Can You Solve This Nearly 300-Year-Old Medical Mystery?

(updated below)

     Image: Henri Gervex (1852-1929)
     Doctor Preau Operating at the St.
     Louis Hospital.
Honoured SIR and MADAM,

In researching the history of science one often comes across bizarre claims about the natural world that reveals the limit of knowledge available to researchers of the past. However, sometimes a case comes up that seems to be a genuine mystery even today. Such is the case for this eighteenth-century woman who was afflicted for two years with what her doctor referred to as "hairy crustaceous substances" that were voided in her urine.

On July 16, 1733 a Mr. John Powell of Pembroke, Ontario wrote a letter to the Philosophical Transactions of the Royal Society of London (the most esteemed scientific journal of the time) outlining this curious medical anomaly. As my background is in natural history, not medical history, I'm at a loss as to what this could be. If anyone has any thoughts I would appreciate your input (though I would encourage you not to read the description during lunch).

As Powell wrote to the Royal Society:

She has for this considerable time voided one or more of these hairy crustaceous Substances every Day or Night; they looking, when they are first voided, like Hair and Coralline [algae in the family Corallinaceae, see here for assorted images]; and her Pains are so very exquisite, that we are forced, every Third Night at farthest, to give her an Anodyne to quiet her; and that often cannot be done, her Pain being so very great.

Powell writes that the crustaceous substances were sometimes very long and that the woman would have to pull them out, upon which "they put her to most exquisite Pain . . . and oftentimes a good deal of Blood comes off with her plucking them, which makes her very sore inwardly."

[V]ery often the Substance she voided would be so stiff and ropy, that we could scarce separate it from the Pot; and at other times so pliant, that you might take it up a great Height with a Sprig of a Broom, or a Feather, and so fall down again like a Lump into the Pot.

Powell also reported that the woman experienced both pain in her bladder and in the bottom of her feet (which may have been unrelated), a weakness in her limbs, and the inability to stomach drinking milk.

Milk will by no means agree with her: She often tried to conquer it, but never could, it constantly making her very sick in her Stomach, and the vomiting it up in great large Lumps.

She also experienced what Powell referred to as "a Crepitus [a cracking sound usually associated with arthritis in the joints], or a breaking of Wind, as it were, in her Bladder; which would make one believe, that there is an Aperture from the Intestinum Rectum to the Bladder." However, Powell states that another physician analyzed the woman and could find nothing unusual with her bladder nor any evidence of kidney stones.

In response to this unusual medical case Sir Hans Sloane, royal physician to Queen Anne, George I and George II, wrote that he had experienced something similar but gave no indication as to what may have caused it.

I have considered, and am satisfied, that the hairy Excretions are generated most likely in her Kidneys. I have seen, in my Practice, some Instances of the like, and have by me what was brought off by Urine from some of them. The first I remember, was from a Gentleman near the Exchange, who would frequently, Forty Years since, void with his Urine long Hairs, which were received on white Paper; and, the Urine passing off, would remain there, and, by their Transparency and Angles, yielded, on viewing by a Microscope, the finest Colours imaginable, such as we find by a Prism. This Gentleman did not suffer much, though he complained of a Sharpness of Urine. The Person who was affected the most, and applied to me for Help, was a Brewer, who had such Hairs matted or woven together, voided by Urine with great Pain: But then there was no calculous Matter, or very little, added to them. It is very likely that, that Matter is added to those of your Patient in the Bladder, by being retained there.

Sloane's advice to Powell was the following:

I believe Bath-waters drank warm, Mallow-tea, Linseed-tea, Oil of sweet Almonds, Syrup of Marshmallows, little and often taken, with Baths of emollient Herbs, may be of great Use; and perhaps moderate Exercise may help them off.

My guess is that, except for the exercise, none of this medical advice had the slightest effect (the best course of action prior to the advent of scientific medicine, according to York University historian David Wooton, was to avoid doctors altogether). However, Sloane insists that his Brewer patient "was cured by drinking plentifully of soft Liquors, which he often poured down; and twice a Week he took the purging Waters [sulphate of soda or sulphate of magnesium]."

I am at a loss as to how to explain these cases. I therefore submit my query to the beneficent gods of the intertubez.

Your most obedient, and most humble Servant,

Eric Michael Johnson

Update: There have been many excellent ideas to explain this, however, I think a reader solved the mystery. Read through the suggestions below and then visit this post to see if you agree with the diagnosis.

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It's of course very difficult to draw conclusions, but the contemporary thought of a colo-vesicle fistula is not a bad thought. This can cause gas a stool to pass in the urine.

This is one of the letters I actually had in mind when I talked about how interesting old journals are to read in their entirety, rather than just seeking out specific articles. And I have no idea what the poor lady was suffering from. We should ask Orac if it could be Morgellons.

Did the patients consume quantities of greens which might cause an excess of oxalic acid? Possibly other, or in combination with other, minerals common in urine. Which might variously crystallize as either a softer or harder substance according to dilution level.

Strands, pure speculation, are a result of blood, released as the crystals damage tissue, gelling in contact with the mineral present. Excreted protein, in contact with the mineral, possible pH, might also be threadlike.

That's my WAG and I'm sticking with it. Until some better explanation comes along.

My guess is renal aspergillosis?

It's extremely uncommon, but a fungal ball in the kidney might produce the sort of fuzzy/hairy growths that are described here. Crystallization on the growths (as described in the second piece) could be explained by uric or oxalic acid deposition on the fungal mycelia. However, while the "suspcious masses" passed in renal aspergillosis might look something like the "coralline growths" described in the first one, I'm at a loss for what might produce long hairs without much pain.

-- ACS

On reflection, renal aspergillosis seems like it covers all the bases. All the case studies I've just read are in diabetic or immunocompromised patients. Peripheral neuropathy secondary to adult-onset diabetes could explain the limb weakness, foot pain, and renal aspergillosis.

-- ACS

Also, don't look at that first picture (it's of a cardiac fungal ball) unless you're prepared to be looking at pathology photos.

-- ACS

Okay: yes, I know this is my fourth post in a row. But I've been thinking about this overnight, and I think that "coralline" might be a reasonable description of the fungal conidia in the mycelial network, assuming that the "hairs" are cast-off bits of a renal fungal ball. The only problem is that (AFAIK), aspergilium's conidia are distinctive and not at all "coralline" (they're ball-shaped). So it's probably some sort of fungal infection, but probably not (?) aspergilium itself.

Here's a picture of the relevant bit:

-- ACS

Wow, that's great (and disgusting). After reading through the case study of renal aspergillosis I agree that it seems to fit. The only trouble is that the description in Philsophical Transactions was not of a soft mass, as in the case study, but hair-like material that was described as "stiff and ropy." Could uric or oxalic acid deposition on the fungal mycelia explain that?

I don't think so? I'm not entirely certain. My impression of kidney stones is that they have a tendency to be sort of crumbly or sandy; however, not having poked at them myself, I'm not sure. More likely, mycelia matted with blood, pus, or mucus might come out as ropy or sticky.

re: the shape of the strands, my first thought was that there was a biofilm inside her kidneys, or that her ureters were somehow shedding their linings, creating casts that mirrored their shape. If the fungal mat wasn't destructively expanding into the remainder of the kidney, you could end up with ropy strands shaped as 'casts' of the interior of the ureter.

This is all just speculation, at this point, thoguh.

could renal casts be passes whole? usually these are microscopic though...however it if was some form of renal crystal formation as the gentleman from Bath may have been then changing urine pH through liquid or diet intake can potentially have helped him if that then dissolved said crystals...

By Anonymous (not verified) on 21 Feb 2010 #permalink

Maybe some sort of tumor - a bladder papilloma or teratoid tumor?

Passage of tumor masses in the urine has been reported.
[Lakhkar BB, Bhaskaranand N. Tumor masses in urine in Wilms tumor. Indian Pediatr. 1996,33(1):71.]
In this case, a 5 year old boy with Wilms tumor voided masses that were described as "grayish white worm-like structures". Wilms tumors can have hair (teratoid Wilms tumors).

Okay, it's a stretch.

By Anonymous (not verified) on 24 Feb 2010 #permalink

I'd put my money on an ovarian dermoid cyst invading the bladder.

"Patients with spontaneous rupture of a dermoid cyst into the bladder may present with
complaints such as pilimiction (passage of hair in urine), pyuria, hematuria or passage of
other material from a dermoid cyst. Pilimiction, however, is pathognomic." (see first link below)

see also: