508 PHILOSOPHICAL TRANSACTIONS. , ' [aNNO 1774. 



This subject, Eleanor Pilcher, was about 52 years of age. About 25 years 

 before she first began to complain of pain in her back, of a difficulty in making 

 water, and of other nephritic symptoms, which gradually increased. Soon 

 after this she began to void gravel with her urine, and to pass several very small 

 stones; and these symptoms continued to return very frequently, and with much 

 severity. About 10 years after the first appearance of these complaints, a 

 swelling came on in the left lumbar regicn, which, after having been very 

 painful, for a considerable time, suppurated. This wound, which very soon 

 became fistulous, continued open ever after, and constantly afforded an ichorous 

 discharge. It was not till Dec. 1772, 15 years from the appearance of the 

 tumour, that this discharge began to abate, and that the wound, from being 

 perfectly easy, became painful and inflamed. During all this time, the nephritic 

 symptoms had continued to return, without any variation, the urine had con- 

 stantly afforded a gravelly sediment, and several small stones had passed through 

 the meatus urinarius; but these concretions were now about to take a different 

 course. The pain in the back, which had commonly affected the left side, 

 became much more intense than usual, but was not attended by any of the other 

 symptoms, which had been the usual forerunners of a fit of the gravel. The 

 discharge, from the wound, was suddenly diminished, and the pain and inflam- 

 mation exceedingly increased, though the urine continued to pass in a healthy 

 quantity, and without difficulty. These complaints continued during 8 days, 

 and then a round and smooth calculus, weighing about 12grs., was extracted, 

 with some difficulty, from the wound. After that time no gravel was voided 

 with the urine, though no urine ever passed through the wound ; and 6 other 

 paroxysms, like that he had described, took place, in which the same symptoms 

 occurred, and which had terminated in a similar manner, so that 7 calculi had 

 passed through the wound, only 2 of which had been preserved, and the least 

 of them weighed 6 grs. During the intervals of these paroxysms, the patient 

 enjoyed a state of ease and health ; and the orifice of the wound, soon after the 

 exclusion of a calculus, returned to its usual size, admitting with difficulty a 

 common probe. This case appeared to be a great proof of the powers of nature. 

 The right kidney did not seem to be affected, and as no urine ever passed through 

 the wound, it should seem as if the secretion by the left kidney was destroyed; for, 

 as no gravel was then voided with the urine, the left ureter was probably closed. 



The case however, though a very interesting one, is not perfectly singular, 

 for Delecamphius relates, that he saw a man who passed several stones through 

 an abscess of the loins, that had become fistulous. And Tulpius, in the 4th 

 ^book of his Observationes Medicae, gives the history of a patient, who after 

 undergoing much pain, from a nephritic complaint which he inherited from 

 his father, at length passed a stone from the kidneys, externally through the 



