A Belgian surgeon by the name of Uytterhoeven, by the suprapubic method extracted a concretion weighing two pounds and measuring 61/2 inches long and four wide. Frere Come performed a high operation on a patient who died the next day after the removal of a 24-ounce calculus. Verduc mentions a calculus weighing three pounds three ounces. It was said that a vesical calculus was seen in a dead boy at St. Edmund's which was as large as the head of a new-born child. It has been remarked that Thomas Adams, Lord Mayor of London, who died at the age of eighty-two, had in his bladder at the time of his death a stone which filled the whole cavity, and which was grooved from the ureters to the urethral opening, thus allowing the passage of urine. Recent records of large calculi are offered: by Holmes, 25 ounces; Hunter, 25ounces; Cayley, 29 ounces; Humphrys, 33 ounces; Eve, 44 ounces;and Janeway, 51 ounces. Kirby has collected reports ol a number of large vesical calculi.
Barton speaks of stone in the bladder in very young children.
There is a record of a stone at one month, and another at three years. Todd describes a stone in the bladder of a child of sixteen months. May removed an enormous stone from a young girl, which had its nucleus in a brass penholder over three inches long.
Multiple Vesical Calculi.--Usually the bladder contains a single calculus, but in a few instances a large number of stones have been found to coexist. According to Ashhurst, the most remarkable case on record is that of the aged Chief Justice Marshal, from whose bladder Dr. Physick of Philadelphia is said to have successfully removed by lateral lithotomy more than 1000 calculi.
Macgregor mentions a case in which 520 small calculi coexisted with a large one weighing 51 ounces. There is an old record of 32stones having been removed from a man of eighty-one, a native of Dantzic, 16 of which were as large as a pigeon's egg. Kelly speaks of 228 calculi in the bladder of a man of seventy-three, 12 being removed before death. The largest weighed 111 grains.
Goodrich took 96 small stones from the bladder of a lad. Among the older records of numerous calculi Burnett mentions 70;Desault, over 200; the Ephemerides, 120; Weickman, over 100;Fabricius Hildanus, 2000 in two years; and there is a remarkable case of 10,000 in all issuing from a young girl. Greenhow mentions 60 stones removed from the bladder. An older issue of The Lancet contains an account of lithotrity performed on the same patient 48 times.
Occasionally the calculi are discharged spontaneously. Trioen mentions the issue of a calculus through a perineal aperture, and there are many similar cases on record. There is an old record of a stone weighing five ounces being passed by the penis. Schenck mentions a calculus perforating the bladder and lodging in the groin. Simmons reports a case in which a calculus passed through a fistulous sore in the loins without any concomitant passage of urine through the same passage. Vosberg mentions a calculus in a patent urachus; and calculi have occasionally been known to pass from the umbilicus. Gourges mentions the spontaneous excretion of a five-ounce calculus; and Thompson speaks of the discharge of two calculi of enormous size.
Of the extravesical calculi some are true calculi, while others are simply the result of calcareous or osseous degeneration.
Renal and biliary calculi are too common to need mention here.
There are some extraordinary calculi taken from a patient at St.
Bartholomew's Hospital and deposited in the museum of that institution. The patient was a man of thirty-eight. In the right kidney were found a calculus weighing 36 1/2 ounces, about 1000small calculi, and a quantity of calcareous dust. In the left kidney there was a calculus weighing 9 3/4 ounces, besides a quantity of calcareous dust. The calculi in this case consisted chiefly of phosphate of magnesium and ammonium. Cordier of Kansas City, Mo., successfully removed a renal calculus weighing over three ounces from a woman of forty-two. The accompanying illustration shows the actual size of the calculus.
At the University College Hospital, London, there are exhibited 485 gall-stones that were found postmortem in a gall-bladder.
Vanzetti reports the removal of a preputial calculus weighing 224grams. Phillipe mentions the removal of a calculus weighing 50grams from the prepuce of an Arab boy of seven. Croft gives an account of some preputial calculi removed from two natives of the Solomon Islands by an emigrant medical officer in Fiji. In one case 22 small stones were removed, and in the other a single calculus weighing one ounce 110 grains. Congenital phimosis is said to be very common among the natives of Solomon Islands.
In September, 1695, Bernard removed two stones from the meatus urinarius of a man, after a lodgment of twenty years. Block mentions a similar case, in which the lodgment had lasted twenty-eight years. Walton speaks of a urethral calculus gradually increasing in size for fifty years. Ashburn shows what he considers the largest calculus ever removed from the urethra.
It was 2 1/8 inches long, and 1 1/4 inches in diameter; it was white on the outside, very hard, and was shaped and looked much like a potato. Its dry weight was 660 grains. At one end was a polished surface that corresponded with a similar surface on a smaller stone that lay against it; the latter calculus was shaped like a lima bean, and weighed 60 grains. Hunt speaks of eight calculi removed from the urethra of a boy of five. Herman and the Ephemerides mention cases of calculi in the seminal vesicles.