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Dissolving the Stone: the Search for Lithontriptics

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Dissolving the Stone: the Search for Lithontriptics 2 Dissolving the Stone: The Search for Lithontriptics Introduction Substances and compound remedies with a capacity to “destroy” urinary stones, the so-called lithontriptics, formed a major field of interest of eighteenth-century pharmacology and therapeutics. Urinary stone disease was clearly a very common condition, probably due to a combination of contemporary dietary habits and frequent infections. The important role of lithotomy (cutting for bladder stones) in seventeenth- and eighteenth-century surgery is indicative of how widespread the disease must have been, as are the large collections of concrements stemming from that time, such as those bequeathed by Sir Hans Sloane and William and John Hunter. 1 Though cutting for bladder stones had been practised since antiquity and a variety of operative techniques had been developed over the centuries, it was still a procedure greatly feared by the many sufferers. There was still the risk of death, besides the trauma and pain patients had to endure during and after the operation in the era before effective anaesthesia and antisepsis. Even if lithotomy as such was successful, incontinence, fistulae, and male impotence were common complications. On the other hand, the symptoms of patients with urinary stones could be so severe as to make them desperate for help: colics, when calculi and “gravel” descended from the kidneys; bloody urine and sharp pains from bladder stones, that could make movements torture, especially when travelling in a carriage; finally, obstruction of the bladder through stones and clotted bood, inability to urinate, and – if catheterization failed – death in agony. 2 With both the disease and its surgical therapy feared, it is understandable that patients and doctors alike looked for “milder” treatments with oral remedies that would somehow break or dissolve the stones. Articles on this subject figured prominently in the Philosophical Transactions of the Royal Society of London and the Essays and Observations, Physical and Literary of the Edinburgh Philosophical Society. A special bibliography, compiled in 55 Andreas-Holger Maehle - 9789004333291 Downloaded from Brill.com09/27/2021 02:18:04PM via free access Dissolving the Stone the early 1830s by the Norwich surgeon John Green Crosse (1790- 1850), listed no less than 103 monographs and 74 articles on lithontriptics, published internationally since 1700. 3 Several experimental studies and clinical observations came from authors that were well known and widely respected in the eighteenth-century medical world, such as Stephen Hales and James Jurin in London, Robert Whytt and Charles Alston in Edinburgh, Thomas Percival in Manchester, Claude-Joseph Geoffroy, Sauveur-François Morand and Antoine François Fourcroy in Paris, Anton de Haen in Vienna, and Johann Andreas Murray in Göttingen. Historians, however, have so far concentrated on the more spectacular or external aspects of the topic. Arthur Viseltear has described the events which, in 1740, induced Parliament to grant the empiric Joanna Stephens (d. 1774) the high reward of £5,000 for revealing the recipe of her “Medicines for the Cure of the Stone”. 4 The death of Sir Robert Walpole in 1745, which some contemporaries believed to have been hastened (if not caused) by the use of Jurin’s Lixivium lithontripticum , has been studied by Viseltear, too, and, more recently, by Edmund Anthony Spriggs. 5 Viseltear also summarized some of the controversial trials that were made to evaluate Mrs Stephens’s medicines. 6 A full historical account and analysis of eighteenth-century research on these and other supposed lithontriptics has not yet been provided, however. This is particularly true for the many remedies and substances tested before and after those two early proprietary medicines. 7 The relevance of the subject in eighteenth-century medicine, on the other hand, has recently been pointed out again. Philip Wilson has shown that remedies for bladder stones were frequently listed in contemporary domestic manuals, obviously being perceived by the public as an alternative to the dreaded, though technically improved, lithotomy operations. According to him, experimentation with the “dissolvents” led physicians to claim competence in advising the right therapeutic choice in a particular patient. 8 Moreover, David Harley has recently suggested a political faction over the issue of Mrs Stephens’s medicines, the project of a reward for her having been “mainly supported by Whig physicians and opposed by Tory surgeons”. 9 In contrast to this previous work, the present chapter focuses on the more internal, scientific aspects of the subject. In particular, it analyses the methods used in evaluating the efficacy and harmlessness, or noxiousness, of lithontriptics and looks into the contemporary debate on the validity of these methods. Attention is also drawn to the theories on the mode of action of remedies against urinary stones. In 56 Andreas-Holger Maehle - 9789004333291 Downloaded from Brill.com09/27/2021 02:18:04PM via free access Dissolving the Stone doing this the influence of advances in chemistry is studied as well, with respect to ideas both about the properties of lithontriptics and the constituent elements of their target, the urinary concretions. My study concentrates on the period from about 1730, when Stephen Hales conducted a first series of experiments on the stone dissolving powers of various substances and mixtures, to the second decade of the nineteenth century, when Alexander Marcet outlined a full scheme for the pharmacotherapy of calculi based on recent insights in animal chemistry. 10 Beforehand, however, some remarks on the long tradition of lithontriptic medicines have to be made. Traditions The idea that certain substances, taken orally, had the power to destroy stones in the urinary tract was by no means new in the eighteenth century. The recommendation of such remedies can in fact be traced back at least to the materia medica of Greco-Roman antiquity. As in other areas of pharmacology, Dioscorides (fl. AD 40- 80) was influential here, by describing several medicines that would “break” bladder stones. 11 He attributed such a power to the vegetable remedies cardamom, laurel, kotyledon, semen paliuri, gum of the plum tree, lithospermon, and saxifrage, as well as to the so-called lapis Judaicus (i.e. fossil spines of sea urchins imported from Judaea) and to “stones found in sponges”. The last four of these recommendations seem to have been based on an argument by analogy: like the urinary calculus, the lapis Judaicus and the lime-like concretions in sea sponges were kinds of “stones”; saxifrage was known to be a shrub growing on rocky ground, thus “breaking” its way through the stones; and lithospermon was so called, because its seeds were “hard as stone”. In addition to their lithontriptic property, Dioscorides ascribed a diuretic effect to some of these remedies. 12 Very similar knowledge was reproduced by Pliny the Elder (AD 23- 79) in his Natural History . He too mentioned “sponge stones”, which, taken in wine, would cure bladder affections, and break and expel calculi. Probably meaning the same as had Dioscorides with saxifrage, Pliny wrote that “empetros” or “calcifraga”, growing on rocks in the coastal mountains, had a diuretic and stone-breaking effect. Like Dioscorides, he also regarded the seeds of paliuros as lithontriptic and its root as diuretic. 13 A different tradition is reflected in the works of Aretaeus (c. AD 150-200). Among others he named water-parsnip as a simple medicine for breaking urinary stones and as a compounded remedy one made from vipers and the lizard “skink”.14 Both vipers and the “skink” were also included in the 57 Andreas-Holger Maehle - 9789004333291 Downloaded from Brill.com09/27/2021 02:18:04PM via free access Dissolving the Stone materia medica of Dioscorides, but neither for bladder stones nor other diseases of the urinary tract. 15 A whole range of lithontriptics, grouped according to their strength, was eventually given in the writing De affectuum renibus insidentium dignotione et curatione , which has been ascribed to Galen of Pergamon (c. AD 130-199 or after 212), but is now regarded as a later compilation. The first category, “stone grinding” remedies, included a decoction of roots of quick-grass, damasonium cress, and maidenhair fern. If this had no success, the use of “stone destroying” medicines was advised, such as roots of asparagus, bdellium Arabiae, marshmallow seeds, lithospermon, betony, saxifrage, pennyroyal, the root of the Egyptian caper bush, and seeds of domestic figs. The lapis Judaicus was put in a third group of more effective, “strongly stone breaking” remedies, which also included vitrum ustum (burned glass), lapis Cappadox (sponge stones), and semen paliuri. For the first group of lithontriptics this pseudo-Galenic text provided a pharmacological explanation: plants such as damasonium and maidenhair had a lukewarm quality and thus counteracted excessive body heat, which was thought to harden “thick matter” in the urine and to form stones in this way. For the same reason the use of very hot, diuretic substances was forbidden here: the “thick matter” would only be hardened further and stones be formed more quickly. 16 The idea that calculi were concocted out of the “thickest and muddiest” parts of the urine in an overheated, “feverish”, and inflamed bladder had in fact been formulated in the Hippocratic writing Airs, Waters, Places . Sandy and muddy drinking water, feverish bowels heating the bladder, and in children the consumption of “unhealthy, too hot and bilious milk” were given as causes of the stone disease. In addition, the Hippocratic text Internal Affections stated that sand-like stones were generated in the kidneys when phlegm stagnated and solidified there. Here the author recommended to “clean the patient downwards” with the juice or root of scammony. 17 Generally, however, an explanation for the choice of certain substances as lithontriptics was not given in the texts of antiquity. Their efficacy was merely affirmed.
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