A DISQUISITION ON REMEDIES WHICH DISSOLVE THE STONE, IN THE KIDNEYS, or HUMAN BLADDER. WHEREIN THE DIFFERENT MEDICINAL SUBSTANCES and COMPOSITIONS, RECOMMENDED FOR THIS INTENTION, ARE IMPARTIALLY SCRUTINIZED; AND THEIR RESPECTIVE LITHONTRIPTIC VIRTUES ASCERTAINED. Translated from the orginal LATIN of the late celebrated G. VAN SWIETEN, M.D. First Physician and Privy-Counsellor to their Imperial Majesties, Perpetual President of the College of Physicians at Vienna, Honorary Member of the Royal College Physicians at Edinburgh, A.R.S.P.S, A.R.C.P.S, &c. LONDON: Printed for J. WILLIAMS, No.39, Fleet Street, MDCCLXXIII. A DISQUISITION ON LITHONTRIPTIC MEDICINES. THE Stone being a very terrible and frequent distemper, it is not to be wondered at, that nu- merous attempts have been made to discover a reme- dy Capable of dissolving it. It appears from an experiment made by the cele- brated Boerhaave,* that the primary elements of the stone have been dissolved in healthy animal fluids, which afterwards, in an united state, form hard stones. These elements, while they remain separated B from *He filled a cylindrical glass, nearly the diameter of a man’s middle finger, with the urine of an healthy young man, perfectly free from any calculous complaints, and whose family had never been subject to this disorder. While the urine was still warm and quite clear, having been made after a good night’s rest, be- fore breakfast he examine it with a microscope, but could not discover the least heterogenous substance. This urine was exposed to the open air, in mild weather (the Fahrenheitian thermometer then being at 72 degrees) and the mouth of the glass only covered with paper, to keep out the dust. In [2] from each other, no ways injure health; they only become hurtful when united. Hence this disorder would be radically cured, were a remedy known, ca- pable of separating the accreted calculous elements, and dissolving them again in the circum-ambient fluid, from which they were originally formed, whereby they might be evacuated with the urine. To In about seven minutes and a half he examined the urine again, with the microscope, which now appeared full of corpuscles, re- sembling little bits of wool, which moved rapidly up and down the glass, some ascending, while others descended, and so vice versa; whence the corpuscles seemed to be of equal weight. Presently afterward, something whitish appeared in the urine; and fatty streaks, like those which are observed when spirit of wine is gradually mixed with water. While he was examining this new phenomenon with the microscope, a cloud was formed from these streaks, which at first floated pendulous throughout the whole glass, but gradually receded from the sides, and col- lecled itself towards the axis. The little flocks, resembling wool, began now to disappear, and were collected into a cloud, which every moment becoming thicker, at length subsided to about half an inch from the bottom of the glass, which was six inches deep: the superior part of the cloud reached within an inch of the exterior surface of the urine. This cloud, examined with the microscope, seemed replete with very minute shining atoms; and the like particles began to adhere to the sides and bottom of the vessel. These atoms, at first white, grew reddish in about half an hour, then changed to a deeper colour, and in about two hours became of the same color as the sand deposited at the bottom and sides of a chamber-pot, wherein urine has been left for some time. But these elements of a growing stone remained so entangled with the cloud, that, they did not subside to the bottom of the glass, but assumed the form of a brownish cloud. However, by degrees some of these corpuscles increased much in size, that they fell to the bottom; and at the same time, in the uppermost part of the urine, similar atoms concreted, which also, upon gently shaking the glass, quickly subsided. In the same manner these atoms grew larger, ail round the sides of the glass, and in twenty-four hours time became as large as mustard seeds. Their shape was that of a rhombus, with equal and ob- tuse opposite angles; other parallelopid corpuscles, redder and larger, intersected them: square corpuscles, but very few in number, sometimes also intersected them. Boerhaave [3] To fulfil this intention many remedies have been tried, by applying them to human stones, out of the body; but I believe spirit of nitre alone is capable of perfectly dissolving the human stone, which it ef- fects with a considerable effervescence, as Hoffman observes. But it is apparent, that such a corrosive menstruum cannot be applied to the stone existing in the body; because it must absolutely destroy the parts wherein the stone might be lodged. Van Hel- mont well describes the requisite qualities of a lithon- triptic medicine. “it readily changes into urine, “ that it may reach the affected part. It possesses the “ property of dissolving the union of the component “ parts of the human stone. It is friendly to nature, “ that it may ruffle the constitution. It is the gift “ of God, not prepared by human art, but only se- “ parated and forced out by means thereof. It is “ extremely subtile, to enable it to destroy its object “ afar off. It possesses these virtues specifically, and “ not from its second qualities; for such are com- B 2 monly Boerhaave never observed that corpuseles as large as those which were formed on the bottom and sides of the glass, con- creted in the urinary cloud. These rhombodoidal atoms were here and there affixed together sideways, so as to become large, from the attachment of six such bodies to each other. This rhomboidal shape of the elements of the human stone is also confirmed by Peyrescus, as Gaffendi observes. From the above experiment it evidently appears, that the hu- man stone is produced by granulation, not from different ele- ments or a confused mixture of concreting humours, but solely by the apposition of similar elements; and, contrary to the opi- nion of Van Helmont, its generation is successive, not instanta- neous. Also if the smoothest pen is dipped in fresh made healthy urine, a shell of soft sand accretes thereto, which increases in quanity by the addition of other urine. Thus stones may be generated out of the body the calculous elements adhering, as to a base to any solid body they meet with in the urine as the ce- lebrated Nuck has demonstrated by an experiment he made on a dog. [4] “ monly deceitful. They err who ascribe these pro- “ perties to corrosives alone: for neither does the “ ostrich digest iron, nor fowls pearls, little stones, “ &c. by corrosion, but by a particular power of dis- “ solving hard bodies, and tartareous concretions.” No wonder Helmont believed the stone might be dis- solved, for he boasted that he was possessed of the Alcahest or universal solvent, which so perfectly dis- solved all substances, that it caused them to flow like water. Moreover the learned Cardan says, “that “ in his time a man travelled through Lombardy, “ who cured all diseases, safely, certainy, and quick- “ ly, with a certain potion,” and adds, “ that he “ firmly believes this person is now in hell, for not “ having revealed his secret in his last moments, for “ the good of posterity.” But as there is no certainty that such a medicine has really existed, capable of perfectly dissolving the stone, and yet of such a mild nature as no ways to injure the part wherein the stone may happen to be lodged, the most skilful of the profession have ta- ken into consideration, whether the stone may not un- dergo such a change, as readily to crumble to pieces, and thus be easily evacuated from the body. The human calculus is not a simple homogeneous body, the component parts whereof are entirely simi- lar, because composed of such, but upon a chemi- cal analysis, yields the same products as other ani- mal bodies, viz. volatile salt, phlegm, and oil, a black friable caput mortuum remaining, which when all the empyreumatic oil is consumed by calcination leaves an earth no longer cohering. Hence it was reasonably enough imagined, that if any of the constituent parts of the human stone could be [5] be separated from the others, the cohesion of the rest must be diminished and thereby the stone rendered friable. Now as the volatile salt is expelled from a stone by means of fire, more quickly than the other parts, the separation thereof from the rest was princi- pally expected; and as lime, when mixed with sal armoniac, instantly emits a subtle, volatile, alcaline spirit and the same phenomenon enfues when it is mixed with human urine, quick lime has a long while been considered as a lithontriptic: for Bartho- line says, “ it is clear from the authority of Basil Va- “ lentine and others, that nothing exceeds spirit of “ quick lime in its lithontriptic virtues; and I have “ repeatedly experienced, that strong lime-water, “ made from the shells of crustaceous fishes, general- “ ly dissolves human stones, out of the body, into “ a jelly, when digested therein a few days with a “ gentle heat.” One Dickenson, a celebrated Eng- lish chemist of the last century, also extols, as an extraordinary medicine in the stone, a water distilled from the antinephritic, plants boiled some time with a quanity of egg-shells thoroughly calcined. Other medical professors have judged, that the co- hesion of the parts of the stone might be destroyed, by separating tbe earthy particles from the rest; as earth is the Principal cause of the stability of bodies, resists a very intense degree of fire. Hales has demonstrated, by his most excellent ex- periments that air is firmly united to all vegetable, animal and mineral substances, and makes a consi- deral part of their bulk, and coheres so strongly to the other component parts, that an intense fire is re- quire to dissolve their union. Air, while thus con- tained in bodies, is unelastic but as soon as separa- ted from the other parts of a body, it recovers its pri- mitive elasticity, and expands itself. Now above one half [6] half of an human stone consists of mere air, a larger quantity than is contained in any other known sub- stance, whether animal, vegetable, or mineral. If, therefore, the contained air can be expelled from the human stone, its size, of course, must be conside- rably lessened: moreover it seems highly probable that the inelastic air intimately mixed with the whole substance of the stone, when having regained its pri- stine elasticity, it escapes from the stone, may force the adjacent particles out of their original places, as it suddenly expands itself: for the fixed air of a human calculus, not more than three-quarters of a cubic inch in size, when forced out by means of fire it became elastic, filled the space of 516 cubic inches. What a prodigious difference! Whence not only the bulk of a stone must be lessened by the expulsion of the air, but also the cohesion of its component parts with one another must be weakened, and the stone be thereby rendered brittle. But Hales demonstrates that all human stones do not part with their fixed air with equal facility. The same is also confirmed by the experiments of Lobb, who affirms that a stone may be dissolved by every thing capable of separating and expelling the particles of fixed air contained therein; because that the parti- cles of air being intermixed with the other component parts of this concrete, by the loss of them, vacant spaces must be left between the other component particles; that is, the stone must crumble to pieces He steeped flint stones and bits of marble in the juice lemons; presently air-bubbles issued from these substances, resembling the froth upon the surface of liquors, which for several hours constantly encreased in quantity; and at the same time, a fine light, white powder subsided to the bottom of the glass. Whence he draws this conclusion, that the dissolu- tion [7] tion of above stones was effected, in consequence of the acid particles of the lemon juice having de- stroyed the union between the air and the other com- ponent particles of these substances; and he thinks it probable that these particles of air were what cement- ed the other parts. From the ingenious ex- pirments of Stack, a famous Swiss physician, Lobb, mature deliberation, concluded that all animal stones abound greatly in a viscid, inelastic matter, ana- logous to mucilage of quince-seeds; and that every thing capable of rendering the air latent therein, ela- stic, is a real dissolvent of the stone. Macbride, an eminent English physician, has proved from conclusive experiments, that this inelastic air contributes greatly towards cohesion, especially in animal and vegetable substances: he even thinks that fixed air is the primary cause of the cohesion of the as they do not separate from one another before this air has been extricated. This cohesion of the inelastic air with the other constituent parts, is often so strong, as to require a considerable degree of fire to dissolve its union; and such bodies may be kept unchanged for many ages. Hales extracted by fire a large quantity of air from stag's horns; but this air was not extricated from it's union with the other parts without a very strong fire; when white fumes issued from the receiver, the air separated in great quantity, as also when the fetid empyreumatic oil was forced out by a most intense fire. Moreover, every body knows that the horns of deer killed many ages ago, are still preserved in the halls of country gentlemen. On the contrary, where elastic air is separated by fermentation or putre- faction, cohesion is diminished, nay sometimes wholly lost: but if this inelastic air can be restored to the [8] the bodies from which it has been extricated, they cohere together again, as firmly as at first. Macbride steeped some putrid flesh, almost dissolved into a stinking gore, in some wort, then strongly fer- menting: in less than an hour the flesh smelt much less offensive, and in five hours became quite sweet; and though it before scarcely cohered, was now again firm: the same effect followed, when a piece of rot- ten meat was hung over the steam of fermenting wort. It is an indisputable fact, that a large quantity of air is generated by liquors in a Hate of fermentation, which air was before inelastic: this Helmont calls the gas sylvestre, which when taken in with the breath, in a considerable quantity, instantly suffocates men and animals: now this identical vapor destroys putridity, and strengthens the cohesion weakened thereby, the air, as it seems, being restored, which, from putridity was separated, and had escaped from its union with the other parts. Bodies when deprived of their fixed air seem bibulous, and greedily imbibe similar air, and fix it again: for it appears from the experiments of Hales and others, that this fixed air, now rendered elastic, sometimes soon looses its ac- quired elasticity, and is again fixed in other bodies destitute of such fixed air. Calcarious earths abound in such fixed air, and have a great affinity therewith; but when deprive of this fixed air, from calcination, become caustic, and readily dissolve in water; but when this fixed air is restored, they lose their caustic quality, and no longer dissolve in water, as is demonstrated by a very curious experiment. Let lime water, filtered through paper be poured into a glass vessel: in another glass vessel put a quantity of pearl ashes; join these vessels toge- ther by means of a crooked glass tube, the ends of which fit the necks of the two glasses so nicely, that nothing [9] nothing can escape through the joints. In the top of the vessle that contains the pearl ashes, bore a hole, to which apply the pipes of a small funnel, through which gradually Pour in oil of vitriol, or any other acid, to cause an effervescence. As soon as the mix- ture begins to effervesce, remove the funnel, and stop the hole, that the air, separated during the efferve- scence, may be compelled to pass through the con- necting tube, into the glass containing the lime water. This done the lime water will grow turbid in a few minutes, and the lime will subside to the bottom, which upon pouring off the water, will strongly ef- fervesce with oil of vitriol. Some phenomena are hence comprehended, that puzzled the greatest chemists. Volatile alcaline spirits distilled with quick lime, never produce vola- tile alcaline salt in a solid form, because they are de- stitute of fixed air, the band which cements particles together: nor do they cause an effervescence when mixed with acids, a circumstance still more surprising. The reason of these phenomena is as follows: Quick lime, when added to sal armoniac, not only at- tracts the acid, but also the fixed air contained in the sal armoniac, wherefore, in distillation the volatile salt alone Is raised with the phlegm deprived of its fixed air. Now as effervescence is produced by the separation of the fixed air, and its regaining its elastic property, by the union of an alcali with an acid, hence alcaline salt, deprived of all its fixed air by quick lime cannot of course effervesce with acids, Hence such volatile alcaline spirits, if again satu- rated with fixed air, would effervsce with acids. This is the case in fact, as the above plain experi- ment demonstrates. For when, in the apparatus, the air force out by means of the effervescence between the acid and alcali, is compelled to pass through the crooked tube into the vessel containing the volatile al- C caline [10] caline spirit with quick lime, the spirit, within ten minutes, becomes so saturated with the fixed air which it attracts, that it will now cause a strong effervescence with acids. The very same effect is produced, when air, extricated from liquors in a state of fermentation, is, by the like artifice, derived into a glass vessel, con- taining an alcaline volatile spirit with lime. Besides, the same air extricated by fermentation, received into lime water, precipitates the calcarious particles, whence, in the space of five days, three grains of such earth was produced from six ounces of lime water. But though fixed air becomes elastic, when its con- nection with the other parts of a substance is dissolved, it differs in its properties from the air of the atmo- sphere, and in particular is more quickly and readily imbibed by bodies deprived of fixed air. For fixed air separated by means of effervescence, in ten minutes time rendered volatile alcaline salt capable of effer- vescing with acids. The same air extricated through fermentation, in the space of five days precipitated the calcarious particles from lime water, which though left in an open vial a whole fortnight, exposed to the air of the atmosphere, had not deposited, during that time, a single grain of calcarious earth. Yet fixed air seems to exist in the air of the atmosphere, or the circumambient air may be rendered inelastic. For we observe that lime water, when long kept, collects a scum on its surface, which is in reality calcarious earth, which, by the action of fire, may again be con- verted into quick lime. Moreover, lime long exposed to the air, loses its caustic quality, and is no longer soluble in water. Nieuman kept spirit of sal armo- niac prepared with quick lime, ten years, which hav- ing almost lost all its volatility, strongly effervesced with acids; because in this great length of time, the spirit had again become saturated with fixed air, which is absolutely necessary to cause effervescence. The [11] The celebrated Boerhaave, who never determined readily in cases the least doubtful, says, “It has some- “ times been doubted whether all that might be thus “ generated would be so far of the same nature, as “ that it ought to be called by the same name of ela- “ stic air? or, on the other hand, whether bodies “ being reduced, after a certain manner, into their “ minutest particles, might not have their nature al- “ tered, and, by a real transmutation, be changed in- “ to this elastic air, which afterwards being again “ concreted with other things, might produce new “ solid bodies? and consequently, whether, besides “ common elastic air, there was not in nature “ something else very much resembling it, and yet “ not perfectly the same.” The ingenious and accurate experiments of Dr. Black concerning the fixed air, latent in bodies, merit an attentive perusal; moreover Macbride supposes them previously known, in order to the better under- standing of his own. Now as the quantity of fixed air contained in a human stone constitutes above one half of its own bulk, there is great reason to suppose that a stone may not only be much lessened in size, from the expulsion of this air, but also be rendered friable; as the pre- ceding experiments demonstrate that this fixed air contributes greatly to the cohesion of bodies. It is well known that the air is expelled from the human calculus by fire, and corrosive substances; but these agents cannot be applied to a stone lodged in the body Whence this expectation only seems to remain, that a medicine be discovered capable of extracting the fixed air from the stone, yet of so mild a nature as not to injure greatly the parts containing the stone. As quick lime possesses these properties, the reason is ap- C2 parent [12] parent why lithontriptic medicines of high repute have been prepared from this substance. I shall next examine the lithontriptic medicine of Mrs. Stevens, which obtained the approbation of the British parliament, who gave her ten thousand pounds to publish the secret. The origin of this remedy was as follows: Mrs. Joanna Stephens, about the year 1720, began to administer egg-shells baked in an oven, and afterwards powdered, as a solvent of the stone Some time after, she began to burn the egg-shells in an open fire, till they became perfectly white, and found them more efficacious in proportion to the length of time they were suffered to continue in the fire. The dose prescribed was a scruple three times a day, in a glass of white wine. But as these powders frequent- ly occasioned excessive costiveness, she added a small quantity of soap, which she imagined might likewise assist the dissolution of the stone, and remedy the above complaint. She followed this method some which, as experience proved, expelled gravel from kidneys, and sometimes even dissolved stones in the bladder. About the twelfth year of her practice, she began to administer calcined egg-shells in larger do- ses, frequently with the addition of half an ounce of Alicant soap, dissolved in some liquid; and as this medicine proved remarkably serviceable to a man up- wards of eighty years of age, who had long been af- flicted with the stone, but during the use of this re- medy voided many scales and fragments of stones, this case afforded a more strinking instance of the lithontrip- tic virtue of her medicine, than any of the former ones; whence she afterwards increased the dose both of the powder and soap, and then met with still greater suc- cess. Hence it is apparent that the virtue of this me- dicine solely depends on egg-shell lime and soap. The [13] The medicine having by this time grown into vast repute to prevent a discovery of its composition, Ihe other ingredients with it, as garden-snails cal- cined and powdered, to one part of which she added six Parts of egg-shell lime, and this mixture was kept a stone jar, close stopped. She also added chamo- mile fennel, burdock, parsley, or the roots of these plants when they could not be procured green; to these she also sometimes added mallows, marshmal- lows, without finding the least difference in the effect of the remedy. She added also a small quantity buckthorn plantain burnt to ashes, which she also mixed with the solution of soap. Indeed she owned that the above ingredients were only added to disguise the medicine. These ingredients being therefore left out, the re- medy was rendered more simple, by giving only two scruples, two scruples and a half, or even a drachm of egg-shell lime in any liquid three times a day, the pa- tient drinking, after each dose, one third part of a de- coction prepared from two ounces, two ounces and a half or three ounces, of Alicant soap dissolved in a pint of water, or rather more, and sweetened with ho- ney or sugar. Hence the proportion of the lime to the soap was as one to eight; by this means the body, was generally neither too loose nor too costive; for as, the powder would bind the body, the soap would ren- der it laxative, and both impart a dissolvent virtue to the urine; the dose of each was increased or lessened, according to the different state of the bowels. How- ever, if a purging came on, recourse was immedi- ately had to opiates. Persons of a strong constitution were to use the extreme dose of each medicine; for the generality of people the middle dose is sufficient. But the best way is to begin with the smallest dose, when the stomach is weak, and the pains violent, and to render the medicine milder by calcining the powder [14] powder less, or by exposing it longer to the open air; for every body knows that the fiery quality of all kinds of lime is lessened by these means. The lowest dose is also sufficient for very weak and old persons, as stones formed in old people are easy of dissolution. But young persons ought to take as large doses, as the stomach can bear; for Dr. Hartley affirms, that from repeated experiments he is certain these medicines act less quickly in young habits, and that he never knew an instance of any constitution being injured from the encreased dose of these medicines, or their long con- tinued use. Whence his general rule was to admini- ster to every one as large a quantity as the stomach could bear; for the larger the quantity taken, the more quickly does the stone putrify and dissolve, and the different circles become more soft, which, when the medicine has been regularly taken some time, are generally voided with the urine. For Dr. Hartley observed in himself, when afflicted with the stone, that the urine is changed by these medicines, and becomes more volatile, alcalious, smells like stale, putrid urine, and effervesces with oil of vi- triol, oil of sulphur per campanam, spirit of nitre, spirit of sea salt, vinegar, and lemon juice, as is generally the case when these medicines are taken any length of time. Moreover experiments demonstrate, that human stones steeped in the urine of a person under a course of lithontriptic remedies, decrease in weight, but when digested an equal length of time in natural urine, acquire a greater degree of weight. Whence he concludes that urine, from a plentiful use of quick lime and soap, is impregnated with a po- wer of dissolving the stone, though at the same time it becomes alcalious and putrescent. But as physician in diseases, from the appearance of the urine form a judgment of the state of the blood, from which that fluid [15] fluid has been secreted, many eminent gentlemen of the faculty have apprehended that the putrescency, and alcaline acrimony might corrupt the healthy fluids of such Persons as took Mrs. Stephens’s medi- cine. mead inveighs bitterly against them, and blame some of the faculty, “ for having acted a part “ much below their character, in suffering themselves “ to be imposed on, and encouraging the legislature “ to purchase an old woman’s medicine at an exor- “ bitant Price.” For he apprehended, from the high- ly caustic quality of this remedy, “that it might “ prove serviceable for the expulsion of gravel, but “ could never dissolve hard stones; and that a long “ continued use thereof was by no means free from. “ great danger.” Nevertheless, he acknowledges, with his usual candour, that lime-water alone has done infinite service when prepared from the shells of fish calcined, which in his opinion is different from common quick lime; and the experiments of Whytt demonstrate that shell lime water possesses greater lithontriptic virtues than that which is made from stone lime. The quick lime used by the builders in Holland is prepared from all kinds of shell-fish, and of this lime their lime water is made. If this lime is cast into urine newly voided, a considerable ebulli- tion and heat are immediately produced, and an ex- tremely acrid volatile vapour affects the nostrils, like a flash of lightning. Indeed Boerhaave says, “All “ these phenomena hold more true with respect to “ stone than shell lime;” which last, however, he made use of in his chemical experiments; at least it is apparent that calcined shells afford a real and effica- cious quick lime. Whence the ill consequence, ap- prehended from Mrs. Stephens’s medicine, is equally to be feared from quick lime, and lime water, on which the chief efficacy of her lithontriptic seems to depend as will be observed hereafter. Huxham [16] Huxham allows the lithontriptic virtue of Mrs. Stephens's medicines; but from the alcalious qua- lity imparted to the urine, by a plentiful use there- of, questions whether the blood and humours may not be likewise affected in the same manner, which he justly thinks a dangerous circumstance in tender constitutions. As he had known a gentleman, who having been tortured with the stone several years, had taken soap-lees for several successive weeks, which caused a putrid scurvy; of which, indeed, he recovered, but at the expiration of a few weeks died of a confirmed hectic, and a complication of disorders. But his death cannot fairly be ascribed to this remedy alone; though it certainly was imprudent to admini- ster it when the patient laboured under a complica- tion of disorders, was consumptive, and besides of a very tender, weakly constitution. Whether a long continued use of these medicines would prove as dangerous to a person troubled with the stone, and perfectly healthy otherways, may justly be doubted. For it is certain that many have taken these medicines a long time, without suffering any re- markable injury in their health. They are nauseous and every stomach cannot bear a continued use of them; though many, in hopes of relief, have per- sisted in their use with great resolution: and though the urine is rendered acrimonious, alcalious, and causes an effervescence with acids, it does not follow that the blood and juices are affecfted in the same manner by them. For the urine contains a much greater proportion of salts, and more acrid ones too, than are observed in the blood or serum; which the affusion of lime-water, instantly emit a very subtle vapour. Now lime-water mixed with the blood, heightens its colour, but causes hardly any other change, according to Schwencke, who takes no notice that any acrid vapour was produced from the above [17] mixture. As the more acrimonious salts are natural- ly voided with the urine, it being thus rendered more acrid than common, will flow over whatever stones may be lodged in the kidneys, and will act with great- er force on such stones as may be contained in the bladder; so that the external coats being macerated in this lixivium, will be softened, separated from those beneath them, and at length be voided with the urine: whence the bulk of the stone must daily be diminished, and at last the nucleus be expelled. Mo- rand an excellent judge of this matter, who was commisssioned by the Royal Academy of Surgery at Paris to scrutinize the effects and utility of Mrs. Ste- Phens’s medicines, attests, that many had taken them, a great length of time, without the least injury to their health and that some had manifestly received great relief from them, indeed such vast benefit that they thought themselves perfectly cured of the stone. It does not, however, appear, from his observations, that these medicines effected an absolute dissolution of the stone, some patients voided fragments of stones with their urine. As persons afflicted with the stone are frequently incapable of holding their water, fragments of the stone were not observed to be voided till this complaint was in great measure removed, and thence the urine, impregnated with the lithontriptic virtues of the medicine, rendered capable of acting a consi- derable time upon the stone lodged in the bladder. Hard stones, he asserts, which when sawed through may be polished like marble or agate, were no ways changed or eroded by Mrs. Stephens’s medicines, which, however, acted on softer stones, especially in aged persons; but least of all in very young people. but as it is almost impossible to ascertain the degree of hardness of a stone contained in the human blad- der, Morand advises all grown persons to make a trial of Mrs. Stephens’s medicines, before they sub- mit to the operation of lithotomy, which though D greatly [18] greatly improved by modern surgeons, is by no means free from danger; and may be performed with equal safety after a trial has been made of Mrs. Stephens’s medicines. But he also observes, that they are by no means proper when there is an ulcer in the urinary pas- sages, of which purulent urine is a certain sign, be- cause these medicines increase the pains: yet a man aged thirty-four, afflicted with the stone, and an ul- cer in his bladder, took Mrs. Stephens’s medicines for three months; his pains were considerably in- creased, and he died about six weeks after he had left off taking them. Upon opening the body, it evi- dently appeared that the medicines had acted upon the stone, and there was reason to believe that the stone would have been intirely dissolved, provided the pa- tient could have persisted longer in their use. Several other cases are also related in the memoirs of the Royal Academy of Sciences at Paris, which demonstrate that Mrs. Stephens’s medicines act upon the stone in the bladder, and diminish its bulk; and that thin scales se- parated from the whole surface thereof, have been voided with the urine, as has been manifest upon the extraction of the stone by lithotomy, or on opening the body after the patient’s death. But as these medi- cines act slowly, they must be persisted in a long time. Other instances have also demonsrated, that a long continued use of these medicines has remarka- bly relieved the different symptoms of the stone, even where, after the operation, there has not been the least appearance that they had acted on the stone, or lessen- ed its size. Thus a man had taken Mrs. Stephens's medicines six months, and found great relief from their use: his pains left him, he could walk, ride on horseback, or in a coach, and could use any exercise without inconvenience for a whole year. At length he began to perceive an heat in his bladder, attended with [19] with a strangury, and an incontinence of urine. These symptoms were relieved at first by bleeding, and cooling medicines, but soon returned again. At last the patient resolutely submitted to the operation of lithotomy, as the only means of a cure, and a stone was extracted which weighed an ounce and a quar- ter, hard, compact, and of a rusty colour, which did not appear to have been at all acted on by Mrs. Ste- phens’s medicines; yet, during their use, the urine had constantly deposited a large quantity of white sediment. The patient, after he had left off the me- dicines, used to void very fine reddish sand, resembling the extracted stone: he recovered the operation, and live many years afterwards, in perfect health. An- other person took the above medicines three years, at first every day, then at intervals, whenever he was in pain, and always found relief from them; but never was affected in his health, from so long an use of them; except that he rather grew more corpulent. Hence it may be concluded, with justice, that Mrs. Stephens's medicines may be taken without hurting the constitution; that the bladder is not injured by the urine rendered more acrimonious thereby; and the lithotomy may be safely and successfully had re- course to, after a long continued use of them; a cir- cumstance of great moment. For although they do not appear to act upon hard stones, yet they exceed- ingly relieve the symptoms, and even for a great length in time; whence it seems as if lithotomy may safely be deferred, as long as the patient continues free from complaints. Moreover, the candid ob- servations of Hartley confirm the action of these me- dicines on the stone; who, in his dissertation on Mrs. Stephens's lithontriptic gives the figures of se- veral stones eroded thereby, and relates several cases, where upon searching the patient, stones have been felt in the bladder, and during the use of these medi- D2 cines [20] cines many stony scales have been voided with the urine, and at length the very nucleus of the stone it- self, the symptoms entirely ceasing: in some no stone has been felt, though the bladder has been searched at three different times, after the evacuation of the above substances. He owns however, that upon searching two per- sons, who had voided many fragments of stone, and one of whom imagined, after a sudden, but not pain- ful suppression of urine, he had voided the nucleus of a stone, that contrary to expectation, a stone was felt in the bladder: yet one of these patients, du- ring two years and an half, the other almost three years after he wrote the above, continued free from every symptom of the stone, nor felt the least incon- venience from any motion of the body whatever, even from being jolted in a carriage over the stones, an exercise that commonly much exasperates the pains this disorder. As Mrs. Stephens’s medicines contain a large quanti- ty of calcarious earth, a doubt has been raised, whether the thin scales voided during their use, supposed to be separated from the stone, were not calcarious particles that had slightly accreted to the stone, and were thence easily broken off its surface; and therefore the size of the stone rather enlarged than lessened, by the use of these medicines; or at least the diminution of the stone a matter of uncertainty, from the above circumstance. The ingenious experiments of Macbride prove that even the most limpid lime water contains a calcarious earth, which instantly subsides, as soon as it has re- gained the fixed air, of which it was deprive by fire. Whence when these medicines set at liberty the fixed air contained in the human calculus, and at- tract it themselves, a calcarious earth is regenerated from the same cause as renders the stone friable. Yet [21] Yet it does not follow, that the scales voided with the urine consist only of calcarious earth. De Haen, in his practice of physic, mentions a burgher of Crem- nitz, who often voided with his urine, “a great quan- “tity of white, glutinous matter, that after standing a “while turned into white, brittle gravel,” yet this man had never taken any thing in the least resembling Mrs. Stephens’s medicines. Besides such calcarious scales alone are not voided after the use of these medicines. For instance, a per- son who, when a boy, had undergone the operation of lithotomy, being attacked with a return of his disorder, was twice examined, at different times, by an eminent surgeon, who, upon the introduction of a finger into the fundament, both times plainly felt a stone in the bladder, the size of an egg. Having ta- ken these medicines, he soon voided a large quantity brownish rotten gravel, and many white scales. This discharge gradually ceasing, the cases of the stone were voided, to use the expression, inasmuch as the fragments consisted of several different scales laid over each other, many of which were irregularly shaped, externally white, but when rubbed seemed brown within side. At last the nucleus itself was discharged in pieces, brittle and porous, the symptoms then en- tirely going off. The patient being now examined a third time by the same surgeon, in the same manner, no stone at all could be felt. It is not probable that all the above substances voided by this patient were mere calcarious earth, beyond a doubt they partly consisted of the eroded substance of the stone. This candid author owns, “that the lime con- “tained in the medicines is deposited in the urinary “passages:" for as the urine, impregnated with these remedies, is commonly turbid and whitish, and also quickly deposits a white, heavy sediment, he, in concert [22] concert with Hales, investigated the nature of this se- diment, and of the fragments voided with the urine, during the use of Mrs. Stephens’s lithontriptic. By way of experiment, he filled the bowl of a tobacco- pipe with bits of a real human stone; a second he filled with the fragments voided by a patient during the use of these medicines; a third he filled with the dried sediment of the urine of another patient. He placed the pipes upon a fire. The two first substan- ces nearly evaporated; but out of twelve grains of the dried sediment, seven grains were left in the pipe. Whence it appears, that this terrene sediment is not of the same nature as the human stone; but that the fragments, voided with the urine during the use of Mrs. Stephens’s medicine, and the human stone, are both of the same nature. Stack also, from his own experiments, which merit repeated reading, concludes, “that the calcarious “matter passed unchanged into the urine, as he has “observed in the sediment of different urines.” An human stone digested in a calcarious menstruum, first loses its nebulous coat, as he calls it, because examined with a microscope it has such an appearance; the stone is next covered with a whitish, hard, calcarious substance; then a thin scale peels off, the internal surface of which is porous; beneath this is placed another thicker coat, perforated with wider holes; and the same takes place in all the succeeding coats, quite to the nucleus; the innermost coat having the largest holes. These experiments perfectly coincide with those of Macbride. The lime contained in lime-water becomes visible when it has attracted the fixed air from other bodies; and the experiments of Hales prove that a great quantity of such air is con- tained in the human stone. Stack demonstrates that this air is confined in a certain glutinous substance, resembling mucilage of quince-seeds; which he has observed [23] observed forms one of the component parts of both flints and human stones; when a human stone is di- gested with lime water, the lime, now saturated with fixed air, subsides, and the different layers of the stone, quite down to the very nucleus, become porous. Does not the loss of the fixed air produce this effect? At least this supposition is highly probable. And as this air continuing entangled with the glutinous sub- stance may in its exit take part thereof away with it, and, through the apposition thereof to the sides, ren- der the holes of the outermost coats narrower than the others, is not this the cause why the holes are widest in the coats nearest to the nucleus of the stone? The above, at present, are mere conjectures; but the result of experiments, not the effect of a lux- uriant fancy. If the Roman Senate judged the citizen worthy of applause, who had resolution enough not to despair of the republic in the most desperate situa- tion those great men certainly deserve commenda- tion, also, who venture to entertain expectations of solving this most difficult problem in the science of physic, viz. the dissolution of the stone in the bladder. It cannot be denied that the profession has already made some progress in the discovery of medicines called lithontriptics, because they diminish the bulk of stones, and thereby facilitate their expulsion. Yet, it must be confessed, the most celebrated have often proved ineffectual; for some stones are so extremely hard, as to elude the action of all known lithontrip- tics: others, which less strongly cohere together, yield to the efficacy of these medicines. Moreover, it is apparent from a variety of instances, that the most excruciating tortures of the stone have not only been alleviated but even totally removed, for several months, nay years, though the stone was not dis- solved, but still remained in the bladder. What a prodigious [24] prodigious happiness is even this last circumstance to the miserable sufferer! But though it appears from unquestionable autho- rity, that Mrs. Stephens’s medicines have been of great service, yet it frequently happens, that patients cannot persist in their use a sufficient length of time, as they often occasion a violent and insuperable nausea, whence the most eminent of the profession have done their utmost to surmount this inconvenience. Indeed, it is apparent, from the preceding account of Mrs. Stephens’s medicines, that many ingredients were added that only increased the bulk, not the effi- cacy of the medicine. For when Mrs. Stephens dis- closed the composition of her medicines, she owned that the additional ingredients might be safely omit- ted, as they had only been used to disguise the me- dicine. Whence Hartley retained only the egg-shell lime and soap, and thus much lessened the dose of these medicines. However, the middling dose, for an adult (for they were to be taken in different doses, according to the strength and age of the patient) sufficient for one still amounted to two ounces and a half of Alicant soap, and two drachms and a half, troy weight, of calcined egg-shells, which powder being extremely nauseous, and the quantity of soap large, the medi- cines even thus reformed, can be taken but by few, any length of time, without bringing on an insupe- rable nausea. Hence Whytt has attempted a farther emendation of them. From the experiments of Hales thereon, he judged that their efficacy chiefly depended upon the quick lime; and that, for this reason, lime-water would answer as well as the above nauseous medi- cines. (25) cines. The circumstance of Mrs. Stephens’s having a first used calcined egg-shell alone and of her having added the soap afterwards to remedy the costiveness usually brought on by the powders, confirmed him in his opinion. And as from the experiments of Hales, the other ingredients of which soap is composed, (viz.) oil and the alkaline salt called potash, conduce not in the least towards the dissolution of the stone; its whole virtue must depend upon the quick lime, or lime-wa- ter used in making the soap. Wherefore leaving out the soap and egg-shell lime, he determined to try effects of lime water by itself: for thus he imagined the lithontriptic virtues of a greater quan- tity of lime might, with safety and less inconvenience, be conveyed into the blood. For of the powder (al- ready half flaked, and consequently greatly weakened by being exposed sixty days to the open air) only a few scruples are taken in a day, and if swallowed without enough liquid, occasion great heat and uneasiness in the stomach; for every body knows that a fiery heat is generated the instant water is pour- ed on lime; and if it is sufficiently diluted it can have little other effect than weak lime-water, which is found by experience to dissolve stones out of the bladder. Is it not therefore reasonable to expect, that when taken in large quantities, and but little weak- ened by drinking of other liquors, the urine like- wise may be so far impregnated with its virtues, as to acquire a power of dissolving the stone. But as reasoning a priori, unsupported by experience, is not sufficient to ascertain the virtues of any medi- cine; Whytt embraced the first opportunity that offered to make a trial of lime-water, the effects of which will best appear from the following history. Mr. David Miller, about sixty years of age, had been for many years distressed by stones passing from E the (26) the kidneys to the bladder. Sometimes he had se- vere fits of pain once or twice in a year, and sometimes but once in two or three years; and these of two, three, four, and even of eight and fourteen days con- tinuance: but always in a few days after these fits, he voided one or more stones, till at length, having been thus afflicted thirty-six years, after a very severe fit, that lasted two days, a stone arrived in the bladder; but though he used his ordinary means of riding, walking quick, jumping, and drinking plentifully of proper liquors to make it pass, yet all his endeavours were in vain. For half a year af- ter this, he was troubled with frequent obstructions in making water though without any great simulat- ing pain, except in voiding the two or three last drops. He soon found the stone increase and be- come heavier in the bladder, and upon riding a mile or two his urine was always mixed with blood; be- sides he lost all power of retaining his urine, so that it went from him every eight or ten minutes, which was accompanied with excruciating pain, yet some times with intervals of ease for a day or two, after sweating and keeping warm. At first he drank milk and water; but in the eleventh month after the last nephritic fit, he began to take soap, first to the quantity of half an ounce every day, which he gradually increased, till in the beginning of the fifteenth month he took an ounce and a half in a day; but without finding any relief; his Pain, bloody urine, and incontinence of urine, still conti- nuing as before. Dr. Whytt therefore now advised him to drink large quantities of lime-water with the soap, begin- ning with a pint, and gradually increasing the quan- tity to three pints a day, and to drink no more of any other liquor than was absolutely, necessary to quench his (27) his thirst, that the urine might be more fully impreg- nated with the lithontriptic properties of the lime. Within four or five days, he recovered in great measure the Power holding his water, and from this time had less pain, and less bloody urine, upon using exercise, than before; so that about the middle of the seventeenth month, from his first attack, though he walked fast above six miles, yet,he held his water for nine or ten hours together, and voided it with little pain, and unmixed with blood. The second evening after, when going to bed, and trying to make water, he found a stone entering the beginning of the urethra, and obstructing the passage, He slept little, and often attempted to make water in vain; but the next morning he voided a smooth stone, the size of a common bean, of a whi- tish colour: whereas all those he passed formerly were of a brown colour and rugged. It appeared plainly to be part of a larger stone, and though he was greatly relieved, from voiding this stone, yet he felt still a stone in his bladder, and his urine deposited a large quantity of white sediment with some brownish flakes. During the whole eighteenth month he was much indisposed, the stone frequently entering the beginning of the urethra and afterwards rolling back into the bladder; however, his pains were not very violent and he could hold his urine half a day toge- ther and felt no pain when he voided it. The pa- tient encouraged at this success, persisted in the use of soap and lime-water, which last he frequently drank at his meals instead of other liquors, and fan- cied that his urine tasted of it. At length, about the beginning of the nineteenth month, in the evening, he perceived that a stone had got into the beginning of the urethra, which almost wholly obstructed his urine. However, next morning, after a sound sleep, E2 it [28] it came away. It was larger than the stone voided before, and seemed evidently a fragment of the same stone. For some days after voiding this stone the urethra was very tender, and a little painful, which occasioned his making water more frequently than usual; but this soon went off, and ever since he has been perfectly free from pain, and all symptoms of the stone or gravel, which happiness he chiefly as- cribes to the lime-water, as he had no relief from a constant use of soap. Two years after the expulsion of the last stone, the patient sent Dr. Whytt an attesta- tion of the truth of the above fact; wherein he affirmed that he continued free from all nephritic complaints. Whytt afterwards relates many experiments, which demonstrate that lime-water prepared from sea-shells, acts on animal stones immersed therein, in such a manner that their outsides change white, soft, and fri- able; and when the external coat falls off, the lime- water acts in the same manner upon the inner layers, and thus diminishes the bulk of a stone. Lime-wa- ter is prepared in the following manner: a gallon of boiling water is poured upon a pound of fresh made shell quick lime, and after the mixture has stood five or six hours, the water is filtered through paper, and kept for use in a bottle with a glass stopper. Several pints may be drank in a day with safety, even by young persons. He like wise observed, that lime-water, when mixed with urine, prevented the accretion of the ele- mentary principles of the stone. Dr. Whytt has also made various experiments the substances commonly used in diet, in order to de- termine whether they do or do not diminish the li- thontriptic virtue of lime-water; in consequences whereof he advises, that all fermented liquors, acid fruits, such as gooseberries, strawberries. cherries, ap- ples, [29] ples pears, and the like, and honey ought not to be used by those who take lime-water as a lithontriptic. Lime-water, when drank, does not render the urine alkalious, as Mrs. Stephens’s medicines do; which phenomenon therefore must happen from the great quantity of alcaline salt contained in soap. Now Hales has observed that pot-ash does not dissolve the stone: but soap acts upon the stone; its lithontriptic virtue must therefore principally depend upon the lime that enters into its composition. Possibly soap acts also by dissolving the glutinous substance disco- vered by Stack in flints and animal stones, as has al- ready been mentioned. Whence an ounce of soap is directed every day with a plentiful use of lime-water, beginning at first with a small quantity, and gradually increasing the dose. Where the stomach cannot easi- ly bear the soap, the same effect may be procured from shell lime-water alone drank plentifully and long persisted in, without intermission. If a patient finds relief from drinking lime-water, Whytt would have the use thereof continued for several months, and even years, provided the stone is large. I have observed in my commentaries on the aphorisms of Boerhaave, that lime-water is excellent to cleanse the blood of a muriatic acrimony: but though I have there ad- vised sparing use thereof, apprehensive that for the reason there recited, some bad consequences might ensue a plentiful use thereof, I have since found from repeated experience that the human body bears with- out injury large quantities of lime-water, though con- stanly taken a great while, and that it affords pro- digious relief in the stone. The case of the shoema- ker related by De Haen is remarkable. The poor fellow had been troubled with the stone seven years, at length he began with drinking only a few ounces of lime-Water, mixed with an equal quantity of milk, gradually increasing the quantity till he took two quarts of [30] of lime-water with the same quantity of milk, and an ounce of Alicant soap, everyday, so that he took se- venteen pounds of soap, and above one hundred and eighty seven gallons of lime-water, besides milk, in the space of seven months. About the third month his pains entirely left him, and he could hold his water, and though he left off taking the medicines constantly, and being discharged from the hospital, fed heartily on salted meats and high seasoned food, he still continued free from his complaints. Nevertheless, upon search- ing the bladder, a stone was plainly felt, and his urine was mucous. Having been bled, on account of a phlethora, his blood exhibited every good appear- ance, a conclusive proof that lime-water may be taken as above directed without the least apprehension of danger. I myself advised an old officer to drink lime- water mixed with milk, without the addition of soap, who was thereby entired relieved of the complaints he suffered from a stone in his bladder. It is certainly a vast matter, to be able to alleviate the symptoms, in cases where lithotomy cannot take place with a pro- bability of success. Patients who loath milk may drink lime-water by itself; but in all probability the lithontriptic virtues of lime-water are strongest when it is drank unmixed with milk. Macbride attributes the lithontriptic virtue of lime- water principally, to the power whereby the lime con- tained therein, attracts the fixed air that constitutes so considerable a part of the stone; his experiments demon- strate that the addition of a third part of milk weakens the lithontriptic quality of lime-water; the milk satu- rating part of the contained lime with its fixed air and precipitating it, whence the lime water is rendered inert, and less capable of destroying the cohesion of the parti- cles of the stone. Moreover Dr. Alston has observed, that [31] that most of the ingredients usually added to lime-wa- er, more or less weaken its lithontriptic virtue; whence he advise it to be drank alone without any mixture. He is also of opinion, that the real cause why lime- water sometimes produces no remarkable good effect dissolving the stone in the bladder is, because in the first passages it meets with the vapor of the fer- menting aliment, which, as has already been men- tioned, precipitates the lime. Nay, should the lime- water pass into the bladder, possessed of its whole li- thontriptic power, it would there meet with the urine, which fluid also contains fixed air, by which part least of the lime-water would be saturated, and thus its lithontriptic virtue weakened. To this cause also he attributes the earthy matter that generally subsides from the urine of persons who drink lime-water, for he supposes it precipated from the lime-water. The expectations formed from lithontriptlcs are, that the urine impregnated with their virtues, may act upon the stone lodged in the bladder, which is steeped in such medicated urine; whence the patient is directed to hold his water as long as possible. From the above observations it is apparent, that by the use of these remedies patients often receive vast relief, and also that there is the greatest reason to expect that the stone will be diminished in its bulk by persevering therein. However, as all lithontriptic remedies, inwardly taken, lose some part of their virtues, both in the first passages, and during their circulation with the fluids of the body before they can arrive at the bladder with the urine, and act upon the stone; physicians have justly though of injecting such lithontriptic liquids into the bladder through the urethra, as it was rea- sonable [32] sonable to suppose might be borne without injury to the structure of the bladder. Thus Whytt has proposed, that during the internal use of the above lithontriptics, five or six ounces of tepid lime-water should be injected into the bladder with a syringe every day, immediately after the patient has made water, and be retained as long as the patient possi- bly can; and thinks this injection would succeed still better if thrown up several times a day: now as the repeated introdudtion of a common catheter must prove very troublesome and painful, if a flexible catheter was kept constantly in the bladder, this inconvenience would be avoided, and the injection might be repeat- ed as often as might be thought proper. But sometimes the bladder is so tender that it can- not bear lime-water, though rendered more lenient by being mixed with new milk; as De Haen has re- marked in the shoemaker already mentioned, who though he resolutely persisted in the internal use of lime-water and soap, could not possibly bear an injec- tion of lime-water and milk, which was attempted to be injected into his bladder, with an instrument con- trived for that purpose, “ however cautiously, or in “whatever quantity administred.” Whence the opinion of Whytt seems perfectly just, that the pa- tient ought to drink lime-water some weeks, to dimi- nish his pains, previous to its being used as an injec- tion: for by this means the inside of the bladder will become less tender, and more easily bear and retain the injection longer, whereby it may more effectually erode the surface of the stone in the bladder. Nevertheless as the stomach and bowels can with- out injury easily bear lime-water, which may also be dropped into the eye without any remarkable incon- venience, and is used by surgeons to foment old ulcers [33] ulcers without giving pain, lime-water does not seem acrimonious enough to injure the human bladder. However, should the internal coat of the bladder hap- pens to be so extremely tender as to be much irritated by an injection of lime-water, a drachm of starch, or the fourth part of the yolk of a new-laid egg may be mixed with half a pint of lime water; the starch, when dissolved in the lime-water, should be just brought to boil over the fire, and kept constantly stir- ing till perfectly smooth: by this means the in- jection will occasion far less uneasiness, though its li- thontriptic power is no ways weakened. The mu- cilages of linseed and gum Arabic have been tried for the same purpose, but they both diminish the efficacy of lime-water when mixed therewith. As these injections, to prove beneficial, must be frequently repeated, it is dangerous to make this at- tempt by passing a common catheter into the blad- der frequently patients afflicted with the stone complain of exquisite pain, though the instrument be passed by a very dexterous and experienced surgeon: nay many, after having been once searched for the stone, can upon no account suffer a second introduc- tion of the instrument, even though a considerable time. has elapsed. To say the truth, as the injection requires to be thrown up at least once or twice every day, few males either can or will comply with their use. For which reason another method has been in- vented, by means of which lime-water may be thrown up the urethra forcibly enough to overcome the sphincter muscle of the bladder, without the least in- jury to the parts, whereby the repeated passing of a catheter into bladder is avoided. Mr. William Butter has contrived an instrument for this purpose, by means of which the patient may throw up the injection himself without any other assistance. The contrivance is as follows: the lime-water is tied up F in [34] in a hog’s bladder, the neck whereof, by means of pipes, the second of which has a moveable cock, is nice- ly fitted, to another ivory pipe, which is introduced a good way up the urethra, lest the lime-water should regurgitate, and the bladder being pressed, the con- tained liquor passes through the pipes with a con- siderable degree of force, which may be moderated at will. The bladder is fixed on a hollow piece of wood, shaped externally like a pair of bellows, the the upper side of which being pressed downwards, the bladder is compressed, and the contained liquior forced out. As it is far easier to improve than in- vent, in all probability Butter’s instrument might be rendered more simple. The following precautions must be observed in using this instrument: The pa- tient ought to make water immediately before the operation; he should lie in bed upon his back, with his legs drawn up to his body, and his thighs asunder; he should breathe in his usual way, and be sure not to give any resistance to the injection, when he feels it entering the bladder, and to restrain any attempt to make urine, although he should at that time have a small inclination to it. The lime-water should be blood-warm: the bladder fixed to the pipe must be strongly and firmly tied, or it will be apt to burst, or to allow the lime-water to escape. The pipe should be dipped in oil, previous to its introduction, after the pipe is introduced, the patient must compress his yard very firmly with his hand, else the liquor, in- stead of making its way into the bladder, will re- turn by the urethra towards the point of the yard. No more liquor should be put into the bag than is in- tended to be thrown into the bladder. In females the pipe may be passed quite into the bladder, with great ease, and without giving any pain; and as women may easily be taught to make the injections themselves, the stone in females must in time be so certainly dis- solved, that for the future it will only be necessary for [35] for them to have recourse to lithotomy in very rare scales And as the severe stimulating pains, are ow- ing to the roughness of the surface of the stone, shell- lime water injected as above, two or three times a day, would not fail, in a very short time, to give certain relief from these pains, by converting its surface into a soft chalky substance; and dissolving its sharp points, Several cases are described that confirm the efficacy of this method.* Hales has made several other experiments con- cerning the dissolution of the stone; particularly he infused human stones in acid and alcaline liquors, mixed at the very time of their effervescing, in hopes at the fixed air, latent in the stone in such great plenty, might be separated, and rendered elastic, from the sudden concussions of the effervescing liquor, and thereby a dissolution of the united, elementary particles stone be effected. The result of this experi- ment often repeated was, that some stones emitted a great many air-bubbles, and also became brittle, but the experiment did not produce the same effect on hard human stones: nor did the liquor produced by the mixture of the acid with an alcali, act at all upon human stones steeped therein. Indeed Hales owns, that these experiments did not in the least incite him make a trial thereof on patients; as the application of effervescing liquors to the stone, ought to be fre- quently repeated, to produce any considerable effect, and the acid and alcaline liquors should be injected se- parately, that the effervescence might be caused in the bladder itself: now both these liquors are too acrid to be suffered in the human bladder without injury. From the foregoing observations it appears that shell-lime water may be safely used internally, either A method for the cure of the stone chiefly by injections, p 61. F2 by [36] by itself or with Alicant soap, and that it has proved serviceable to numbers, nay has sometimes entirely ta- ken off the different symptoms, though the stone itself still continued in the bladder, in appearance no ways al- tered by the medicine. Moreover, many of the above- recited cases demonstrate that lime-water really pos- sesses a lithontriptic power, especially if the stone is not very compact and hard; which effect it must exert in a greater degree, provided it be injected pro- perly into the bladder; for then it would be digested in its full strength, several hours, with the stone, assisted by the warmth of the body, and thus the most san- guine expectations might be formed of diminishing the bulk of the stone, at least of rendering it so friable that by degrees its whole substance might be voided with the urine, and the patient thus radically cured. Besides it is highly probable, that a constant use of lime-water, prevents the separation of fresh calculous elements from the urine; for the experiments of Whytt demonstrate that the separation of such particles from the urine, out of the body, is not only prevented by the addition of lime-water, but that in urine suffered to stand in a chamber-pot forty eight hours, the stony concretion formed round the sides and bottom, was presently dissolved by pouring lime-water upon it; and though the chamber-pot was then suffered to stand unmoved thirty hours longer, no more stony con- cretions adhered to its bottom or sides. Now if no fresh stony particles are added to the stone contained in the bladder, its surface must, by de- grees, be abraded by the urine and the pressure of the bladder, when the urine is forced out by the contrac- tion thereof, as well as from its rotation in the cavity of the bladder, when full of urine, and from walking, or any other cause, the patient moves his body. 'Tis true indeed, that the internal surface of the bladder also abraded by the stone, but the membranes con- tinue [37] tinue whole, though they are sometimes greatly thickened in cases of this kind. Now the bladder is part of a living body, in which the abraded parts are constantly restored by nutrition: but the stone is an inanimate substance, that is incapable of receiving nourishment; hence unless from the apposition of fresh calculous particles, its bulk must consequently be lessned by degrees. But the prodigious relief that persons afflicted with the stone receive from a con- stant use of lime-water, as I know by experience my- self and as is attested by authors of the best credit, suf- ficiently authorizes the administration of this remedy, even though it had no lithontriptic virtue. In all probability there are many remedies, which relieve the symptoms of this disorder, though they do not dis- solve the stone. Linnæus, in the preface to his oration, on the in- crease of the habitable earth, spoken at Upsal, in 1743, makes mention of Uva Ursi, a shrub very common in Sweden. The use of this plant has since been strong- ly Recommended by the Montpelier physicians. Half a drachm of the powdered leaves are to be taken in chicken broth, ten successive days, as a lithontriptic. These leaves are highly astringent; whence in Swe- den they are in high reputation for the purpose of tanning leather. It is well known that the hides of animals, to render them fit for our various uses, re- guire to be macerated a long while, whereby they become so soft and flaccid, that they can scarcely be touched without being torn: hence tanners always use astringent substances to restore their lost firmness. Different plants are used for this intention in different countries particularly such as cost but little. Where- fore Uva Ursi, being a strong astringent, and common in Sweden, is there used for the purpose of tanning lea- ther As [38] As this shrub grows plentifully on the mountains of Austria and Styria, wholly buried in snow during several months of the year, I easily procured a quan- tity of its leaves, the powder of which, by my direc- tion, was administered even in a larger dose, to patients troubled with the stone, frequently with such extra- ordinary benefit that the patient has imagined himself perfectly cured, though upon searching the bladder a stone has been plainly felt, as De Haen allures us. Some were soon relieved, others were longer before they obtained ease from their pains, which when in- tolerable were quieted by opiates, curing the use of the Uva Ursi. But that the relief did not proceed from the opiates only, is evident from this circumstance: opiates were not wanted afterwards, though the stone still remained in the bladder. Besides, the urine which smelt very offensively,and was highly alcaline previous to the use of Uva Ursi, soon became like healthy, na- tural urine; the purulent discharge, and heavy viscid mucus, frequently voided with the urine by person troubled with the stone, stopped; the stone however still continuing in the bladder. Nor was this cessa- tion of the symptoms of short continuance only, but lasted during several months; and it has been remark- ed in some who left off taking the Uva Ursi, that the different symptoms returned; which however were quickly relieved again by a repeated use of the medi- cine. Repeated experience has convinced me, that it is of remarkable service in ulcerations of the urinary passages, where there is not the least reason to suspect the disorder caused by a stone; whence this medi- cine deserves to be used in practice, though we know nothing certain concerning its lithontriptic virtues. Helmont recommends the juice of the birch tree which flows from its wounded branches in spring, as an useful medicine in the stone; he prefers the juice of the branches as more pure and rich than that which exsudes from the trunk, which is almost; entirely aqueous [39] Aqueous if the trunk is wounded near the root. He particularly expected great things from this remedy, both as a preventative of the stone, and to alleviate excruciating symptoms of the disorder. Boyle affirms of this juice, that he has known many persons afflicted with the stone greatly relieved by it, parti- cularly one of his cousins, who had, in vain, tried an incredible number of remedies. For his use Boyle Procured a large quantity of this juice in the spring season. and kept it fit for use by covering its surface with sallad oil, to prevent the access of the air, or by fumigating the cask with burnt brimstone, to pre- vent its fermenting, whereby he procured him a lon- ger alleviation of his tortures. But this juice does appear to possess a lithontriptic power for upon opening the body of this gentleman, who died of another distemper, a large stone was found in the bladder, which did not seem to have been acted on by the medicine, though taken in large quanities, and for a considerable time. In all probability, these remedies prevent the growth of the stone, at least, they are taken; it is certain they relieve the syptoms, and render life more tolerable to the un- happy patient: now this is a matter of some conse- quence. Helmont remarks these two circumstances in the cure of the stone; viz. the prevention of its increase and the destruction thereof when formed. A “ remedy is required capable of preventing the future “ increase of the stone, by rendering the urine medi- “ cinal, &c. but the schools have been solely intent “ on expelling the stone, and relaxing the urinary pas- “ sages: therefore in the cure of the stone, a double “ intention is obvious; first, to remove the predispos- “ ing cause; secondly, to destroy the stone already “ formed.” To effect either is a matter of great difficulty; for we learn from medical history, that some Persons have had stones repeatedly formed in the bladder, and have been under a necessity of un- dergoing [40] dergoing the operation of lithotomy several times. Now to dissolve a stone already formed in the body, or to erode it in such a manner, that lessened in its size, or broken to pieces, it may be discharged with the urine, is a matter of equal difficulty. One menstruum is only hitherto discovered, that is able to dissolve human stones, viz. spirit of nitre: but this is so acri- monious, that if injected into the human bladder, it would entirely destroy its structure. If given in- wardly, it will require to be very much diluted, in order to be borne without injury by the stomach and bowels; but when diluted, its solvent virtue is de- stroyed, and before it can arrive at the bladder, from being mixed with the different fluids of the body, it in all probability wall be rendered quite inert. Whence physicians in general, have no opinion of the lithontriptic virtues of spirit of nitre. Pechlin relates, that a French empiric in Hol- land boasted of being in possession of a certain lithon- triptic. He used to dissolve, before the eyes of the spectators, in a certain liquor, an human stone, which he instantly precipitated again with oil of tartar per deliquium, or some alcaline lixivium. The clear li- quor seemed tolerably mild if tasted after the precipi- tation had been made: but he would not suffer any one to taste it, previous to the addition of the alcaline lixivium, pretending he was tied by oath not to re- veal the secret. At last this nostrum was discovered, and found to be acrid: one of the medical students, produced a small quantity of dulcified spirit of nitre, which dissolved a human stone with equal facility as the empiric’s liquor, and upon the mixture of oil of taatar, the very same precipitation was caused, and as it likewise resembled the nostrum both in colour and smell, it was judged to be the very same, by the whole audience; whereupon the impostor took his leave of the place. But even dulcified spirit of nitre, cannot be [41] be borne by the bladder, unless greatly diluted, and mixed with a large quantity of water, must be- come inert; which upon the same account must also happen, when it is given internally. It is clear from the preceding observations, that no flight advantage has sometimes been reaped from quick lime and soap mixed together in different me- thods, or administered separately. Now soap contains a portion of alcaline salt, rendered more acrid by the addition of quick lime, together with a vegetable or animal oil. For soap is made in the following man- ner: an igneous, fixed, alcaline salt, prepared with quick lime, is dissolved in such a quantity of clear hot water, that the lye produced thereby will bear a new laid egg. This liquor is called capital soap lees; a part whereof is diluted with a further quantity of water till a new-laid egg sinks to the bottom of this second lye. An equal quantity of oil is mixed with this second weaker lye, and the mixture is gently boiled until the water wastes away, and the ingre- dients begin to unite together. Thrice the quan- tity of the oil, of capital soap lees is now added, and whole is boiled together, till it becomes a solid, hard substance, called soap, which if too acrid, is rendered less so by the addition of more oil; on the contrary, if the oil predominates, a little more capital soap lees is added. From the composition of soap, it is apparent, that its lithontriptic virtue principally depends on the capital soap-lees,which contain an alcaline salt rendered more acrimonious by lime; whence several ingenious men have tried numerous experiments to ascertain the de- gree lithontriptic power this medicine posse- ses. Hartley relates several experiments made by Hales with soap-lees, on two human stones, one of which was large and of a pale brown colour, the G other [42] other of a dark brown, and very hard, which, when sawed through, glistened like polishied marble. A part of the first stone was dissolved by being boiled half an hour in capital soap-lees: during the opera- tion a vast number of air-bubbles issued from the stone, which circumstance he justly considers as a cer- tain sign that the stone is very near breaking to pieces. And by infusion alone, a piece of the same stone dis- solved, in a longer or shorter time, according to the degree of heat; and even in consequence of a cold in- fusion, the stone was dissolved by capital soap-lees in three days. A piece of the other harder stone, boiled in the above lye a full hour, did not dissolve, but the external surface was rendered so soft as to resemble a kind of stiff mud; and the internal parts became rot- ten and friable; another bit of the same stone became rotten and friable, in consequence of having been infu- sed in the same lixivium with a gentle heat, for seven days; whence it appears that soap-lees wholly dis- solved the stone of moderate hardness, and rendered the other brittle; but a lye of fixed alcaline salt alone, though of the same specific gravity, and therefore equally saturated with alcaline salt, had no effect on pieces of the same stones steeped therein. From the above experiments Hartley concludes, “ that a lye prepared of quick-lime and fixed alca- “ line salt, is a most powerful dissolvent of the stone, “ far beyond a lye of alcaline salt alone, and excelled “ only by spirit of nitre.” He relates several other experiments which de- monstrate that the urine is medicated by this reme- dy, so that a small quantity suffices to prevent the ap- position of fresh stony particles from the urine to the stone already formed, and if a larger quantity is taken, the urine will erode the stone, which is con- stantly steeped in it. Moreover it is proved that lime- water possesses a sufficient degree of lithontriptic vir- tue, [43] tue, which is increase in proportion to the strength of the lime, and the smaller quantity of water with which the lime is quenched. In preparing lime-water as a lithontriptic gallon of water is usually added to a pound of lime; for lime-water of this strength may safely be drank in large quantities, as is evident from the preceding observations. But capital soap-lees are highly acrimonious, and from this liquor inspiffated is prepared the potential caustic called lapis infernalis by surgeons; which ap- plied to the skin presently produces a gangrenous eschar on the part whence it is apparent that soap- lees can only be given in a small dose and mixed with a large quantity of some soft fluid. Harley judged that half an ounce of capital soap- lees might be taken in half a pint of new milk four times a day without injury. But he candidly owns, that a sufficient number of experiments had not been made to ascertain this fact with precision, and exhorts the profession to be strenuous in their endeavours to determine the matter. Meanwhile, in my opinion, it is the safest way to begin with a small dose; for in beginning of such a cure the pains are increased, as Jurin experienced in his own case. I lately advised a person afflicted with the stone to take sixty drops of capital soap-lees every morning, in rather above three quarters of a pint of veal broth and gradually to en- crease the dose of the lees in a proportion of the broth. He has since acquainted me by letter, that when he had augmented the dose to 120 drops, his pains raged with greater violence, and he voided a large quantity of mucus with his urine. Jurin in- creased dose by degrees, till at last he took every day an ounce and a half capital soap-lees; but in like manner diluted in a liquid, which however was hardly mucilaginous. Nor does it appear that he G2 perceived [44] perceived any relief, till he had taken the soap-lees four months. Towards the fifth month he voided some stones; but was not perfectly cured at the ex- piration of seven months. Whence Whytt prefers lime-water, because it much sooner relieves the pa- tient. Dr. Chittick administers a nostrum, which if taken several months, has frequently dissolved the stone; the patients send a mess of broth every day to him, wherein he mixes his nostrum, which from the ingenious experiments of Dr. Blackrie, evident- ly appears to be only capital soap-lees. This remedy is vastly acrid and fiery, wherefore it cannot be taken inwardly, unless exceedingly diluted; hence it is probable, that when it arrives at the blad- der, with the urine, it is rendered almost wholly in- ert; an objection that has, with reason, repeatedly been raised against the boasted virtues of other li- thontriptics. However, beyond a doubt, alcaline salts rendered more acrimonious by the addition of quick lime, possess considerable solvent qualities, though diluted with a large quantity of water. In my commentaries on the aphorisms of Boerhaave, I have taken notice of a similar medicine, as highly efficacious in dissolving of gouty chalk-stones. It is composed of tartar calcined in an earthen vessel with three times its weight of quick-lime. This saline mass is dissolved in clear water, and filtered, and then inspissated into a salt, which is afterwards again dis- solved in such a quantity of water, that the solution when tasted, occasions no uneasy sensation on the tongue; yet this very weak solution dissolves gouty chalk-stones in a few days. Now if it be considered that the most emiment physicians acknowledge a great affinity between stones in the bladder and gouty chalk-stones, it will be evident that we ought not to despair of the action of similar remedies on the stone in the bladder, though exceedingly diluted. Some [45] Some medicinal,waters also dissolve human stones, if steeped therein; yet the contents of such are diluted with a great quantity of pure water. Thus the Ca- roline baths, though they incrustrate the pipes through which they are conveyed, and substances dipped in them with an hard stoney shell, yet remarkably les- sen the bulk of human stones, if steeped therein; as Springfield has observed in renal and other stones, steeped not only in the water of these baths, but also in the urine of persons who drank those waters; while, on the other hand, human stones, when infused in the urine of persons who have not drank the above waters, are increased in size: but these waters take not the same effect on stones of the gall bladder. Hence it is ap- parent, that those who think the urine may be changed by medicines taken into the stomach, so as to soften and erode the surface of the stone in the bladder, and thus by degrees diminish its size, or render a rough stone smooth, and thereby less injurious to the bladder, do not entertain ill-grounded expectations. Hartley, from experiments, concludes, that even Pure water is a lithontriptic: he says, “that if a “ stream of pure water passed through the kidneys “ and bladder, a sufficient space of time every day, “ it would entirely dissolve whatever stones might be “ lodged in either part." But he would have the incrustating quality of healthy urine prevented by medicine, which other- wise by a constant application of new stoney particles, would augment the size of the stone faster than the stream of the water could waste it. This effect, he is of opinion, maybe obtained by the use of a lithon- triptic composed of quick lime and soap. Whence this and other similar remedies act in a two-fold man- ner: first, by preventing the increase of the stone; secondly, by imparting a medicinal quality to the urine, [46] urine, whereby it is enabled to act. upon the stone; as he has proved by an experiment made on his own urine, which greatly lessened the bulk of an human stone steeped therein, at the time he was taking these medicines. The very accurate Stack, from his expe- riments, concluded, “that urine which generates “ stones differs at different periods, so as at parti- “ cular times to generate more, at others, fewer “ stoney particles; and that sometimes in a different “ state of the body, the urine may, on the contrary, acquire a lithontriptic quality." The accounts of herdsmen, who affirm, that cattle housed during winter, and kept on hay, are afflicted with the stone, and are cured in the spring by being turned out to grass, confirmed him in his way of thinking. More- over, he perceived in a smooth stone voided by the uri- nary passage, evident signs of corrosion on the inside of the outermost circle, that seemed to have been made at a time when the urine had acquired a lithontriptic property; to which fresh stony matter had afterwards accreted, when the urine was disposed to generate the stone. Lobb took another method to impart a lithontriptic quality to the urine. But as the stone contains a great quantity of fixed air, he did not with for a quick dissolution of it, though it could have been effected; afraid, left from the elasticity suddenly re- stored to the inelastic air, an explosion and other mis- chiefs should ensue in the human body. Upon which account, he rather chose to effect the dissolu- tion of the stone by substances friendly to the consti- tution, viz. aliments. He therefore endeavoured to ascertain by experiments, Whether among the foods and sauces commonly used, there might not be some possessed of a lithontriptic property, when applied to human stones out of the body; if such were dis- covered, he was of opinion that those were to be eaten [47] eat in preference to other aliments, and all such were to be abstained from as did not act upon human stones out of the body; not because he imagined they were hurtful, but as they hindered the taking of more proper aliments, the stomach being incapable of containing more than a particular fixed quantity of solid and liquid food. This great physician was perfectly sensible that aliments when received into the human body, are divested of their own nature, and assume that of our bodies; nevertheless it is a certain fact, that some substances, while they as yet continue in the sto- mach impart a flavour to the urine, as asparagus, turpentine, &c. whence, it is probable, that other qualities of liquid and solid aliments also may quickly arrive at the kidneys and bladder: although the sensi- ble qualities of the urine do not appear to have un- dergone the least change. He made a great many experiments of this kind, and steeped human stones in decoctions, or infusions of the different vegetable substances that supply the table. Among the prin- cipal dissolvents of the stone, he reckons, "the juices “ of lemons and radishes, and the strong decocted “ juices of mulberries and strawberries, vinegar, the “ juices of elder berries, pears, and grapes, honey and “ water, asparagus juice, parsley, milk, chocolate, “ smallage, cucumbers, the decoctions of leeks, onions, “ raisins and figs, sorrel, wood sorrel, water gruel, “ barley water, and rice gruel, orange juice, hops, tea, “ and especially raisin and elder wines, and cyder." However all these vegetables act very slowly on the stone. Whence the urine ought to be medicated many months by a plentiful diet on such vegetables, in order to render the stone in the bladder friable, and to Produce any considerable effect. Hales ob- served that the pulp of onions, and the juice thereof mixed [48] mixed with water acted very powerfully on the hu- man stone; and thence concluded that a plentiful use of onions would entirely dissolve a stone in the blad- der, or least prevent its further growth. A further reason why the effect of the above remedies must be slow, is their being mixed with the urine: for Hales has taken notice, that human stones are dissolved by long maceration in water, and are covered over with a white mucous matter; but that the dissolution there- of did not succeed so well, if only one fortieth part of urine was added the water, though the glass, con- taining the stone and water mixed with urine, was set in hot dung. Hence to prevent the formation of renal stones, Zecchius, as Baglivi informs us, recommended a plentiful draught of warm water, about a pint to be drank immediately before dinner. Piso, and Alexan- der had advised the same remedy many years before; who affirmed, that after the voiding of the first stone, they had never known any more formed in persons who regularly pursued the above method. And as a much greater quantity of warm water can easily be borne by an healthy person, many have pre- scribed it several times a day with considerable vantage. Whey prepared from the milk of animals fed on vegetable food alone, is justly preferable to that pre- pared from the milk of stall fed beasts, as besides a great quantity of watery particles, the solvent virtue of grass is contained therein. I have known calculous concretions in the gall-bladder and billiary ducts hap- pily dissolved by a plentiful use of ptizans and whey prepared with grass. And Sydenham always at night drank plentifully of small beer, to relieve the nephritic complaints under which he laboured That [49] That the solids of the human body are relaxed by aqueous liquors, particularly when drank warm, is an incontrovertible fact; and especially the kidneys, through which a large quantity of aqueous urine constantly flows. Among the causes of a stone in the kidneys, a too great laxity of the kidneys has been enumerated by some authors; who were appre- hensive, that some grosser fluid than that intended by nature would be secreted through the relaxed renal canals, which might afford the basis of a stone if it should lodge in the pelvis, or its branches. But continual and more copious stream than usual, of thin watery urine must cleanse away any ad- hering matter. Whence there seems no likelihood of such an accident. Many also have apprehended a general debility of the habit, relaxed by an emollient and spare diet: for Lobb directs, that “stone patients should wholly “ abstain from animal food, and the plentiful use of “ aqueous liquors;" and not without reason. But this disorder is trivial, compared with the tortures of a renal stone, and may easily be remedied after the stone is cured. And the languids state of the body that happens, in consequence of a long continued use of such a diet, is considered by Boerhaave as a good omen. “The use of these, continued till the body “ become loose, and remains so a good while, is “ highly serviceable, though some debility should “ ensue therefrom; for this favourable symptom fre- “ qently resolves even an inveterate disorder.” Helmont is of opinion, that a plentiful use of sea salt never hurts a stone patient; “but, on the contra- “ ry, that he has seen many who, by a plentiful use “ of salt, have prevented further growth of a “ recent and increasing stone.” In another part of his work he extols spirit of sea salt taken in white H wine, [50] wine, which medicine, he says, “not only removes “ the fatal stranguries, to which old people are sub- “ ject, but also in persons where a stone has been “ lodged several months in the bladder, by the use “ thereof, the stone has been, at length, lessened in size, “ and voided by the urinary passage, which, before “ the patient had taken spirit of sea salt, having fre- “ quently entered the beginning of the urethra, had “ as often been obliged to be forced back into the “ bladder with a catheter,” FINIS. 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