution of their envelopes. 
1st. “ Simple follicular cysts, superficially located in the 
“ mucous membrane, with a thin envelope, containing only 
“ tibro-elastic tissue and lined by pavement epithelium. 
2d. “ Cysts caused by a dilatation of lobulated glands (found 
“ by Heule in exceptional instances in the upper portion of the 
“ vagina and the cervix) with thin walls, no endothelium, and 
“ always small in size. 
3d. “ Cysts, whose walls consist of the mucous membrane, 
“and at least a portion of the fibro-muscular coat of the 
‘•vagina; these cysts have no special capsule, but are found 
“ merely by a separation of the strata of the vaginal wall 
“ by an effusion, and occur chiefly in the lower third of the 
“ canal.... 
4th. “ Cysts in the perivaginal cellular tissue, with separate 
“ walls and varied contents (cheesy, dermoid), (14) which grow 
“ down into the perivaginal space, and push the whole wall of 
“ the caual before them. 
“ Briefly, these four varieties may be divided into three 
“ groups; a, mucous cysts, arising from closed or open 
“follicles; b, interstitial cysts, located in the sub-mucous or 
“ fibro-muscular layer; and c, the sub-serous situated above, 
“ under the peritoneum ; below, between rectum and vagina. 
“ Of the fifty cases, the majority come under class b, iuter- 
“ stitial, about 6G per cent, being found below the middle of 
(14) Italics mine. T. L. 20 
“ tlie vaginal canal, a portion, where even those authors who 
“ claim positively to have found glands in the vaginal mucosa, 
“ admit their absence. 
“ The etiology of these cysts varies. That of the follicular 
“ cyst is probably to be sought in chronic catarrh and intiamma- 
“ tiou of the vaginal mucous membrane, and in the physiologi- 
“ cal hyperemia occurring during pregnancy. The interstitial 
“ cysts probably arise in consequence of pressure, contusions 
“and extravasations during parturition. (15.) Still, of the 
“ fifty cases collated, only eight were parous women, and two 
“ were undoubted virgins, one being a newborn child. The 
“ rarity of the cysts in the lateral portions of the vagina 
“certainly does not.speak in favor of Veit’s opinion, that 
“ they originate in a persistauce of the Wolffian bodies; or 
“ possibly the lower ends of Muller’s ducts may remain patent, 
“ and occasionally be the starting point of vaginal cysts. 
“ Strains and local injuries irrespective of childbirth are 
“recorded as causative agents in several cases, aud Verueuil 
“ believes in the occasional formation of bursa? mucosa? in the 
“ recto-vaginal septum.” 
To the above record, I will add the following : A few years 
ago, I was invited by Dr. Just Touatre, of this city, to see a 
case of cyst of the posterior vaginal wall. The contents were 
liquid, and the tumor was so voluminous as nearly to oblite- 
rate the vagina. 
Dr. Touatre informs me that he has since had another case 
of vaginal cystic tumor, occurring this time, on the anterior 
wall, about one inch above the vulva. The patient suffering 
pain, during intercourse, from this tumor which was somewhat 
larger than a walnut, consulted a druggist of her acquaintance. 
On discovering the tumor, he proceeded to open it with a 
(15) It seems to me that the calculus, whose history forms the subject of this paper, 
must have originated in an interstitial cyst, and it will be remembered, that Mrs. S. gave 
birth to nine children. It is true, her last child was born before 1861, lint this fact would 
not necessarily invalidate the hypothesis adopted, because the stone obtained from the 
vagina of Mrs. S. is evidently not of recent formation, and we have no means of determin- 
ing any thing like the exact age of a production of this nature. It is therefore not 
irrational to suppose that the interstitial cyst, whence it came, may have had its origin 
in pressure sustained during parturition. The stone, once formed, may have lain dormant 
for years, until the recent cauterizations, described as having been made by the mid- 
wife, producing inflammatory action, may have proved the immediate cause of its ex- 
pulsion. T, L, 21 
knife, making a free incision, and this operation was followed 
by the escape of a clear liquid. The druggist then cauterized 
the interior of the pouch with solid nitrate of silver. The 
liquid did not collect again, but the patient did not get well, 
The interior of the tumor became transformed into a pyogenic 
membrane, which suppurated freely, and coition became so 
painful, that the woman applied to Dr. Touatre for relief. 
The nature of the morbid condition having been ascertained, 
Doctors Touatre and Souchou dissected out the cystic sack, 
and the case made a speedy and permanent recovery. 
Dr. Touatre has had the politeuess to write me, that, in a 
medical work in his library, he has found reference made to a 
memoir by Huguier entitled: “ Kystes sous muqueux du vagin.” 
(16.) Unfortunately, neither Dr. Touatre nor I have been able 
to consult this memoir of Dr. Huguier. Still, as it dates back 
to 1847, it is hardly likely, that if it mentioned cases resembling 
that of Mrs. S., these would have been allowed to remain 
buried in oblivion during so many years. 
The name of Dr. Huguier and the interest attaching to every- 
thing emanating from his authoritative pen suffice to render 
this supposition plausible, to say the least. 
It will be remarked that an important difference exists be- 
tween the vaginal cysts mentioned by the authorities, whose 
writings have been passed in review, in the preceding pages, 
and the case of Mrs. S. 
Nowhere, in the literature of the subject, do we find even a 
hint thrown out of any vagiual cyst, whose contents were cal- 
culous, as in the instance I have the honor to report to-night. 
True, Dr. Munde, in the instructive article quoted above says 
that the contents of some cysts in the perivaginal cellular tissue 
are cheesy or dermoid, but he makes no mention of ever having 
heard of a calculous production in such conditions. It will be 
remembered that I have, in the course of this paper, quoted 
Sir Astley Cooper as saying that he had once seen an athero- 
matous or melicerous cyst, which had undergone ossification. 
Bearing in mind, also, the extract from Green’s Pathological 
(16) Huguier: Kystes sous muqueux du vagiu ; in Memoires de la Societe de Cbirur* 
gie de Paris. Vol. I. in qto. 1847. p.p. 336—384. 22 
and Morbid Anatomy (to be found higher up), in which, under 
the head of secondary changes in cysts, the author says: Cal- 
“ cification and ossification of the wall may also occur 
“ Calcification of the contents is also common ” (17), it appears to 
me, that the following question may, without scientific impro- 
priety, be asked : does it require a great stretch of the imagina- 
tion to suppose that the stone obtained from the vaginal wall 
of Mrs. S., may represent the ossification or calcification of the 
cheesy or dermoid contents of a cyst corresponding to the de- 
scription given above by Dr. Munde ? 
I am indebted to the courtesy of my friend Dr. J. C. Carter, 
for the perusal of the article on “ Cysts of the Vagina,” which 
is to be found at page 50G, Vol. X, of Von Ziemsseu’s Cyclope- 
dia of the Practice of Medicine. This having been lately pub- 
lished (1875) may be supposed to convey all the information 
that is to be had, concerning the question under examination. 
The article is by Scbrceder, and strikes me as being the one 
alluded to by Dr. Munde, in his report quoted above. It is 
based upon the following authorities: “ Heming, Edinburgh 
“ Medical Journal, January, 1831. Ladreit de la Charriere. 
“ Archives Gener, 1858, Vol. I, p. 528. Saxinger—Spitalzeituug, 
“ 1863, No. 39. Veit, Frauenkrankheiteu II. aufl. 1867, p. 544, 
“ Winkel, Archiv. f. Gym B. II. p. 383—Kaltenbach— Archiv. f. 
Gym, B. V., p. 138.” 
This paper throws no additional light upou the subject, and 
makes no mention of cysts, with calculous contents. As the 
main features of Schroeder’s contribution have been made use 
of by Dr. Munde (quoted above) it is unnecessary to enter into 
details, in their regard. 
The only thing which has fallen under my observation, pre- 
senting any resemblance to the case of Mrs. S., is to be found 
in a back number of the “ Archives Generates de Medeciue,” in 
which I discovered a notice of a thesis by Dr. Bourdillat, pub- 
lished in Paris, by Victor Masson, and entitled : 
“ Calculs de l’urethre et des regions circonvoisines cliez 
“ l’homme et chez la femme.” (18.) The reviewer of this thesis 
says : “ A special paragraph is devoted to those calculi, which, 
as in man, may be developed in the neighborhood of the female 
Uurethra, and in particular in the vagina. 
(17) Italics mine. T. L. 
(18) Archives Generalta de Medecine, Jnin, 1870, p, 764, Pails. 23 
Unfortunately the reviewer enters into no details, and owiug 
to the impossibility, for the present at least, of procuring a 
copy of Dr. Bourdillat’s thesis, I am unable to ascertain whether 
or not that gentleman describes any case or cases which may 
be comparable with that of Mrs. S. 
If nothing of the kind is to be found either in Dr. Bourdillat’s 
monograph, or in the memoir of Dr. Huguier, then gentlemen, 
as far as my reading goes, I believe that I now present for your 
inspection the first instance of a calculus obtained from a cyst 
of the vaginal wall, of which I am able to find a published 
record. 
It is not probable that Van Swieten was acquainted with 
any similar case, else, he, with customary minuteness, would 
not have failed to transmit the same to posterity, but the stone 
exhibited to night affords another proof of the truth contained 
in his shrewd remark quoted above, and reproduced here, as 
the conclusion of this paper : “ There is scarcely any part of 
“ the body in which a calculus has not sometimes been 
found.’7 
Note. Since the reading of the above paper, Prof. Logan has 
shown me a calculus extracted from the sub lingual gland of 
an elderly lady. 
The composition of this calculus is analogous to that of the 
one passed by Mrs. S., and furnishes a corroboration of the 
opinion expressed by Prof. Jones, in his letter, a copy of which 
is given above. 
Dr. H. D. Schmidt, Pathologist of the Charity Hospital, has 
had the kindness to make a preliminary microscopical examin- 
ation of the calculus presented by me to the Orleans Parish 
Medical Society, and he gives the following opinion as the 
result of such examination, reserving a more positive and 
detailed report, until such time, as a fine section of the stone 
can be made. Dr. Schmidt expresses himself as follows : “It 
“ is supposed that the entire mass is the remains of a racemose 
“ gland of the vagina, into the acini of which, the inorganic 
“ matter was deposited. The specimen examined appears to 
“ consist of a number of laminated round bodies, each enclos- 
“ ing a nucleus composed of small round elements, which seem 
“ to be the remains of glandular epithelial cells.”