June 1997


Author Affiliations


Arch Dermatol. 1997;133(6):700. doi:10.1001/archderm.1997.03890420026003

MR. G., aged about twenty-four years, an American by birth, has been suffering since November 7, 1896, from bladder trouble. Says that for some time previous to that date he had been drinking pretty freely. Always enjoyed good health. He came to Cincinnati on account of this trouble, which had previously been diagnosed by his local physician as stone in the bladder. Thompson's searcher was used and a foreign body could easily be detected, but no distinct click could be elicited. A cystoscopic examination was then made, with the result that a stone was found in the bladder. The stone was located on the left side of the viscus, a little above the trigonum. It seemed to be adherent to the mucous coat, and its outline was frequently obscured by a floating mass, which every now and then passed between the calculus and the cystoscope.

This case seemed to be an ideal one for litholopaxy, nevertheless, on February 22, 1897, median lithotomy, which subsequently proved to have been the better operation, was performed. In its removal the stone broke into numerous fragments. The exterior, or shell of the stone, was composed entirely of lime salts, while the interior, or nucleus, was the bean. The nature of the bean could not positively be determined; it reminded one very much of the appearance of a large lima bean or that of a peanut. The dimensions of the bean (in its swollen condition) were about one inch in length by seven-sixteenths of an inch in thickness. The stone weighed over 110 grains. The husk of the bean, which was not adherent to the body of the bean, separated the nucleus from the external shell of the stone, and as a consequence the two parts of the stone separated as soon as the stone was broken.

Many obscure facts have been cleared up since the character of the calculus was made out. Firstly, the reason why a distinct click could not be elicited on striking the stone with the searcher; and, secondly, the reason why the foreign body, instead of lying loose in the viscus, was found adherent to the bladder wall. No doubt slight adhesions were formed between the bean and the mucous membrane before the deposit of lime salts took place.

J Cutan Genito-Urin Dis. June 1897;10:271-272.