I.
Copy of a Letter from John Pringle, M.D. F.R.S. to Dr. Robert Whytt, Professor of Medicine in the University of Edinburgh, and F.R.S. relating to the Case of the Right Honourable Lord Walpole; with Dr. Whytt's Answer. Communicated by Dr. Pringle.
London, 22 Feb, 1757.
SIR,
Read April 21, 1757.
I Imagined, that upon hearing of Lord Walpole's death, you would be desirous to know the state of his Lordship's health from the time he published his own case; whether he continued the use of his medicines to the last; what distemper he died of; and, if his body was opened, what was the condition of his bladder and kidneys. I informed myself, as well as I could, of all these particulars; and I hope I shall be able to give you some satisfactory account of most of them.
Last year, in the month of March, about ten months before his Lordship's death, I happened to meet him at a friend's house, where he dined, and never saw any man of his age with a more healthful appearance. He was then in his 78th year. He ate with an appetite, and of a variety of dishes; drank some Madeira, and was very chearful the whole time. His Lordship then told me, that he had enjoyed perfect health since he sent his case to the Royal Society; that he thought it probable there was still a stone in his bladder, but so diminished, or smoothed, as to give him no uneasiness; that he did not think it safe to go about the streets of London in a coach, but that he went every where in a chair; and that, in the country, he could travel 40 miles a day in his post-chaise, without fatigue, or feeling any of his old pains upon the motion. That he continued to drink, for a constancy, three pints of oystershell lime-water daily; and to take, as often, from half an ounce to a whole ounce of soap, by way of lenitive. All these circumstances I am sure of, because I noted them down when I came home.
From this time to the beginning of winter, Lord Walpole (as Mr. Graham, his apothecary, informed me) continued in the same state of health; but some time after coming to town, his Lordship was seized with a lingering feverish disorder, very much affecting his spirits, but intirely unconnected with the stone. Dr. Shaw, who attended his Lordship for about a fortnight before his death, told me, that there had never been any stoppage of water, or passing of bloody urine, or any pain about his bladder or kidneys, during his last illness; but that he now and then felt some irritation in making water, a symptom too inconsiderable to require any other medicine than the continuation of his lime-water; which, in smaller quantity, he drank till within two or three days of his end.
Mr. Ranby and Mr. Hawkins, surgeons, with Mr. Graham, were present at the opening of the body; and from the two last I received the account of the dissection.
The coats of the bladder appeared to be a little thicker than natural, but were otherwise sound. The glandula prostata was of a large size, but not distempered. They found three calculi, two lying loose in the bladder, and the other, a very small one, sticking in the passage, at that part, which is surrounded by the prostate gland. Mr. Graham favoured me with a sight of them all. The two first were very much alike, being of the shape and size of the kernel of a Spanish nut; only the sides were irregularly flattened, but without forming any sharp angle. The surface of each was every where smooth, except where there had been a separation of some small scales, not so thick as one's nail; and the largest exfoliation from one of these stones appeared to have been nearly about the breadth of the nail of my little finger. The polish otherwise, as well as the colour of both, might be compared to a boy's marble. One of these calculi weighed 21 grains, the other 22 grains: they were heavy for that bulk, and seemingly of a hard substance. The smallest stone having been put up with some others of the same size, taken out of the gall-bladder, Mr. Graham could not be positive which of them it was; and therefore I can only say, that what he thought most likely to be so, was about the size and shape of the seed of an apple, with the point broken off, and the edge ragged. This, as I observed, was found in the passage, seemed to be coming away, and probably had occasioned that irritation the patient had now and then felt during his last illness. It weighed only about a grain.
No parts could have a sounder appearance than both the ureters and kidneys. The first were not dilated; nor did the last contain any stone, mucus, or gravel: the pelvis in each was of a natural size.
The rest of the abdominal viscera were in the same healthful state, except the gall-bladder, which was full of stones. The largest was about the size of a small chesnut, but rounder. The surface was smooth, particularly at one part, where it seemed to have rubbed upon a lesser calculus, of the shape of one of the vertebræ of a small animal, without the processes. This last had a hollow on each side corresponding to the convexity of the large stone; and these cavities being finely polished, it seemed as if sometimes one side, sometimes the other, of the small stone had been turned to the great one, and had been shaped in that manner by the attrition. The largest calculus weighed one drachm two scruples and two grains; the small one but nine grains: they both sunk in water; and felt specifically heavier than any stones I have ever seen taken out of the gall-bladder. Besides these two, there were several very small calculi of irregular shapes, and of rough surfaces, which all together did not weigh above five grains. Mr. Graham, who had attended his Lordship for about 40 years, assured me, that he never had any symptom that indicated a stoppage of the bile, or the passage of a stone from the gall-bladder into the intestines.
Neither the head nor breast were opened.
These are all the materials, I can furnish you with, relating to this case. If you desire to be more particularly informed of any of these circumstances, let me know, and I will endeavour to procure you all the lights I can. In the mean while, I should be glad to have your remarks upon what I have now sent you; and since you have been so long in the train of thinking, with more than usual attention, on this subject, I presume it would be very agreeable to the gentlemen of the Royal Society to have a paper from you on this occasion; and the rather, as his Lordship began his course of soap and lime-water, upon hearing of your success by that method of cure. I am,
SIR, &c.
John Pringle.