_Copy of a Letter from_ John Pringle, _M.D. F.R.S. to Dr._ Robert
Whytt, _Professor of Medicine in the University of_ Edinburgh, _and
F.R.S. relating to the Case of the Right Honourable Lord_ Walpole;
_with Dr._ Whytt’_s Answer. Communicated by Dr._ Pringle.
[Read April 21, 1757.]
London, 22 Feb, 1757.
+SIR,+
I Imagined, that upon hearing of Lord Walpole’s death, you would be
desirous to know the state of his Lordship’s health from the time he
published his own case; whether he continued the use of his medicines
to the last; what distemper he died of; and, if his body was opened,
what was the condition of his bladder and kidneys. I informed myself,
as well as I could, of all these particulars; and I hope I shall be
able to give you some satisfactory account of most of them.
Last year, in the month of March, about ten months before his
Lordship’s death, I happened to meet him at a friend’s house, where
he dined, and never saw any man of his age with a more healthful
appearance. He was then in his 78th year. He ate with an appetite,
and of a variety of dishes; drank some Madeira, and was very chearful
the whole time. His Lordship then told me, that he had enjoyed perfect
health since he sent his case to the Royal Society; that he thought it
probable there was still a stone in his bladder, but so diminished, or
smoothed, as to give him no uneasiness; that he did not think it safe
to go about the streets of London in a coach, but that he went every
where in a chair; and that, in the country, he could travel 40 miles
a day in his post-chaise, without fatigue, or feeling any of his old
pains upon the motion. That he continued to drink, for a constancy,
three pints of oystershell lime-water daily; and to take, as often,
from half an ounce to a whole ounce of soap, by way of lenitive. All
these circumstances I am sure of, because I noted them down when I came
home.
From this time to the beginning of winter, Lord Walpole (as Mr.
Graham, his apothecary, informed me) continued in the same state of
health; but some time after coming to town, his Lordship was seized
with a lingering feverish disorder, very much affecting his spirits,
but intirely unconnected with the stone. Dr. Shaw, who attended his
Lordship for about a fortnight before his death, told me, that there
had never been any stoppage of water, or passing of bloody urine, or
any pain about his bladder or kidneys, during his last illness; but
that he now and then felt some irritation in making water, a symptom
too inconsiderable to require any other medicine than the continuation
of his lime-water; which, in smaller quantity, he drank till within two
or three days of his end.
Mr. Ranby and Mr. Hawkins, surgeons, with Mr. Graham, were present at
the opening of the body; and from the two last I received the account
of the dissection.
The coats of the bladder appeared to be a little thicker than natural,
but were otherwise sound. The _glandula prostata_ was of a large size,
but not distempered. They found three _calculi_, two 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. Mr. Graham
favoured me with a sight of them all. The two first 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 my 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 that bulk, and seemingly of a hard
substance. The smallest stone having been put up with some others of
the same size, taken out of the gall-bladder, Mr. Graham could not be
positive which of them it was; and therefore I can only say, that what
he thought most likely to be so, was about the size and shape of the
seed of an apple, with the point broken off, and the edge ragged. This,
as I 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.
No parts could have a sounder appearance than both the ureters and
kidneys. The first were not dilated; nor did the last contain any
stone, mucus, or gravel: the pelvis in each was of a natural size.
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 chesnut, but rounder. The surface was
smooth, particularly at one part, where it seemed to have rubbed upon
a lesser _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 one drachm two scruples and two grains; the small one but nine
grains: they both sunk in water; and felt specifically heavier than
any stones I have ever seen taken out of the gall-bladder. Besides
these two, there were several very small _calculi_ of irregular shapes,
and of rough surfaces, which all together did not weigh above five
grains. Mr. Graham, who had attended his Lordship for about 40 years,
assured me, that he never had any symptom that indicated 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.
These are all the materials, I can furnish you with, relating to this
case. If you desire to be more particularly informed of any of these
circumstances, let me know, and I will endeavour to procure you all the
lights I can. In the mean while, I should be glad to have your remarks
upon what I have now sent you; and since you have been so long in the
train of thinking, with more than usual attention, on this subject,
I presume it would be very agreeable to the gentlemen of the Royal
Society to have a paper from you on this occasion; and the rather, as
his Lordship began his course of soap and lime-water, upon hearing of
your success by that method of cure. I am,
SIR, _&c._
John Pringle.