This coarse delineation represents the figure and true bulk of the calculus; which, I believe, is still in my patient’s custody.
2. In February 1752. I was called to relieve a poor woman of this place, Sarah Ewdall, aged 30 years and upwards, and the mother of several children. She laboured under the jaundice, and complained of a severe acute pain striking thro’ from the right hypochondrium to her back, with frequent vomitings. A præternatural hardness, of a compass not exceeding the hollow of the hand, was then plainly to be felt at the pit of the stomach, or a little nearer to the right hypochondrium. When that particular part was pressed, she complained of great pain. The pain at this part was always increased by attempting to lie upon the left side. She was blooded, fomented externally, had emollient saponaceous clysters injected, and a nitrous apozem, and pills composed of galban. & sap. Castillens. and soon after recovered. She had frequent returns of the same complaint after this; but I saw her not again till Jan. 1755, when she lay insensible in a fit, which for several days deprived her of the use of her speech and of all her senses, only she tossed her limbs about. About a quarter of a year after she had recovered from this fit, Mr. Cooper of this place, her apothecary, informed me, that from a small sore at the pit of her stomach, which came since her last illness, she had voided several gall-stones. Curiosity prompted me to inquire into the matter of fact from herself. She shewed me the sore, which was now almost cicatrized. She said, that soon after her last illness a little pimple arose upon that part of the pit of the stomach, which had been hard ever since she had been subject to the jaundice. This pimple broke, ran matter, and at different times the calculi, which she shewed me, had come out with the matter. Her stomach had been somewhat painful before it broke, but was now easy. The calculi, which she shewed me, had the appearance of being fragments of larger ones, and some were almost dust; tho’ she assured me they all came from the sore in that condition. Of these fragments I have two or three of the largest now in my custody: they are light, swim on water, smooth like soap; are of a yellow colour, and in some parts brown like snuff; and consist of similar concentrical layers. The poor woman has since then been troubled with returns of pain and jaundice, in the intervals of which her skin is perfectly clear and white. She is still alive, and ready to attest the truth of this narrative.
J. Johnstone.
Kidderminster, Sept. 11th, 1757.
LXXII. A remarkable Case of Cohesions of all the Intestines, &c. in a Man of about Thirty-four Years of Age, who died some time last Summer, and afterwards fell under the Inspection of Mr. Nicholas Jenty.
Read Feb. 9, 1758.
THE subject was tall, and partly emaciated. I found nothing externally but a wound in the left side, which seemed to me to have been degenerated into an ulcer. As I did not know the man when he was alive, and had him two days after his decease, I cannot give an immediate account of the cause of his death. But in opening his abdomen, I found the epiploon adhering close to the intestines, in such a manner, that I could not part it without tearing it. It felt rough and dry. And as I was going to remove the intestines, to examine the mesentery, I found them so coherent one with the other, that it was impossible for me to divide them without laceration. Then I inflated the intestinal tube, for the inspection of this extraordinary phænomenon; but, to my great surprize, all the external parts of the intestines appeared smooth; very few of the circumvolutions were seen, occasioned by the strong lateral cohesions of their sides with each other. The substance of the intestines was rough, and a great many pimples, as big as the head of a pin, appeared in them, and were almost free from any moisture. It is proper to observe, that these pimples have been taken for glands by the late Dr. James Douglas, and others; whereas they are in reality nothing else but the orifices of the exhaling vessels obstructed, and are not to be met with except in morbid cases.
After having made incisions in that part of the colon next to the rectum, I found the peritonæum, or external membrane which invests the intestines, and the viscera of the abdomen, to be of the thickness of a six-pence; and I fairly drew all the intestines from their external membrane without separating their cohesions; the peritonæum, or external membrane, afterwards appearing like another set of intestines. I found a fluid in the intestines; and I will not take upon me to say, how the peristaltic motion must have been performed. And afterwards I parted the stomach from its external tunic, as I had done the intestines. I found no obstruction in the mesenteric glands; but every evolution of the mesentery firmly cohered together. The liver also adhered closely to the diaphragm, and its adjacent parts: and in the vesicula fellis I found the bile pretty thick, neither too green nor too yellow, but a tint between both. I met with nothing remarkable in the other parts of the abdomen. In opening the thorax, I found the lungs closely adhering to the ribs laterally, and posteriorly and interiorly close to the pericardium. In making an incision to open the pericardium, I found it so closely adhering to the heart, that I could not avoid wounding that organ, and with much difficulty could part it from it. I met with no fluid in the pericardium. The heart was small; and in the internal side the pores of the pericardium appeared so large, that one might have insinuated the head of a middling pin into them. They have been described by some anatomists, who have met with cases somewhat similar to this, but without such universal adhesions; and they have been supposed to have been glands. The same pores likewise appeared on the heart; which, in my opinion, are nothing but the extremities of the exhaling vessels. In removing the heart, I found the dorsal, and other lymphatic glands above the lungs, quite large, indurated, and of a dark greyish colour. Nothing remarkable appeared in the lungs; only, that the portion of the pleura, which invests the lungs, and is generally thin, was here thick and rough; and thro’ a glass it appeared as if covered with grains of sand; and might in several places have been easily torn from the lungs.
The aorta was pretty large; and in that part of it, which runs on the tenth dorsal vertebra, I found a cystis, as big as an olive, full of pus; and lower down, immediately before that vessel perforates the diaphragm, I found another, something less, full of matter likewise; both which portions I have by me. That portion of the aorta, where the cystis appeared, was rather thicker than the other, and osseous. In opening the cranium, I found in that part of the cerebrum, which lies over the cerebellum, a table spoonfull of pus, of a greenish colour; and examining it thro’ a glass, there was an appearance of animalcula in it.