Bladder and kidney stones

49 Annotations

First Reading

Emilio  •  Link

Kidney stones
I've had a couple of these myself. They form naturally as certain substances reach saturation point in the bladder, at which point some of the excess crystallizes to form stones. They can be jagged or smooth, small enough to pass naturally or much too large. The body has various ways to prevent crystallizing from happening, the best of which of course is to keep a nice high ratio of fluids to solids in the urine. Drinking lots of water and not going to excess with substances, such as alcohol, that tend to dehydrate you are thus the best ways for those susceptible to prevent stones.
What contributes to stones depends on what the stone is made of. The most common ones (and my own particular ones) are made of calcium oxalate, which can form relating to eating lots of dairy products (rich in calcium) and lots of meat or green leafy vegetables (increasing oxalate levels), while vitamin A or the B-complex vitamins can help prevent them. The sheet of foods to watch out for that my doctor gave me contained most foods except onions, though, so the most important things for prevention seem to be drinking lots of fluids and keeping a balanced diet of
many types of food.
This said, there are also various non-dietary conditions that can contribute to stones as well. For me, though, the dietary stuff has been most important (I knew I'd been drinking a lot of alcohol and relatively little water before my last stone, so I wasn't too surprised when it arrived). The NIH has quite a detailed site on stones here:
http://www.niddk.nih.gov/health/k….

Pauline  •  Link

March 26 - Sam's Kidney Stone Surgery
Sam had his stone removed by Thomas Hollier of St. Thomas's and Bart's on March 26, 1658. He celebrated his survival of the surgery and the relief from pain every year on this date. Claire Tomalin's biography, 'Samuel Pepys: The Unequalled Self,' gives a well-researched description of this surgery, its risks, the preparations, the surgery itself, and the follow-up care. Here is the gory heart of her account, but read her book for the all the preparations--the foods and herb, the fast-binding done in place of an anesthetic--and the follow-up care--a really amazing passage in the book:

"The surgeon got to work. First he inserted a thin silver instrument, the itinerarium, through the penis into the bladder to help position the stone. Then he made the incision, about three inches long and a finger's breadth from the line running between scrotum and anus, and into the neck of the bladder, or just below it. The patient's face was sponged as the incision was made. The stone was sought, found and grasped with pincers; the more speedily it could be got out the better. Once out, the wound was not stitched--it was thought best to let it drain and cicatrize itself--but simply washed and covered with a dressing, or even kept open at first with a small roll of soft cloth known as a tent, dipped in egg white. A plaster of egg yolk, rose vinegar and anointing oils was then applied."

Paul Chapin  •  Link

Well, here's something I've had some firsthand experience of, unfortunately. In my case, the stones were uric acid crystals (excesses of uric acid can also lead to gout, which I didn't have). Foods to avoid are anchovies, and acids in general. Immediate treatment is allopurinol, also used against gout. Long-term treatment to prevent recurrence is a mixture of roughly 3 parts potassium citrate to 1 part citric acid, dissolved in a glass of water, twice daily. This metabolizes as a base and keeps the urine basic, thus inhibiting formation of the acid crystals. The concoction tastes like an insipid sort of Kool-Aid. Now in my second decade of drinking it, and I keep on because it works, no recurrence.

I'm not sure anybody would want to read this, but in the context of this page of notes it seems pretty mild.

Emilio  •  Link

[Annotation for 1 Jan 1659/60 by Susannah. Adds new details and historical perspective on the operation.]
Pepys' Operation
He was cut for the stone by Thomas Holiyer, who was a surgeon at St. Thomas's Hospital. We are told "it came out intact, the size of a tennis ball. The proud (and lucky!) survivor had it set in a case, which cost him twenty-four shillings." (Roy Porter, The Greatest Benefit to Mankind: A Medical History of Mankind) He may have survived because he was first on the day's list to be operated on (so the surgeon's tools and hands were relatively clean), and because the operation was done not at the hospital but at the home of a relative. The incision was about 3 inches long and the extraction took less than a minute. (Liza Picard, Restoration London)

Judy  •  Link

I believe what Pepys had was a bladder stone, not a kidney stone as we usually think of it. He was lucky that the stone was in his bladder, not his kidney, because that would have been inoperable by the rough means they had.

paul beard  •  Link

Judy is correct, that is a bladder stone. Until the adoption of the less invasive tools used today (which sound like descendants of the itinerarium mentioned above), the only option for a kidney stone was to cut open the kidney and remove it. Two occurences and that kidney would be almost vestigial in effectiveness. This assumes you survived having that kind of procedure performed under the prevalent conditions. I'm not sure who was more brave, the doctor or the patient.

How they diagnosed something like this, other than symptomatically, is beyond me.

David Quidnunc  •  Link

Biographer Arthur Bryant on Pepys's stone:

"Pepys early life had been dogged by his problems with the Stone or Ye Stone. Many of his family suffered and he was to keep interest in the disease of the stone even in the Animal world. He held a yearly anniversary party for his friends. Since he was 20 he had suffered under a constant series of attacks of stone in the bladder.

"In the winter of 1657-8 the trouble grew rapidly worse so that by March an operation could no longer be averted. Remember now that we are in a period when medical science had not invented (or discovered) anaesthetics and septic germs were rife. A major operation was more than likely to result in death rather than cure. No wonder he was worried about having the Operation!

"The surgeon was one Thomas Holier, assisted by a brilliant young Doctor Joyliffe. On 26th March the operation took place and was a complete success. In the same year Hollier cut thirty more for the stone and all lived, though soon after four others whom he operated on perished."

--"Samuel Pepys: The Man in the Making," by Arthur Bryant [paragraph breaks are mine, not Bryant's], quoted here:
http://www.ferdinando.org.uk/pepy…

David Quidnunc  •  Link

Pepys at a funeral for an unfortunate patient

On 3 December 1659, Pepys attended a funeral for a businessman who died after an operation performed by the same surgeon who operated on Pepys. Here's a passage from a letter he wrote to Mountagu about the matter:

"Being this morning (for observacion sake) at the Jewish Synagogue in London I heared many lamentacions made by Portugall Jewes for ye death of Ferdinando ye Merchant, who was lately cutt (by the same hand wth my selfe) of ye Stone.

"[Addressed] For ye right Honoble Generall Mountagu at Hinchingbrooke, Huntingdon. post pd 2.

"[Endorsed] Sam: Pepys Decembr 3. 1659"

The passage is quoted here:
http://www.ferdinando.org.uk/pepy…

Judy Bailey  •  Link

If all of this discussion hasn't freaked you out and you want more information on the historical treatment of bladder stones, complete with diagrams of the instruments used and sketches of the early surgeons, click on the following URL: http://www.urolog.nl/artsen/featu…

vincent  •  Link

J Evelyn did describe the stone[Samuel P's] being the size of a Tennis ball: J Evelyn june 10th 1669.

bobrog  •  Link

If the stone was the size of a tennis ball, this does not fit well with the description of the size of the incissiion (3inches).Sorry to be so negative, but a 3inch stone sounds a bit to large to be true/correct.Anyone out there with a better medical knowledge that can comment,
thanks

vincent  •  Link

Tennis ball: what size in 1660-80, it may have grown too?

Glyn  •  Link

We are talking about the sport known as "real tennis" rather than "lawn tennis". I think the ball is much smaller.

Peter  •  Link

Whatever the true size of the stone, there is plenty to marvel at. The operation was performed without anaesthetic. The importance of sterilsation was unknown at the time. It is amazing that Sam didn't die of shock during the operation, or that he didn't contract an infection. He survived some 45 years after the operation, even though the wound apparently never really healed. He had a lot to be thankful for.... as do we!

vincent  •  Link

re: stone vs ball : perusing Lizard Book, Restoration London between pages 234/235 there is a picture of Chas. TWO playing tennis. The bat is circular and not much bigger than the hand. The ball could only be ? a guess 1.5 inches diam?.

David Quidnunc  •  Link

Pepys's stone -- 2 inches in diameter

From Claire Tomalin's "Samuel Pepys: The Unequalled Self," (Chapter 4: "Love and Pain") p 62:

"Hollier could be proud of his work, especially considering the size of Pepys's stone, described as 'very great' by his medical colleagues; it was as big as a tennis ball, according to Evelyn, who saw it later. Real tennis, the only kind then played, uses very slightly smaller balls than modern lawn tennis, but still with a diameter of about two inches; the stone must have been exceedingly awkward to get hold of and extract through a three-inch incision. [Note 46] Fortunately Hollier was at the height of his powers as a lithotomist; that year alone he operated successfully on thirty patients. The following year, 1659, was not so good; his first four died, presumably because his instruments had picked up some infectious matter that no warm water or milk of almonds could clear."

From Note 46 for Chapter 4: Evelyn states in his 10 June 1669 diary entry that Pepys showed him the stone, "which was as big as a tennis-ball."

From "Acknowledgments" section, page "x":

"... I have been advised by ... the Real Tennis Club of Cambridge, where I was given the dimensions of the real tennis ball, which the stone removed from Pepys equalled in size."

dirk  •  Link

Sam's bladder stones

"When Pepys died in May 1703, aged 70, the autopsy confirmed that he had lived hard: his lungs were full of black spots, his kidneys full of stones and his gut was discoloured and septic."
Source:
http://www.lrb.co.uk/v24/n22/prin…

This suggests that Sam may not only have been troubled by bladder stones, but also by kidney stones.

We should realize that Sam's way of life is - to say the least - very hard on his digestive system. And let's not forget that after his operation he stuck to drinking a glass of **terpentine** every morning. I'm no doctor, but that can't be very healthy either...
Source:
http://pages.zoom.co.uk/leveridge…

dirk  •  Link

"An excellent way to dissolve the Stone"

A taste of 17th century medicine, from:
The Gentlewoman's Companion (1675).

Quote:
"Take a peck of Green-bean-cods without dew or rain, and two good handfuls of Saxifrage, lay the same into a Still, one row of Saxifrage, and another of the Green-bean-cods; and so distil in this manner a quart of Water; and then distil another quantity of Water from the Bean-cods alone, and use to drink of these two Waters. If the Patient be most troubled with the heat of the Reins, then let him most frequently drink of the distilled Bean-water, and upon coming down of the sharp gravel of stone, let him drink the other."

http://chaucer.library.emory.edu/…

Mereza Italien  •  Link

I don't have personal URL becuase i'm a student please i need some research on samuel pepys

Carolina  •  Link

Sam, I wonder if you were made to try this amongst all the other things?

This from a link from 10th March entry, ref. colewort, which linked to Culpeper and chamomile:

"Also this is certain, that it most wonderfully breaks the Stone, some take it in Syrup or Decoction, others inject the Juyce of it into the Bladder with a Syring; my Opinion is, That the Salt of it taken half a dram in a morning, in a little White or Rhenish Wine is better than either, that it is excellent for the Stone appears by this, which I have seen tried, viz. That a Stone that hath been taken out of the Body of a man being wrapped in Chamomel will in time dissolve, and in a little time too."

david rosenbloom  •  Link

Bladder and ureter stone formation; interested in anyone who has generated "sand" or "gravel" rather than fully formed stones. About the same pain as a stone but much quicker passage.

Roy Clark  •  Link

I am rather interested in the theory that whilst Samual was being "cut of the stone" he was also (accidently) given what we would know today as a vasectomy. That may explain his failing to become a Father in spite of his many afforts in many different arenas.

Adrian Midgley  •  Link

Cutting for the stone might have made him ejaculate retrogradely thereafter, that is all the semen would go into the bladder and later be pee'd out.

Nowadays this is a side-effect of resection of the prostate.

It isn't unrecoverable, and pregnancy can be achieved with suitable technology, but it would tend to reduce his effectiveness at reproduction.

Is there anything to suggest this happened or didn't?

dirk  •  Link

Surgery

Apparently it was the 17th c that saw the invention of a special "chair" for this kind of operation, where the patient was put in a position very similar to that on a gynaecolgist's table, but strapped in. As a matter of fact this kind of chair/table would now also become popular for the delivery of babies. Up to Early Modern times the usual position for a delivery had been sitting (in a special chair with an opening provided in the appropriate place) or standing, leaning against a wall. This would now change. This evolution coincides with the increasing involvement of the doctor in matters of birth in a leading role, in stead of the midwife.

Terry Foreman  •  Link

Like Samuel Pepys, 15, James K. Polk, 17, who would be the 11th US President, was operated for a bladder stone and rendered sterile, dying childless.

January 18, 2004
James K. Polk
by John Seigenthaler
http://www.booknotes.org/Transcri…
[...]
And...documents...left by...McDowell, the Danville, Kentucky, specialist, one of the great surgeons in the history of this country [ were ] relied on to demonstrate that this was really a urinary stone operation. And it was...a brutal operation. Here's a 17-year-old young man, constantly, almost chronically ill with lower-abdomen pains..., and they rush him to Danville, where...Ephraim McDowell, operates.

Now, the operation...was brutal. No antiseptic. And they only could give him brandy. They didn't have any antisepsis to stop the poison. They held him down. His uncle was with him. They put him up on his shoulders. They used what was called a gorget. And if you look at the gorget, I mean, it looks like it sounds, a vicious knife. And they went between the scrotum and the anus, right through the prostate. How he ever survived is remarkable. But he did.
[...]
There's no doubt in my mind...that he and Sarah were childless as a result of this operation...
I created a panel of about nine doctors, ...some specialists, some general practitioners. All... concluded after they looked at it that [ there was ] not much doubt that he was either left sterile or impotent or both. And so it was a childless marriage.
[...]

Terry F  •  Link

PEPYS'S PAIN a letter By William Matthews to The New York Review of Books in reply to an Oct. 8, 1970, review of the L&M edition of Pepys's Diary, sc. "O Calcutta!" By Matthew Hodgart (in part):

"Professor Hodgart disputes about Pepys's stone. It was not a kidney stone, he says, but the size of a tennis ball. Our editorial note that the stone was a kidney stone is mostly based on the fact that after Pepys's death seven stones were found in his left kidney. Professor Hodgart's tennis ball comes ultimately from Evelyn, who said Pepys's stone was that size. But it is important to remember that tennis balls change size, and that seventeenth-century tennis balls were considerably smaller than those used by Pancho Gonzalez; I think they were about one inch in diameter. One thing to remember in connection with even this smaller stone is that the operation was a scarifying experience from which Pepys might well have died; another is that he passed more stones during the diary period and that he frequently suffered excruciating pain; a third is that he, a man who loved children, was somehow cheated of having children." http://www.nybooks.com/articles/1… The Hodgart review, linked to this letter, is accessible in full to subscribers to the NYRB.

Joe  •  Link

There is a scene in HBO's "Deadwood" (the 16th episode of the first season) "Requiem for a Gleet" that depicts the harrowing experience of the trans-urethral procedure for breaking up a bladder stone.

George Lee  •  Link

John Evelyn records in his journal for 3rd May 1650 his observation of several lithotomies whilst in Paris. It lacks clarity but nonetheless gives some idea of what was involved in this gruesome procedure:-
“3 of May, at the Hospital of the Charitie, I saw the whole operation of Lithotomie namely 5 cut of the stone: There was one person of 40 years old had a stone taken out of him, bigger than a turkys Egg: The manner thus: The sick creature was strip’d to his shirt, & bound armes & thighs to an high Chaire, 2 men holding his shoulders fast down: then the Chirurgion with a crooked Instrument prob’d til he hit on the stone, then without stirring the probe which had a small chanell in it, for the Edge of the Lancet to run in, without wounding any other part, he made Incision thro the Scrotum about an Inch in length, then he put in his forefingers to get the stone as neere the orifice of the wound as he could, then with another Instrument like a Cranes neck he pull’d it out with incredible torture to the Patient, especially at his after raking so unmercifully up & downe the bladder with a 3d Instrument, to find any other Stones that may possibly be left behind: The effusion of blood is greate. Then was the patient carried to bed, & dress’d with a silver pipe accomodated to the orifice for the urine to passe, when the wound is sowd up: The danger is feavour, & gangreene, some Wounds never closing: & of this they can give shrewd conjecture by the smothnesse or ruggednesse of the stone: The stone pull’d forth is washed in a bason of water, & wiped by an attendant Frier, then put into a paper, & writen on, which is also entred in a booke, with the name of the person, shape, weight &c of the stone, Day of the moneth, & Operator: After this person came a little Child of not above 8 or 9 yeares age, with much cherefullnesse, going through the operation with extraordinary patience, & expressing greate joy, when he saw the stone was drawn: The use I made of it, was to give Almighty God hearty thankes, that I had not ben subject to this Infirmitie, which is indeede deplorable:”

TerryF  •  Link

"Samuel Pepys: a patient perspective of lithotomy in 17th century England."
Kumar P, Nargund V., Homerton University Hospital and Barts and London, Queen Mary's School of Medicine and Dentistry, University of London, London, United Kingdom. Journal of Urology. 2006 Apr;175(4):1221-4.
PURPOSE: Bladder stones have plagued mankind since ancient times with the oldest stone found in an Egyptian mummy dating from circa 4800 B.C. Lithotomy has also been practiced since antiquity with accounts describing the operation as risky and difficult. There are no contemporary details of the patient description of this ordeal. Samuel Pepys was a notable diarist of the 17th century who described his personal experience of having a bladder stone and subsequent undergoing lithotomy. MATERIALS AND METHODS: A comprehensive review of the medical literature, the diaries of Pepys, biographies and historical texts was performed to compile this historical review. RESULTS: The diaries of Samuel Pepys chronicle life in the 17th century in London. The diaries provide great insight into the contemporary political climate and London life. Stones afflicted Pepys from an early age and continued to trouble him, such that he finally decided to undergo lithotomy in 1658 for bladder stone. He provided a lucid account of his experiences in his diary. CONCLUSIONS: Pepys survived through the skill of an early urologist or lithotomist, the prayers of his family and probably his own strong constitution. He then went on to write his diary during the next decade, giving perhaps unwittingly an insight into his world and times to later generations as well as the personal story of his lithotomy.

TerryF  •  Link

"Samuel Pepys and his bladder stone."
Urquhart-Hay D.,Department of Urology, Wellington Hospital, New Zealand. British Journal of Urology. 1992 Nov;70(5):509-13

Samuel Pepys, as a young man, developed a bladder stone and, by the age of 25 years, realised that only surgery could deliver him from his agony. The chances of success in an age that was ignorant of sepsis were slender, but he opted for surgery. The operation, carried out through the perineum without anaesthetic by a master barber surgeon, was successful and Pepys survived. Although left sterile, he was far from impotent and he went on to achieve fame and fortune as Secretary to the Navy and President of the Royal Society. His greatest fame came after his death with the publication of his diary, which was to become one of the best known and best loved books in the language.
http://www.ncbi.nlm.nih.gov/entre…

JWB  •  Link

"In the 17th century robins (and sparrows) were eaten to break up kidney stones, for which a surgical operation, in those days, was dangerous if not impossible. If the surgeon was not swift and skilful enough to get the stone out within 20 minutes, the pain was so intense that the patient died on the table. People justified eating robins accordingly."

"Why we don't know who killed Cock Robin"
Paul Johnson
http://www.spectator.co.uk/archiv…

Terry Foreman  •  Link

Further link to "Samuel Pepys: A Patient Perspective of Lithotomy in 17th Century England"

Priyadarshi Kumar and Vinod Nargund
The Journal of Urology
Volume 175, Issue 4, April 2006, Pages 1221-1224
http://www.sciencedirect.com/scie…

Second Reading

Bill  •  Link

Any surgery before anaesthesia was surely amazingly painful and I can't image bladder surgery then. The Neal Stephenson novel "Quicksilver" has already been mentioned in this blog, Here is a conversation in the book, later in Pepys life, between Pepys and a man in pain from a "stone".

"Did you bring it?"
"I always have it with me," Pepys said, producing an irregular nodule about the size of a tennis ball, "as you have all your parts."
"To remind you of your mortality?"
"Once a man's been cut for the stone, 'tis hardly necessary."
"Why, then?"
"It's my conversation starter of last-resort. It gets anyone talking: Germans, Puritans, Red Indians . . ." He handed the object to Daniel. It was heavy. Heavy as a stone.
"I cannot believe this came out of your bladder," Daniel said.
"You see? Never fails!" Pepys answered.

Mary K  •  Link

Elizabethan description of cutting for the stone.

I have just come across this Elizabethan description of the operation in the February 1601 diary of John Manningham, a young law student of The Middle Temple.

"One Burneham of London, whoe was the watergate officer at Flushinge, being troubled with the stone so mutche that it was a hindraunce unto him in the execution of his office, ventured a dangerous cure and was cutt for it, but dyed of it. This cure by cutting is a newe invention, a kinde of practise not knowne to former ages. There is a seame in the passage of the yard neere the fundament, which the surgeons searche with a crooked instrument concaved at one ende (called a catheter) whereunto they make incision and then grope for the stone with another toole which they call a duckes bill. Yf the stone be greater then may be drawne forth at the hole made by the same, the partie dyes for it."

The Diary of John Mannigham of the Middle Temple.
edited by Robert Parker Sorlien.
published by The University Press of New England (for the University of Rhode Island). 1976
ISBN No. 0-87451-113-5

Korhomme  •  Link

I was a surgeon before retirement; I understand what bladder calculi are. I have removed them; I've also removed gallbladders for gallstones.

This isn't so much an annotation, as an attempt at a correction. For the past decade or so, many authors, who should know better, have referred to the operation that Sam had as being for 'gallstones'.

I did read this somewhere, probably in a biography of a contemporary, but I cannot now find the original.

Can anyone help?

Hillary Hambric  •  Link

I have read that Pepys kept his bladder stone in a special lacquered box he had built for the purpose. Is there any information about where the stone is now? Was it lost? Thank you!

Third Reading

San Diego Sarah  •  Link

This article is about men's reluctance from the 16th to 21st century to discuss urological and sexual information with their doctors -- until pain is involved. Surprisingly the author doesn't use Pepys as an example, but does cite this incident which reminded me of Pepys:

https://www.historytoday.com/arch…
"Perhaps surprisingly, there were some conditions that men openly and freely discussed. In particular they seemingly discussed bladder stones and their associated symptoms without concern. Some men even showed off the stones they had managed to pass.
"Mathew Purmann noted that in the late 17th century ‘Baron Van Horst Lieutenant Colonel of the Hannover Troops’ had kept his bladder stones and ‘in the year [of] 1687 shewed me a great Box full of Angular, Oval and Round Stones which came from him in Six Weeks Time, the largest whereof was about the bigness of a great Pea’."

Keeping the evidence in a box was apparently fashionable.

Alison ONeill  •  Link

I don't think this has been shared here yet: Sir Eric Riches MC MS FRCS on Samuel Pepys and his stones in the Annals of the Royal College of Surgeons of England (1977) vol 59. It's a PDF download.
https://www.google.co.uk/url?sa=t…

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References

Chart showing the number of references in each month of the diary’s entries.

1660

1661

1662

1663

1664

1665

1666

  • Feb

1667

1668

1669