The Hippocratic oath includes this curious promise: “I will not cut for stone…I will leave this operation to be performed by practitioners.” Bladder stones are among humanity’s oldest known ailments, and its surgery an ancient procedure – but, as Hippocrates warned, one so dangerous that it should not be trusted to doctors. Only specialists could operate to relieve this agonising affliction.
In an age before anaesthesia and antiseptics, lithotomies were often fatal. Samuel Pepys was so glad to survive his that he placed his stone in a reliquary and threw a party for it every year. Others set their stones into jewellery and printed cards commemorating their surgery. Those less determined to defy death resorted to quack medicine or even scraping their insides with wire. Benjamin Franklin, as usual, outdid everyone. When stones blocked his urethral opening, he dislodged them by standing on his head and urinating upside down.
BENJAMIN FRANKLIN had plenty of company in his medical miseries: Isaac Newton also suffered from bladder stones, as did Peter the Great of Russia and Napoleon Bonaparte. Bladder and kidney stones were once a far more common affliction than they are today. Indeed, Franklin’s brother also had stones, and when Ben designed a draining catheter for his blocked bladder, his relief was so immense that he had another made and sent it to his brother with his compliments. And while some sufferers passed their stones relatively painlessly, others were less fortunate, suffering excruciating pain, vomiting, fever, bloody urine and permanent kidney damage.
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So readers sat up and took notice when on 27 April 1738 The Gentleman’s Magazine published this brazen offer by one Joanna Stephens: “Mrs Stephens has proposed to make her Medicine for the Stone publick, on Consideration of the Sum of £5000 to be lodged with Mr Drummond, Banker.” It was an immense sum for an obscure individual with no medical degree – and a woman to boot. Were sufferers really that desperate? They were indeed: more than £1000 poured into the bank.
It helped that the prominent doctor and philosopher David Hartley vouched for the mysterious Mrs Stephens. He spoke from experience: her concoctions had cured him of his own stones, he claimed. Exhorting the public to accede to her demand for £5000, pointing out that the money could be held by a third party until trials had shown her cure worked, he wrote: “I therefore perswade myself, that Mrs Stephens will appear to you in a different light from common Pretenders to NOSTRUMS…”
Hartley campaigned relentlessly on Stephens’s behalf, collecting 155 accounts of patients cured by her secret medication. But in 1739, with the collection stuck at £1352 and 3 shillings she made her boldest move: she petitioned parliament for the full £5000. Her novel proposal was that she would publish the secret ingredients, allowing everyone to try it for themselves. If the cure worked, a grateful nation would make her rich. Parliament approved her extraordinary request, and Stephens turned over her recipe to the Archbishop of Canterbury.
On 16 June 1739, a full-page notice appeared in The London Gazette. Doctors and stone sufferers rushed into their gardens for ingredients. “Take Hens Eggs well drained from the Whites, dry and clean,” Stephens instructed. “Crush them small with the Hands, and fill a Crucible…” They then added crushed snail shells, slaking and baking the mixture into a fine powder; to this was added soap and honey, as well as chamomile, fennel, parsley, burdock and burnt swine’s-cress.
Stephens’s day of reckoning came soon enough. On 5 March 1740, four selected stone patients were summoned to the House of Lords to appear before a panel that included the Archbishop of Canterbury, the speaker of the House of Commons, the president of the Royal College of Physicians and the Prince of Wales’s personal surgeon. The first to testify, a Mr Gardiner, said that after eight months of treatment his symptoms had vanished, and he had passed his stones. The next three men all gave similar accounts: after taking Stephens’s medicine their urine became smelly, turned cloudy, and then – blessed relief – the stones, fragmented into small pieces, were passed at last.
A week later, Stephens received her £5000 reward. Sensibly, she vanished with her mighty haul. Reaction to the news was a mixture of incredulity, curiosity and envy. Books on Stephens and lithotriptic (stone-dissolving) medicines appeared in many languages. Doctors argued over hundreds of cases. Had so many eminent colleagues, as prominent physician Richard Mead claimed, “acted a part much beneath their character” in falling for “an old woman’s medicine at an exorbitant price”?
The French scientist Sauveur Morand determined that the recipe was essentially alkaline soap and lime – the eggshell and snail-shell powder – rendered less noxious by herbs. He then carefully sawed a bladder stone into four pieces, weighed them and put them into four jars: one filled with normal urine, another with urine from a man taking Stephens’s remedy, a third with a soapy solution, and a fourth with the remedy diluted with water.
By modern standards, it was a very small sample. But back then, the very notion of comparative medical trials was exemplary. The jars were kept at roughly body temperature and after a month the stones were weighed again. The stones treated with the remedy had indeed become slightly lighter. But other researchers found the medicine had little effect; still others decided that as lime was the active ingredient, it would be simpler just to drink lime water. These lithotriptic medicines clung on for a while until better treatments emerged. But Stephens became a byword for quackery, and by 1773 the surgeon Percivall Pott could write her off as “an ignorant, illiberal, drunken, female savage”.
Why the disagreement? Doctors were unwittingly arguing about two different disorders: one for which the Stephens cure was effective and another for which it was not. There are two distinct types of stone: acid stones made of calcium and uric acid and struvite stones (“infection stones”) made of magnesium, ammonium and phosphate. These days stones are often broken up with ultrasound, laser or an endoscope. But modern lithotriptics, such as potassium citrate, are still with us, and their use is telling. Potassium citrate is prescribed to render urine alkaline, so this treatment dissolves acidic stones but not infection stones. The Stephens and lime water cures worked on the same principle. Stephens even recommended that patients refrain from urinating too often, the better to let their newly alkaline bladder contents work on the stones.
In older men, uric acid stones can form when an enlarged prostate interferes with urination and keeps liquid sitting for long periods in the bladder. This may have been what Hartley and the elderly male witnesses at the House of Lords had; the Stephens cure was indeed what such men needed. But depending on which kind of stone you had, the Stephens cure might prove either worthy or worthless, which is why subsequent researchers and patients were so vexed by the conflicting case studies.
So her cure appears real enough, for some people at least. But was it really worth a whopping £5000? It depends on how long a view you take. The research prompted by Stephens resulted in a most unexpected discovery. In 1752, medical student Joseph Black wrote to his father from the University of Edinburgh about his student thesis, which was to be “on the Properties & virtues of Lime Water in Dissolving the Stone in the Bladder… as it shows a tendency to remove one of the most excruciating Disorders that render men miserable”. Black had noticed his professors disagreeing with each other over lithotriptic research and had decided new experiments were needed to advance the debate.
First he set about determining what exactly was in lime water. It was thought that lime was made caustic by the addition of a fiery substance, the so-called “phlogiston”. But, by weighing his sample before and after a reaction, he showed that something had been lost, not gained. That something was a previously unknown gas: carbon dioxide. Black’s discovery was a defining moment in the development of chemistry as a modern science. After many twists and turns, the allegedly foolhardy investment in an eggshell remedy had fostered a landmark discovery. In the end the canny Mrs Stephens’s £5000 cure was probably worth every penny.