History and Paleopathology

Epidemiological studies have shown that bladder stone is a disease of communities where the diet is high in grain or rice and low in animal protein. With dietary changes resulting from improved technology, migration, or cultural shift, bladder stone disease is replaced by renal stone disease. This is well demonstrated over the past two centuries in parts of Britain, France and other European countries, Russia, China, and Turkey. It is therefore not surprising that ancient references to stone disease deal almost entirely with bladder stone, with rare mention of the renal colic characteristic of upper tract stones.

Bladder stone was common in ancient Persia (600-300 B.C.), particularly in infants, and was considered a result of ingesting sour milk, fruits, or acidic drinks. The Babylonian Talmud contains references to bladder stone disease and includes the ingenious suggestion that patients should urinate on the doorstep in order to see the stone.

In India, the Rig Veda and Atharva Veda, inscribed around 1500 B.C., consist of incantations against disease, including bladder stone. The Ayur Veda, published much later, around the first century A.D., described suprapubic incision for removing bladder stones. In the second century A.D., Charaka described four types of stones, almost certainly originating in the bladder. The first was white and as large as a hen's egg; the second was rough and cov ered with spines; the third was of a dark color; and the fourth was composed of sperm. The first three stones were probably urate and calcium oxalate bladder stones typical of endemic disease.

Early Chinese literature contains few references to any recognizable disease. However, detailed case histories of 25 patients treated by Shunyii I in the second century B.C. have been preserved. They include a palace superintendent afflicted with hematuria, urinary retention, and bladder stones. This may represent a case of either schistosomiasis or endemic stone disease (Lu and Needham 1967).

In Greece, Hippocrates had earlier recognized both renal and bladder stone and recommended diuretics and ingestion of large quantities of water for their removal. He considered wounds of the bladder wall as invariably fatal and therefore specifically forbade his followers to cut for the stone.

The Assyrian Book of Medicine, probably written around 300 B.C., includes much of the work of Hippocrates. Among the numerous prescriptions for various maladies are two elaborate potions for flushing out or dissolving renal stones. The latter recipe contains 50 substances with particular emphasis on camphor and vinegar. Other Assyrian works contain directions for infusing various preparations into the bladder through a bronze tube to dissolve bladder stones (Thompson 1934).

In Alexandria around 100 B.C., Ammonios developed an instrument for crushing stones within the bladder. In the first century A.D. in Alexandria, Rufus of Ephesus gave detailed instructions for removing bladder stones through a transverse perineal incision.

In Rome during the same century, Celsus performed numerous operations for bladder stone in boys 9 to 14 years of age. His eight-volume De Me-dicina contains a precise description of transverse perineal lithotomy followed almost without modification until the sixteenth century. Galen described the lateral perineal lithotomy, but, more importantly, noted the frequent occurrence of bladder stone in young boys. He also tried giving stone solvents (lithotryptics) in an effort to dissolve the stones.

In Arabic medicine, Rhazes at about the turn of the tenth century described both renal and bladder stones, and he implicated increased salt intake and hot weather as factors in renal stone formation. Around a century later, Avicenna thought that bladder stones formed when the urine contained an excess of matter (Bitschai 1952).

By the eighteenth century, more and more sur vni.154. Urolithiasis (Renal and Urinary Bladder Stone Disease) Table VIII.154.2. Paleopathological specimens of renal and bladder stones

Approx. date

Location

Age/Sex

Size (cm)

Type

Composition

3500 B.C.

El Amrah, Egypt

16/M

6.5

bladder

urate

3500 B.C.

Egypt

-

4.5 x 3.0

bladder

urate, and magne

4.5 x 3.0

sium ammonium

4.0 x 2.5

phosphate

3100 B.C.

Helouan, Egypt

-

3.5 x 3.0

?renal

-

(5 stones)

-

3.0 x 2.0

?renal

-

3.5 x 2.0

?renal

2800 B.C.

Naga-el-Dier,

-

1.6

renal

oxalate/phosphate

Egypt

(4 stones)

1000 B.C.

Egypt

adult/M

large

bladder

-

1000 B.C.

Sudan

(32 cases)

3.0-3.9 ave.

bladder

calcite/apatite

Egypt

ureter

A.D. 0-200

Sinai Desert, Egypt

adult/M

3.0 x 3.5 x 1.5

renal

p hosphate

(2 stones)

8500 B.C.

Trapani, Sicily

20-25/M

2.0 x 1.0

bladder

_

2100 B.C.

Lot, France

adult

4.1 x 3.5 x 3.0

bladder

-

2000-700 B.C.

Yorkshire, England

adult

4.0 x 3.0 x 3.0

bladder

2000-700 B.C.

Yorkshire, England

adult

0.5 x 1.0

bladder

A.D. 450-1000

Somerset, England

adult

?bladder

-

A.D.1300-1500

Aebelholt, Den

40/F

0.4 x 0.3

renal

oxalate

mark

3300 B.C.

Indian Knoll, Ky.

24/M

4.0 x 2.7 x 2.3

bladder

oxalate

24/F

3.3 x 2.3 x 1.2

renal

oxalate/phosphate

40/M

3.3 x 1.6 x 1.0

renal

oxalate/phosphate

1500 B.C.

Fulton Co., 111.

20/F

1.7 x 1.0 x 0.7

renal

phosphate

100 B.C.-A.D. 500

Northeastern, Ariz.

18/M

4.2 x 3.7 x 2.7

bladder

oxalate/urate

A.D. 500-750

Vandal Cave, Ariz.

30-40/M

3.0 x 2.7 x 2.5

bladder

oxalate/urate

A.D. 1000

Arica, Chile

45-50/F

1.5 x 1.5 x 0.6

ureter

phosphate

A.D. 1500

Marion Co., Ind.

50/F

0.7-2.0

renal

phosphate

(31 stones)

A.D.1600-1700

Putnam Co., W.Va.

-

3.1 x 2.0 x 0.5

renal

phosphate

geons were attempting the dangerous lateral perineal lithotomy. Special hospitals for bladder stone patients were opened in England, France, Holland, and elsewhere. In 1753, Frère Come opened such a hospital in Paris and operated on over 1,000 patients. The Norfolk and Norwich Hospital was founded in 1771, and one of every 55 admissions in this endemic region was for removal of bladder stone.

Through paleopathology and careful archaeological technique, actual specimens of ancient renal and bladder stones have been recovered from skeletal and mummified remains. This material has been extensively reviewed elsewhere and is summarized in Table VIII.154.2 (Steinbock 1985).

R. Ted Steinbock

Get The Body Of Your Dreams

Get The Body Of Your Dreams

Everybody wants to lose weight. This is one fact that is supported by the countless weight loss programs on the market along with the numerous weight loss products, ranging from snack bars, powdered juices, shakes and even slimming soaps and lotions.

Get My Free Ebook


Post a comment