ral, but were otherwise sound. The glandula prostata was of a large size, but not distempered. They found 3 calculi, 2 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. The first 2 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 his 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 their bulk, and seemingly of a hard substance. The smallest stone was about the size and shape of the seed of an apple, with the point broken off and the edge ragged. This, as before 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. could have a sounder appearance than both the ureters and kidneys. were not dilated; nor did the last contain any stone, mucus, or gravel: in each was of a natural size.

No parts

The first

the pelvis

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 chestnut, but rounder. The surface was smooth, particularly at one part, where it seemed to have rubbed on a smaller 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 1 dr. 2 scr. 2 grs.; the small one but 9 grs.: they both sunk in water; and felt specifically heavier than any stones he had ever seen taken out of the gall-bladder. Besides these 2, there were several very small calculi of irregular shapes, and of rough surfaces, which altogether did not weigh above 5 grs. Mr. Graham, who had attended his lordship for about 40 years, assured Dr. P. that he never had any symptom that in dicated 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.

II. Observations on the Case of the late Lord Walpole, of Woolterton. In a Letter to Dr. John Pringle, F. R. S. By Robert Whytt,* M.D., F.R.S. Dated Edinburgh, March 16, 1757. p. 209.

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 calcareous powder on 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 (says Dr. W.) 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

* Dr. Robert Whytt, a celebrated professor of medicine in the university of Edinburgh, and author of some valuable physiological works, was born in 1714. He studied physic first at Edinburgh, and afterwards at Leyden, but took his degree of м.D. at Rheims. On his return from the continent, after passing some time in London, he repaired to Edinburgh, where he established himself in practice. About 9 years after he was elected to the professorship of the institutions of medicine, on the resignation of Dr. Sinclair. This office, together with that of clinical lecturer, he continued to discharge with great reputation upwards of 20 years; during which he published his Essay on the Vital and other Involuntary Motions of Animals; his Essay on the Virtues of Lime-water and Soap in the cure of the Stone; his Physiological Essays, in 2 parts; of which the first part is in a great measure supplementary to his Essay on Vital Motions, consisting of a disquisition on the causes which promote the circulation of the fluids in the smaller vessels of the animal body; the 2d part consists of observations on sensibility and irritability, a subject to which the attention of many philosophical inquirers was at that time directed, by the writings of Haller, against whose doctrine Dr. Whytt proved a most formidable opponent. Another work published by Dr. W. during the period above mentioned was his Observations on Nervous, Hypochondriac, and Hysteric Disorders, partly theoretical and partly practical.

By these and other works Dr. W. attained a high degree of celebrity, not only as a physiologist, but also as a practical physician; and for his ingenious and useful inquiries in these and other departments of medical science, he had the honour of being chosen F.R.S.; of being appointed first physician to the king in Scotland, and of being elected president of the Edinburgh College of Physicians. Two years after his decease appeared his Treatise on the Dropsy of the Brain. A complete collection of his works was printed after his death (which happened in 1766) under the superintendance of his son' and Sir J. Pringle.

Dr. Whytt was one of the greatest ornaments which the medical school of Edinburgh has to boast of. Haller, some of whose physiological opinions Dr. W. took so much pains to controvert, has with candour and liberality rarely equalled, said of him, magni certe ingenii vir fuit et perspicacis.

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, 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 oz. of Alicant soap, and 3 English pints of lime-water made with calcined oyster-shells: and from 1748 to 1757 his lordship was kept almost entirely 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.

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. It is 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 I saw a stone weighing near 6 oz. taken from a boy of no more than 14 years of age.

3. Lord Walpole's case not only shows 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 size of a silver penny, covered with a soft white mucus; and on the surfaces of the stones found in his bladder there were some inequalities, which seem to have been made by the separation of thin lamellæ or scales. Further, the small stone

1

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 through 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 kidneys; and since it is not likely that a stone of the size and shape of the seed of an apple would pass through 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 2 larger stones in the bladder were so likewise. But though Lord Walpole'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. Dr. Richard Newcome, then Lord Bishop of Llandaff, while drinking 2 English quarts of lime-water daily, for the cure of the stone in his bladder, poured his urine every morning and evening on a piece of human calculus weighing 31 grains; by which, in the space of 4 months, it was reduced to 3 pieces, weighing in all only 6 grains. On one of these pieces, weighing 2.31 grains, he caused to be daily poured, for 2 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 limewater as above), from June 24 to July 9, was in these few days quite crumbled. into powder. Since this experiment shows, 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* 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.

It is printed in this vol. of the Phil. Trans. p. 221 et seq.-Orig.

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 3 English pints of lime-water, and swallowed for the most part an oz. of soap daily; except from April 1750 to June 1751, during which time he took only 1 pint of lime-water, and one-third part of an oz. of soap daily. However speedily soap and limewater 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 medicine swallowed by the patient, and the exact regimen he observes as to diet.

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 100 miles in his coach, without finding any uneasiness, though the last 2 days of the journey, the horses went at a full trot. 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: but after taking the medicines in the full quantity, he soon became as easy as before.

It would seem, while Lord Walpole used only one pint of lime-water and onethird of an oz. of soap daily, that the petrifying quality of his urine was not entirely destroyed, and that the stony particles newly formed on the surface of the calculi occasioned, by their roughness, the return of his painful symptoms. However, when he had recourse to the medicines in a larger quantity, the petrescent quality of his urine was not only destroyed, but this fluid seems to have acquired a power of dissolving the rough stony particles deposited on the surface of the calculi; and in this way soon removed the pain, bloody urine, and frequent desire to make water, on using any considerable exercise.

Soap and lime-water not only relieve the painful symptoms occasioned by the stone, by wearing off its sharp points and rougher parts, which used to irritate the tender membrane which lines the bladder; but when this membrane has been wounded or lacerated by the stone, there is nothing that will heal it more speedily