Philosophical transactions, Vol. L. Part I. For the year 1757. / Giving some account of the present undertakings, studies, and labours, of the ingenious, in many considerable parts of the world.

by Various; Royal Society

PHysicians have not, perhaps, differed more widely in any thing, than in their opinions of the medicines lately proposed for the cure of the stone. While some imagined, that Mrs. Stephens's medicines, or soap and lime-water, were in most cases to accomplish a dissolution of the stone; others have been positive, that nothing of this kind was to be expected from them: nay, they have condemned these medicines, when used in large quantities, and long persisted in, as hurtful to the stomach, guts, and urinary passages; and have ascribed the remarkable ease, which they almost always give to calculous patients, to their depositing a calcarious powder upon the surface of the stone, by which it is rendered less hurtful to the bladder. And this opinion seems to have been not a little strengthened, by the great quantity of white sediment observed in the urine of those patients, who have used soap and lime-water in considerable quantities. Now, as I am of opinion, that most of these objections and doubts, concerning the effects of soap and lime-water in the cure of the stone, may be cleared by a candid consideration of Lord Walpole's case, I shall trouble you with a few remarks, which have occurred to me, in comparing it with the appearances found in his Lordship's body after death, of which you were so obliging as to send me a particular account.

1. Whatever doubts may have been entertained concerning the cause of Lord Walpole's complaints, yet it now appears evidently beyond dispute, that they must have been owing, not to a scorbutic corrosive humour in his bladder, as was imagined by some[125], but to stones lodged in it. These stones may possibly have lain there since 1734; for from that time to spring 1747, his Lordship was free of any gravelish complaints, only passing some red sand at times. But at what time soever they may have first arrived in the bladder, in 1747 and 1748 they seem to have acquired such a bulk, or were become so rough or pointed in their surface, as to occasion great pain, frequent provocations to urine, and sometimes bloody urine; especially after any considerable motion. These complaints, however, were soon relieved, by swallowing daily an ounce of Alicant soap, and three English pints of lime-water made with calcined oyster-shells; and from 1748 to 1757 his Lordship was kept almost intirely free from any return of them, except for some months of 1750 and 1751, during which he took only one-third part of the quantity of soap and lime-water above-mentioned[126].

2. It is highly probable, nay, I think, altogether certain, that the soap and lime-water not only relieved Lord Walpole of the painful symptoms occasioned by the stones in his bladder, but also prevented their increase.

If these stones came into the bladder in 1734, they must, in so many years as his Lordship lived after this, have acquired a very great bulk: nay, if we suppose them not to have been lodged in the bladder above a year before they began to occasion frequent inclination to make urine, with pain, and sometimes sudden stoppages of urine; yet, from 1746 to 1757, they ought to have grown to a much larger size than that of the kernel of a Spanish nut[127]. 'Tis true, the stone may increase faster in some patients, and slower in others; but stones, after remaining a dozen or more years in the bladder, generally weigh several ounces. Some years since l saw a stone, weighing near six ounces, taken from a boy of no more than 14 years of age.

3. Lord Walpole's case not only shews the power of soap and lime-water to relieve the painful symptoms, and prevent the increase, of the stone in the bladder, but also makes it probable, that these medicines do communicate to the urine a power of dissolving the stone.

In the beginning of 1749 his Lordship voided with his urine a calculous substance of a flat shape, about the bigness of a silver penny, and covered with a soft white mucus[128]; and upon the surfaces of the stones found in his bladder there were some inequalities, which seemed to have been made by the separation of thin lamellæ or scales. Further, the small stone found in the beginning of the urethra must have been in a dissolving state, and considerably lessened in the bulk: for, if it had lain long in the bladder, and never been larger, it ought to have been voided thro' the urethra with the urine; and it could not have arrived lately in the bladder, since Lord Walpole had not had, for several years before his death, any nephritic pains, or symptoms of stones passing from the kidnies; and since it is not likely, that a stone of the size and shape of the seed of an apple[129] would pass thro' the ureters without being felt. Now if this small stone, found in the urethra, was partly dissolved by the virtue of the soap and lime-water; it will appear at least probable, that the two larger stones in the bladder were so likewise. But altho' Lord Watpole's calculous concretions had remained undiminished, and without any symptoms of dissolution; it would not therefore follow, that soap and lime-water cannot dissolve the stone in other patients, where the concretion may be of a less firm texture.

The Rev^d. Dr. Richard Newcome, now Lord Bishop of Llandaff, while drinking two English quarts of lime-water daily, for the cure of the stone in his bladder, poured his urine every morning and evening upon a piece of human calculus weighing 31 grains; by which, in the space of four months, it was reduced to three pieces, weighing in all only six grains. Upon one of these pieces, weighing 2.31 grains, he caused to be daily poured, for two months, the fresh urine of a person, who drank no lime-water; at the end of which time the piece of calculus was found to weigh 2.56 grains, having increased in weight a quarter of a grain. This same piece being afterwards steeped in the bishop's urine (who continued to drink lime-water as above), from June 24th to July 9th, was in these few days quite crumbled into powder. Since this experiment shews, beyond dispute, that lime-water, unassisted by soap, can communicate to the urine a power of dissolving the stone out of the body, it can scarcely be doubted, that it must have the like effect on it, when lodged in the bladder. And that the dissolution of the stone in the bladder has been completed by soap alone, appeared evidently in the case of the Rev. Mr. Matthew Simson, Minister of Pancaitland near Edinburgh; an account of which will soon be made public[130] by Dr. Austin, who opened his body after death. Mr. Simson had, from 1730, been afflicted in a less or greater degree with the symptoms of a stone in the bladder; and in November 1735 was sounded by Dr. Drummond of Perth, and Mr. Balderston, surgeon in this city, by whom a stone was not only plainly felt, but also by the patient himself. In February 1737 he began to take soap; and after 1743 never had any gravelish symptoms. He died in May 1756; and, when his bladder was looked into, there was neither stone nor gravel found in it.

4. It appears from Lord Walpole's case, that soap and lime-water, even when taken in large quantities, proceed very slowly in dissolving the stone.

From July 1748, to the beginning of 1757, his Lordship drank three English pints of lime-water, and swallow'd for the most part an ounce of soap, daily; except from April 1750 to June 1751, during which time he took only one pint of lime-water, and one-third part of an ounce of soap, daily. However speedily soap and lime-water may dissolve the greatest part of urinary stones out of the body, yet being mixed with the aliment and humours of the stomach and guts, and afterwards with the whole mass of blood, it is impossible but their force must be greatly impaired before they arrive with the urine at the bladder. When, therefore, urinary stones are of an uncommon hard texture, we are perhaps scarcely to expect any sensible dissolution of them by the use of soap and lime-water: but when they are of a softer kind, there is no reason to doubt, that these medicines will in time dissolve them; and this will happen sooner or later, in proportion to the hardness of the stone, to the quantity of the medicines swallowed by the patient, and the exact regimen he observes, as to diet[131].

But however slowly soap and lime-water may proceed in dissolving the stone, yet they generally give speedy relief to the patient. Lord Walpole did not take these medicines in the full quantity till the end of July 1748; and, in a few months after, he was not only greatly relieved of all his complaints, but in December was able to ride an hundred miles in his coach, without finding any uneasiness, altho' the two last days of the journey the horses went at a full trot[132]. In winter 1750, and spring 1751, when his Lordship swallowed only one third part of the soap and lime-water, which he had been in use to take, his pains and frequent inclination to make urine returned in a good degree[133]; but, after taking the medicines in the full quantity, he soon became as easy as before[134].