Extracted from the American Journal of the Medical Sciences for April, 1887. 
INTESTINAL CONCRETIONS RESEMBLING SAND, AND 
ORIGINATING IN CELLS FROM THE BANANA. 
By N. L. Bates, M.D., 
MEDICAL INSPECTOR 17. S. N. 
Obscure and puzzling cases may eventually prove to be unexpectedly 
plain. What has been done by one is liable to be repeated by others ; 
hence the history of my cases and of the efforts made to ascertain the 
nature of the unknown substance which caused them may save time and 
trouble to some one who might otherwise become involved in a search 
similar to my own. 
Four years ago I washed from the fecal movement of a child a half 
ounce or more of siliceous, organic cells, closely resembling in external 
appearances fine black sand. Since that time these cells have been 
examined by many of the ablest chemists, microscopists, and physicians 
of the country, who were unable to give any information as to their 
origin, or even to decide whether they belonged to animal or vegetable 
life. Twice I read articles on the subject before societies; in one instance 
before a large audience representing almost every branch of scientific 
research. Specimens were shown, both in the natural state and w'ith 
the microscope, but no one present identified them with any known cells. 
The specimens had been seen and examined by more than a hundred 
physicians and microscopists, when Dr. Robert T. Edes recognized them 
as probably of similar origin to those he had described in the Boston 
Medical and Surgical Journal 'of May 10, 1883, and which had been 
identified as coming from the banana. My cases are as follows: 
Case I.—Yokohama, Japan, July, 1882. Eva M., aged five years. 
Only child of American parents, both living; a pale, delicate-looking 
girl, sedate and precocious, with a history of indigestion, habitual con- 
stipation, and occasional attacks of gastric catarrh. The constipation 
and indigestion commenced when the child was two years of age, and 
were without apparent cause, but led to such care and watchfulness on 
the part of the mother and other members of the family that every minute 
detail of the child’s life could be given. 
On my first visit, the patient had fever, vomiting, gastric pain and 
tenderness, a tense, hard abdomen, and constipation. The bowels wTere 
relieved with great difficulty. Frequently repeated and large enemata 
were thrown well up the bowel, but the atony of the intestine was so 
great that the water was retained and oozed away on a folded sheet 
placed under the hips. I noticed one morning that this sheet was liberally 
sprinkled with a fine black sand; the mother said that these gritty par- 
ticles came from the bowels, caused the child much uneasiness, and that 
she had folded the sheet differently several times on account of them. 
They were clean, and there was no appearance of fecal matter or dis- 
coloration on the sheet. I saved some of the deposit, and directed the 
mother to send me the first fecal movement, and as much of the sand as 2 
BATES, INTESTINAL CONCRETIONS. 
she could gather. Shortly after, the obstruction yielded to an enema 
containing one-half ounce fluid ext. of senna, and an enormous and 
very offensive fecal movement was obtained. The mother sent me only 
a small portion of it, from which I washed a tablespoonful or more of a 
substance closely resembling in general appearance fine black blotting 
sand. I am unable to state how much there was in all, but the mother 
of the child estimated the amount as two teacupfuls of sand in a cham- 
berful of feces. 
The relief was immediate, and practically the end of the case. A 
month later there was a lighter attack of similar character, but no 
obstruction in the intestine and only a small quantity of the black 
deposit. The child passed from under my care a few months later, 
returned to the United States, and died of diphtheria about two years 
afterward. Up to the time of her death there were no severe gastric 
or abdominal attacks, and although carefully looked for, no more black 
specks were ever seen. Had there been any, I am sure they would not 
have escaped recognition. 
Case II. occurred in Washington, November, 188b. This was the 
youngest of several children of parents both living, a girl, six years of 
age, with a pallid, muddy complexion, and a history of malaria, consti- 
pation, pasty clav-colored stools, and worms (?). There was a distended 
but tympanitic abdomen, pain in the left side just below the ribs, but no 
acute symptoms. The urine was normal, and no enlargement of liver 
or spleen was detected. It was only because I was attending another 
child in the same family that my attention was called to this case. The 
mother stated that at frequent intervals, for two years, she had given 
the child santonin and castor oil for worms, and always with good 
effect. No worms had ever been seen, only “ eggs and skins.” I pre- 
scribed the same remedies, and requested that all the movements should 
be saved. The result was the same as on previous occasions, but the 
so-called worm skins were long strings and shreds of tough mucus, and 
the eggs, although in small quantity, at once recalled my Yokohama 
experience. 
I have heard of three, perhaps four, similar cases; one in Japan, one 
in Washington, one in Ohio, and the fourth in Massachusetts. Of the 
first, Dr. Stuart Eldridge, of Yokohama, writes: 
Case III.—“ The child was, in this case, though stout and fairly strong for 
its age, three years, and previously, according to the mother’s account, per- 
fectly healthy, of a pasty complexion, and for some days before I saw it 
troubled with colic-like pains, which were relieved by a stool, to recur spon- 
taneously within twelve to twenty-four hours. I was sent for because the 
mother detected the abnormal particles in the stool; these were so plen- 
tiful in the specimen I examined as to form nearly one-fourth of the whole 
mass, the amount sent me being that of a good copious evacuation.” “The 
grains were exactly like those” in the Eva M., Yokohama case. This case 
was not seen again, and no further history obtained. 
Case IV. is reported to me by Dr. C. H. II. Hall, U. S. Navy. Ilis own 
child, a boy, three years of age, passed a half teaspoonful of black, sandy- 
looking grains after a dose of santonin and castor oil had been given—none 
had ever been seen before, and although looked for, none have been seen 
since. No examination was made, but in general appearance they resembled 
my specimens. 
Case V.—The clinical history is wanting. Prof. Romvn Hitchcock received 
some years ago, from a physician in Ohio, specimens which he is quite sure 
were the same as mine, but he does not now know who sent them nor the 
history of the case. BATES, INTESTINAL CONCEETIONS. 
3 
I have been promised the details of a case occurring in the practice of 
a physician in Salem, Mass., but have not received them. 
In my cases the cells were of such peculiar character that identifica- 
tion would have seemed comparatively easy; yet it was in their most 
striking characteristics that they differ from the banana cells in their 
natural state, where they are white, translucent, and only resemble in 
size and form the objects from the intestine. If a transverse slice of 
banana is placed in a watch-glass and covered with strong nitric or sul- 
phuric acid, a double row of cells, with a spiral fibre between, will be- 
come visible, enclosing three lobes in the centre of the slice, and the 
cells will eventually become of a garnet-red color. They are not so 
deep in color as my specimens, and have not the weight and resistance, 
but otherwise resemble them closely. 
The cells from my Yokohama case could not be readily cut or crushed; 4 
BATES, INTESTINAL CONCRETIONS. 
were deep red-brown in color; had a sp. gr. 1.59; and contained four 
per cent, of silica. With the naked eye and sense of touch they could 
not have been distinguished from so much blotting sand. As passed 
from the bowel on the sheet they were perfectly clean, free from fecal or 
other adherent matter, with nothing to give any clew to their origin, 
except size, form, and the manner in which they were joined together, 
and in none of them was there anything which could indicate a probable 
source. Their appearance under the microscope is well shown in the 
preceding illustrations. 
One of my patients, so the mother said, had never eaten fruit of any 
kind. In answer to a direct question, however, she admitted that the 
child had occasionally eaten a small piece of banana. The Yokohama 
child had eaten banana quite freely some months before I saw her; but, 
as the fact was not mentioned, and the fruit not at all common in Yoko- 
hama, I had no reason to suspect it. I examined the drinking water 
and all suspected foods, including native fruits and candies. 
The Japanese persimmon was suggested as a probable source by a 
Japanese microscopist, but I did not find any cells in them like mine. 
I have recently thought, however, that treatment by nitric acid might 
develop them, and have requested a friend in Japan to make a thorough 
examination of the persimmon. 
The banana may not be alone responsible for this black sand in the 
intestine, but with the recognition of one source, others may be more 
readily ascertained. The number of cases collected, and the clinical 
history of some of them, are enough to give these objects sufficient im- 
portance to be remembered. 
A suspicion of entozoa was or might naturally have been entertained 
in most of the cases. So far as known, all the cases were children, and 
constipation was a prominent symptom. Some, but certainly not all, may 
have been constipated from birth, and had the elongated descending colon 
which Prof. Jacobi has noticed as a cause of constipation in infants. 
Severi, Alberto (Lo Speriinentale, Firenze, 1884, xiii. 482-508) gives 
statistics of measurements of the large intestine in the foetus and in chil- 
dren. From the seventh month of fetal life to the end of the second 
year of child life, the length of the large intestine exceeds the length 
of the child. With increased age and growth the excess is lost, and 
finally disappears. It may be that the more numerous folds and 
flexures of the large intestine of the child favor the accumulation of 
these objects, and that the intestine in later life is not adapted to their 
retention. 
At all events, I am disposed to regard a prolonged stay in the intes- 
tines as necessary for the development of the deep color; hard, sharp, 
and gritty character; high specific gravity, and siliceous contents of 
these cells; and when thus developed, they are no more innocent than 
would be a corresponding quantity of sharp sand. 
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