“A clue in a labyrinth:” The medico-chemistry of the stone in the life of Edward Darrell Smith

Biography of Smith

Edward Darrell Smith was born in Charleston, South Carolina, in either July of 1775 or July of 1778. ²⁶ He received his early education in Philadelphia and Charleston, then entered the College of New Jersey (Princeton University) at age 14 and graduated valedictorian of his class. He went on to earn his master's degree there as well. ²⁷ After Princeton, Smith returned to Charleston to apprentice under Drs. David Ramsay and William Stevens Smith, then studied for a doctorate of medicine at the University of Pennsylvania Department of Medicine. Letters from Smith indicate that he studied under the physician-botanist Benjamin Smith Barton.

After Smith graduated from medical school in 1800, he returned to Charleston and married Sarah Tucker North in 1802. He practiced medicine with Steven and Joseph Ramsay and ran a hospital for sick slaves with Dr. John Parker Gough. ²⁸ In 1801, Smith composed a letter concerning a case of hydrocele to a Dr. Miller. ²⁹ The cause of a Charleston patient’s suffering turned out to be a urinary stone, and the case was Smith’s first attempt as a young physician to map out hints or useful signs that other physicians could utilize to identify suffering of a stone. Between 1807 and 1811, Edward D. Smith traveled to the newly settled upcountry of the state to practice farming in the Pendleton District. ³⁰ Smith still practiced medicine when called, and most of the medical cases Smith later published occurred in Pendleton. ³¹ During this period of time, Smith saw some horrific cases of urinary stones.

The state government of South Carolina had established South Carolina College in 1801. Maximilian LaBorde, a 19th-century historian of South Carolina College, wrote that Edward Smith was considered exceptionally qualified to teach there 11 years later because of his medical training. ³²

As a chemistry professor, he attempted to introduce students to the latest chemical theories. Smith educated students in the subjects of electricity, chemistry, hydrostatics, magnetism, and pneumatics. ³³ His name continually appeared in the records of the college encouraging the Trustees to maintain, repair, and buy the latest chemical equipment from Philadelphia and “northern cities,” devices like gasometers, galvanic batteries, and pneumatic pumps. Smith seems to have had both positive and negative relationships with the legislature of the state in regards to his performance as a professor, but it approved his requests for chemical lab space and equipment. Still, Benjamin Silliman, famous chemist working at Yale, received complaints from Smith about his frustrations with the legislature and the quality of scientific life in the South. ³⁴

During the summer recess of July of 1819, Smith left Columbia for the western part of America. Smith was part of a company that had purchased some land near the Missouri territory. ²⁷ In one of his letters to Benjamin Silliman, Smith was deciding between two trips—one to the north and this one, to the west. It seemed that Smith chose the latter because of his desire to move to the Missouri territory in order to improve his health, most notably his stone troubles. He was hoping, too, to escape frustrations with the state of South Carolina:

I have even contemplated a final residence in that country, in the course of two or three years, on the grounds, that my health is injured by a sedentary life, our institution not being conducted in a manner that I can relish, & an ardent desire to escape from a State, so debased by Slavery, as ours is. ³⁵

Unfortunately, Smith died from bilious fever at a friend’s house in Missouri in 1819. ³⁶ Though Smith is a historical character with few biographical sources, we can retrace his intellectual biography through his writings throughout his life. These reveal the links he perceived between chemistry and humoral pathology.

Humoral pathology in Smith’s education and early writings

Smith published his Inaugural Dissertation: Being an Attempt to Prove that Certain Substances are Conveyed, Unchanged, Into the Circulation; Or, If Changed, that They are Recomposed and Regain Their Active Properties in 1800 in Philadelphia. ³⁷ The dissertation was Smith’s first attempt to revive humoral theory using rational physiological and chemical arguments, proposing that humoral theory might be useful in treating urinary stones. Smith also included a lot of commentary using the most well-known medical thinkers of his day.

In his introduction, Smith reflected on the history of medicine. He argued that, “During the reign of Humoral Pathology, the opinion, that substances were conveyed unchanged into the circulation, was necessarily adopted by the supporters of that doctrine.” At the time, most physicians believed that “disease was seated in the fluids of the human body, and those medicines were valuable in proportion to their power of correcting or altering the vitiated fluids.” As time passed, physicians decided that humoral theory was “not founded upon sufficient grounds” because it did not explain how medicines worked in the body. Smith perceived of the philosophical rejection of humoral theory happening for two reasons: the first was that no active substance (medication) was ever discovered in any part of the circulation, and there were never any active substances found in the stomach; the second was that fluids, including milk, were easily “assimilated to the blood” when consumed. When milk was injected into live animals, it killed them. However, milk applied externally has no effect, and when consumed, philosophers believed that all of the noxious parts were rejected in the “chylopoetic” viscera, allowing only the most nutritious parts of the fluid to remain and pass into the sanguiferous system, or blood.

Smith pointed out that philosophers rejected humoral theory based on sympathy. He conceded that sympathy “… exists between certain parts of the body; but it also seems probable, that this sympathy has had too great a latitude; and that certain circumstances are referred to it, which are more easily explained on other principles.” In Smith's professional opinion, humoral theory was rejected for philosophically unsound reasons.

In order to counter the first argument he cited, the idea that substances are not found to exist in their active states in the body, Smith reviewed several unchanged substances found in the body’s fluids–chyle, milk, saliva, urine, blood, and perspiration–and the “solid parts of the body[,]” including the bones. He framed his inquiry regarding the absorption of active substances in the body as of a “speculative nature” but of interest to the “practical physician.” ³⁸ He argued that if substances applied externally could be conveyed unchanged into and through the body, then medicines could be administered to a diseased system that could not be reached other ways, especially if the patient could not take internal medicines. At the same time, harmful substances may also be introduced to a system in ways that had not been considered, such as the absorption of lead through external handling or through a child's consumption of contaminated breast milk. Smith explained:

In attention to diet in a nurse, is often the unsuspected cause of distressing complaints in the suckling child. Active medicines, taken into the circulating fluids of a nurse, will affect the child in an alarming manner. Instances of this kind are not rare. If by the collection of facts on this subject, any hints may be given, which may lead to the discovery of a solvent of urinary or biliary calculi, it would be of essential service to mankind. ³⁹

Smith cited authorities from Percival to Boerhaave in order to provide intellectual weight to his arguments. One work of note was Lectures on Materia Medica, by Benjamin Smith Barton, one of Smith’s teachers at Penn. ⁴⁰ Smith cited Barton’s work with turpentine, a diuretic that reproduces the effects of “stranguary, diabetes &c.,” when applied on the surface of the body or taken internally. Smith recorded turpentine's travels through the body and bladder, including its appearance in the urine of anatomists who had washed their hands with the “spirits of Turpentine” after dealing with dead bodies. ⁴¹

Smith focused on urine in particular because so many substances found unchanged in it could be identified by their “… colour, taste, and smell, or imbue[d] it with their peculiar properties.” For example, he pointed out that the “extract of longwood” turns urine a “bloody hue.” ⁴² He argued that the fact that substances exist in the urine unchanged is obvious, citing the odorous effects of olives and asparagus. Smith also described “lithontriptic” foods–those with stone-destroying properties–such as garlic and uva ursi (bearberry). Smith argued that garlic travels through the body unchanged to attack stones at their source, as does uva ursi, the acid liquor of which “… attacks human calculi, diminishes them and soften the parts which it cannot dissolve.”

Carbonate of soda, a stone remedy popularized by Joseph Priestley, was useful in alleviating the symptoms of stones because “fixed air” was lithontriptic. Priestley would use this fixed air in his invention of soda water, which would later become a remedy for urinary stones. ⁴³

Highlighting soda’s effectiveness, Smith wrote that soda was “… equally efficacious in alleviating the distressing symptoms of nephritis, and causing large quantities of gravel to pass off by urine.” During the time that Smith was writing his dissertation, there was still a debate about whether fixed air actually traveled unchanged through the bladder, and Smith cited several authorities who had attempted to prove that it did. ⁴⁴ When Joseph Priestley analyzed urine samples from persons taking carbonate of soda, one fifth of them contained fixed air. ⁴⁵ Smith noted Priestley’s hypothesis that “Drinking water containing this air may impregnate the urine with it, and make it more efficacious in dissolving calcareous matters than it would otherwise be.” The work of Mathew Dobson showed that waters “impregnated” with fixed air could dissolve stones. Stones also dissolved after being soaked in the urine of people who drank water containing fixed air, and Sydenham speculated that beers and malt liquors could ease the pain from stones. Smith concluded from these authorities that fixed air must be “conveyed unchanged” through the urine.

One person who disagreed with Smith was Erasmus Darwin. Smith attempted to engage Darwin in an argument, writing, “It is, however, denied, by a celebrated and ingenious writer, that active substances are conveyed through the course of the circulation in the bladder.” Darwin argued, according to Smith, that the “lymphatic vessels” were directly “communicating” with the intestinal “absorbents,” and through a “retrograde action” led to direct passage into the bladder. The phenomenon best exemplified by Darwin’s hypothesis was diabetes. Because of the large amount of urine produced by sufferers of diabetes, which was beyond what physicians thought the kidneys secreted, they thought that urine must pass directly into the bladder by some other type of canal. Smith pointed out another example that supported Darwin’s hypothesis: the passing of mineral water so quickly through the body, which, he claimed, indicated that it must pass directly from the stomach to the ureters. Unfortunately, Smith dodged the opportunity to refute Darwin’s counterexample or further engage, writing, “The limits of this essay will not allow a fuller investigation of the doctrine of the retrograde motion of the absorbent vessels; and the more especially as it is not strictly connected with the present subject of inquiry.” In contextualizing and measuring his own work, Smith strove to encourage the research of others. He concluded his dissertation with the hope that he had inspired “some future enterprising genius” who would continue and expand upon his work.

Medico-chemistry and case studies

Smith published his first case history while he was practicing medicine in Charleston, South Carolina. Smith’s case concerned a 34-year-old man known only as “Captain W.” ²⁹ He is described as having “… a robust constitution, and florid complexion, was attacked with intermitting fever in the latter end of March.” The captain had previously suffered from irregular “paroxysms” that he had attempted to treat himself, and he reported a total block of urination but remembered expelling something while urinating. The expulsion cut his urethra, producing blood; his scrotum began to “tumify;” and the urine output diminished.

The Captain came to see Dr. Stevens, with whom Smith was acquainted. The patient had a fever and dysury, but the swelling was not significant. Dr. Stevens administered diuretics and mercury without success. ⁴⁶ The Captain also had a “quick” pulse, had not urinated in 48 h, and had a scrotum that was very inflamed and swollen to the “size of a man’s head.” Stevens administered cathartics to the patient without success and invited Smith to see him. Smith wrote,

Upon examining the parts, we found that in the most depending operation of the scrotum, on the left side of the raphe, a gangrenous spot, of the size of a dollar, had made its appearance, although not visible in the morning. In this spot a lancet was introduced to a considerable depth, and the puncture enlarged afterwards, without the patient’s being at all sensible of the wound. ⁴⁷

Drs. Stevens and Smith consulted with Dr. David Ramsay after the patient discharged large amounts of putrid fluids. The three physicians decided to give the patient medicine in the form of bark (presumably Jesuit’s bark) for his scrotum and “solutions of sacch. saturini,” or lead acetate, applied to the inflamed parts. ⁴⁸ These remedies seemed to work: the gangrenous area on the Captain’s scrotum healed, the areas around the scrotum were no longer inflamed, and the penis returned to a normal size.

Smith finished the case study with an attempt to explain what had brought on the Captain’s condition. First, Smith surveyed illnesses that could have possibly been the cause: “… venereal affection, hydropic, diathesis, hernia, &c.” He felt strongly that only one illness could have made such an opening in the scrotum: a calculus. He noted that the patient had “gravel symptoms” but had never passed any of those gravel particles out. The patient experienced blocked urination for a couple of days. A violent expulsion was further evidence of a calculus. Finally, Smith argued that the Captain had been experiencing a stone as there were no further problems with gravel or urinating after the conclusion of the case.

One case involved a woman living in the Pendleton district in 1808. ⁴⁹ The case, entitled “A Case of Dysuria,” appeared in 1820 in The Philadelphia Journal of the Medical and Physical Sciences and concerned a woman Smith visited who could not urinate and had two years' history of difficult urination. Other physicians had visited the woman, but none had provided her any relief. In Smith’s published case histories, he provided his readers with vivid descriptions of patients' pain, appearance, and ability to pass fluids. In describing the woman in this case, he noted that she had deteriorated from a “stout and healthy appearance to a feeble and declining state: she had borne several children, but none since the commencement of her present complaint, nor could she assign any particular circumstance as giving origin to her malady.” ⁵⁰

The emphasis on description is one common in practicing humoral medicine. Philosopher and philologist Michel Foucault argued that at that time,

This new structure [of medical practice] is indicated—but not, of course, exhausted—by the minute but decisive change, whereby the question: “What is the matter with you?”, with which the eighteenth-century dialogue between doctor and patient began (a dialogue possessing its own grammar and style), was replaced by that other question: “Where does it hurt?”, in which we recognize the operation of the clinic and the principle of its entire discourse. ⁵¹

Smith’s “A Case of Dysuria” illustrated heroic treatment coupled with humoral medicine. In the proto-professional world in which Smith practiced medicine, it was better to kill his patient through well-intended effort than to let her die from inaction. ⁵² It is clear from the way that Smith framed his narrative that he immediately took action on the woman in question.

Smith administered “cathartic medicine” to ease her pain and common diuretics in an attempt to restore urine flow. ⁵³ These measures were ineffective. Next, Smith wanted to place a small bougie into the woman to allow for urination and perform an “ocular examination,” but the patient refused this, and he respected her wishes. Before Smith left, he administered more palliative measures to the patient and did not see her again for several weeks. The patient returned to an excruciating state, and Smith looked to the next course of treatment,

Apprehending that there might be some mechanical obstruction, such as a small calculus in the urethra, which might require removal, I directed the patient to be laid upon a table as in the operation for the stone, and passing the fore finger of the left hand up the vagina, I introduced at the same time the end of a small probe into the orifice of the urethra. The probe stopped about midway of the canal, but the resistance to its passage did not indicate the obstruction to be caused by a solid body. ⁵⁴

Smith continued to engage in heroic action. He recorded that the probe could not continue through the woman’s vagina until he inserted his finger, which helped him insert the probe into the bladder. At the turn of the 19th century, it was believed that a woman had a longer urethra than a man and often did not require a lithotomy. Physicians believed that to cure a woman of the stone, the physician was better off retrieving the stone manually than with surgery. ⁵⁵

After Smith inserted his finger, regular urine flow returned. He inserted a thick bougie to continue to drain her urine. After Smith dilated the women’s urethra, he noticed that “fleshy excrescences” appeared which were similar to swelling. ⁵³ He used mechanical compression to treat the swelling. ⁵⁶ Lastly, Smith attached a smooth cane reed to the bladder to continue to drain the urine. Smith concluded that a stone had indeed been the cause of the problem, and with his finger pushing dislodging the “solid body.” He thought that the woman’s body returned to balance, because her pain was relieved, and the woman was pregnant again within a year. He published the case in order to supply a “useful hint to other practitioners” ⁵⁷ Publishing case histories was important to physicians like Smith because they aspired to make medicine more scientific. ⁵⁸ Smith considered case histories to be part of a scientific body of knowledge, just like the chemistry he read.

Published in the same volume as “A Case of Dysuria” was the case referenced in the introduction to this article, “A Case of Calculus in the Urethra of a Child Five Years Old.” ¹ The boy’s problems began shortly after his birth, but recently the urination had stopped altogether; he continued to experience fevers and “extreme agony.” Smith wrote that no previous physicians could do any good for the child, perhaps to highlight the heroic character of his own medical practice.

The narrative included a robust description of the child’s condition: “… a small hole was formed in the urinary canal, near to the anus, from which orifice the urine flowed out, and an abatement of the symptoms immediately took place.” The hole described to Smith by the boy’s father grabbed Smith’s attention. The father described all other parts of the boy’s body as damaged. As in the previous case, Smith began to hypothesize. He speculated that a stone had traveled from the bladder to the urethra and was wedged there, preventing urination, and that there was a fistulous orifice behind the blockage described that allowed the urine to escape the body. The father brought his child to see Smith two weeks later.

When the child arrived in Pendleton, Smith confirmed his hypothesis. He found that, “… [t]here was a fistulous opening in the perinaeum, within a few lines of the verge of the anus; and I remarked that air seemed to come occasionally through this opening, which caused me to apprehend that there might be a communication betwixt the rectum and the bladder.” Smith probed the child’s orifice as he did in “Case of Dysuria.” He was convinced there was a stone. Smith observed that the child’s scrotum was distended and concluded that it was due to a build-up of urine.

As a humoral physician, Smith wanted to return the fluids of the body back to a normal state, which would mean removing the blockage. Since the time of Hippocrates, the cause of ill health had been believed to be rooted in a blockage of the flow of the body’s fluids. Other physicians, like Thomas Cooper, argued that despite new theories about disease originating in the solid parts of the body, it was the fluids that truly caused disease. Cooper had mentioned Smith’s work as confirming that idea in one of his published lectures. ⁵⁹

In the case of the child, Smith used a lance to create an opening, which contained pus and “blood water.” Smith then applied “Saturine applications.” ⁶⁰ The inflammation and pus subsided, allowing Smith to continue the operation. He next put his probe into the incision in order to enlarge the opening to remove the stone. With forceps, Smith extracted the stone he had anticipated while the patient admirably “tolerated” the pain. He estimated the stone size equivalent to two drachms, or about the size of a hazelnut.

Smith checked on the patient two days after the operation. The child was without fever, but there was a new “communication” between the rectum and the bladder, allowing feces to flow through the wound made in the scrotum. Smith applied compression on the perineum and told the patient to follow an “abstemious diet.” Two days later, the patient no longer had feces passing through the bladder, and he had urine coming out “the natural passage.” At a check-up six weeks after that, Smith judged the child well. Smith interpreted his intervention effective because the child “… was become a stout and ruddy boy, able both to walk and run, which he never could do before.”

Smith had taken drastic heroic action, and, as a result, he successfully returned the flow of bodily fluids to normal. Chemistry was another tool for the heroic physician to use to adjust the fluids of the body. ⁶¹ By the end of his career, there was a noticeable transition in Smith's practice from an emphasis on treating stones to one of trying to diagnose and prevent them utilizing chemistry, probably motivated by the traumatic cases of stones he witnessed in Charleston and Pendleton.

Smith and medico-chemistry at South Carolina College

Smith continued his chemical work and its medical applications. Smith was trying to rationalize a qualitative theory of medicine—humoral theory—while running a lab that embraced and engaged in debates that regarded seriously the new chemistry that focused on intensive quantification of any fluids found in nature. He wanted to navigate Lavoisier’s notion of chemistry within a neo-Galenic worldview. The Royal Institution (RI) in Great Britain published a letter from Smith in the Halifax Nova Scotia Weekly Chronicle on 15 June 1819: “On the Use of Prussic Acid in Consumptive Cases.” ⁶² Smith was working with his friend, Dr. James Davis, examining the effects of prussic acid on consumption.

A sense of professional obligation inspired Smith to publish his letter, in which Smith admitted that he had stepped away from medical practice to focus on chemistry: “I am new debarred from any regular exercise of the profession, and therefore have not the opportunity of making much experimental investigation of medical subjects.” ⁶³ But he had periodically practiced medicine while at South Carolina College; Dr. Davis acknowledged Smith’s temporary return to medicine during the outbreak of croup in Columbia during the winter of 1815–1816. ⁶⁴

Smith was inspired to try prussic acid against consumption after reading the work of a Dr. Majendie of Paris, a physician who also wrote about urinary stones. ⁶⁵ Felix Louis L’Herminier, an immigrant from the French Caribbean living in Charleston, manufactured the prussic acid for Smith. ⁶⁶ When the supply he received from L’Herminier ran out, Smith manufactured more on his own using the methods found in Thomas Thomson’s System of Chemistry. ⁶⁷

Prussic acid was a very tricky chemical remedy. Describing its dangerous nature, Smith, in his article, commented that, “As to the nature of this substance, it is a most virulent poison, and in this respect you will recongise its analogy to some of our most effectual remedies.” ⁶⁸ Citing the work of the turn-of-the-19th-century authority on poisons, Mathieu Orfila, Smith referred his reader to Orfila’s work on “poisonous qualities, the symptoms, &c ….” ⁶⁹

In treating consumptive cases, Smith prescribed three drops of prussic acid for adults, taken with water, over the course of 24 h. The patient could increase the dosage to 8 to 10 drops, but no one had ever taken a dose larger than 10 drops. After two months, eight or nine cases, all except for one severe case, recovered. As for the case that did not recover, “… the distressing cough, copious expectoration, and wasting hectic were for weeks kept at bay, and the patient so much re-animated as to induce a hope of recovery; but this finally proved delusive.” ⁷⁰ Smith added that the acid had worked as a palliative and had not caused any injuries. The complications that did emerge in patients were stricture sensation in the breast, blood emerging from the lungs, and some effects on the brain, which were relieved after discontinuation of the acid.

Smith used chemical analysis to engage in the new chemistry of intense quantification while furthering his knowledge of the body’s fluids. In July of 1818, he traveled to the head of the French Broad River in North Carolina, where the Mineral Springs of Buncombe were located, in order to study the supposedly healing waters there. ⁷¹ Smith recorded temperature readings and offered some thoughts about the effects of the water on diseases caused by imbalances of the fluids of the body. He recommended that no one with “pulmonic” or “dropsical afflictions” should use the springs. ⁷² Dropsy is the buildup of fluids in cavities, or the “connective tissue of the body,” and pulmonic disease is a disease of the lungs. ⁷³ Given Smith’s humoral background, he cautioned sufferers of these diseases against bathing in the springs because of the risk to their constitutions from the rise in body temperature. Physicians speculated that the constitution of the human body was often affected by climate, temperature, and water, a theory Hippocrates mentioned in his “Airs, Waters, Places.” ⁷⁴

Smith also used qualitative methods in analyzing the springs; he described the water as limpid, with bubbles continuing to the surface, and the taste of the water as “insipid” and hot. ⁷⁵ The water lacked a distinctive smell. Around the springs, there was an unpleasant smell, especially in water that was stagnating or near vegetable matter. Smith carefully added chemicals, like sulphuric and nitric acids and “Sirup” of violets, to the water and recorded the reactions that took place. Since Smith had seen bubbles in the spring water, he tested limewater against common water to determine if fixed air was present in the sample. Smith attempted the experiment multiple times, seemingly confirming the idea that there was carbonic acid in the water. ⁷⁶ He was looking for fixed air in order to explain the assumption that the spring waters contained health benefits, especially for those patients suffering from stones.

According to an unnamed gentleman, the water had a “brisk cathartic effect for a day or two, and after that produced no sensible result.” ⁷⁷ The water could possibly have provided relief for “rheumatism, palsy, or loss of motion from other causes.” ⁷⁸ The spring water represented an exciting possibility for Smith, as he hoped the water could free blocked bodily fluids and return circulation to normal. Smith thought of the body as a hydraulic system, functioning properly when its humors were unobstructed.

Medico-chemistry and the stone

Smith's final article is his most significant and sophisticated. “On the Application of the Medico-Chemistry to Calculous Affections” was published in 1821, approximately two years after his death. ⁷⁹ It included a note of explanation:

This is the last communication for this Journal with which the editor was favoured by the respectable and estimable author of this memoir; it was transmitted a little before his death, but it has not been convenient to publish it before. ⁸⁰

The article emphasized striking new developments in chemistry's effect on living systems, as opposed to just dead matter. Smith explained that,

Although it must be confessed that a rash enthusiasm may have unwisely attempted to explain the mysteries of some Phenomena, that are observed in the living system, by the analogy of the results of the action of chemical agents upon dead matter, it must be granted that there are cases, in which the useful application of chemical knowledge is conspicuous. ⁸¹

As he had in his dissertation, Smith compiled information from authorities like Scheele and William Hyde Wollaston and then incorporated his own experiences. Smith cited the work of a Mr. Brande, a chemist-apothecary, and a Dr. Wollaston, a physician-chemist. ⁸² These two men, like Smith, were interested in using chemistry to treat and understand stones produced in the body. ⁸³ Their work, he wrote, had led to:

… a light that is very cheering to the friends of science and humanity. We are now enabled to take a clear and satisfactory view of timidly groping in the blind paths of empiricism, we may walk boldly upon the highway of correct principles. This is the sure road, and if we are careful not to deviate from it, must gradually conduct us towards the attainment of our object. ⁸⁴

Smith saw the treatment of urinary stones guided not solely by the experiences of a given physician but by general chemical principles. The Edinburgh Review was highlighted in the article because its editors promoted the search for solvents to cure the stone as “… one of the noblest problems in practical chemistry, and among the best services that science could render to the healing art.”

Citing the failure of eminent physician Joseph Black, Smith hypothesized that humanity would never find a solvent to treat urinary stones in a living system. Chemistry had never produced a remedy for the stone, but chemists had produced a means of preventing the stone. William Brande and Sir Everard Home were two chemists making progress in that area. They had found that stones were not all the same and that identifying a stone's composition helped determine the correct “preventive remedy.”

Smith posited that urine analysis is where chemistry “… is of signal benefit and affords us a clue in a labyrinth, that would otherwise be impervious.” Close analysis of patient urine gives off “premonitory symptoms of threatening dangers,” which if responded to could lead to the prevention of the stone. Smith and other physicians believed that urine was made up of acids and alkalis, and in a healthy state, the ratios (“combinations”) are uniform, while disease, causing symptoms such as stones, occurs when there is an “undue predominance of acid or alkaline matter,” a theory that resembles the interpretation of humors.

Chemical analysis provided the means of determining which ratio was out of balance, thus advising the physician as to the course of treatment. Disease most often occurred when there was too much uric acid in the urine. Neutral salts countered excess acid in the body, and the acids that escaped the salt ended up in the bladder. When excess acid had the potential to cause the patient problems, there were signs in the urine: irritation of the patient’s urinary passages or small sand-like crystals in the urine. When there were excessive alkaline salts, white sand appeared in the urine. Knowing how to identify problems allowed physicians to stop the stone at its “germ.” ⁸⁵ Smith was making strong arguments for humoral theory in the hope that the identification of imbalances in the urine would lead to the prevention of stones from forming in the first place.

Smith returned to the work of Erasmus Darwin that he had briefly explored in his dissertation. Although he did not know whether there was a “communication” between the bladder and the stomach through some type of “retrograde action of the absorbents,” he believed that substances that entered into the stomach could have effects on the urine. Because of that connection, he theorized, the stomach could be where chemists and physicians could manipulate the balance of acids.

A calculus complaint required a physician’s judgment in determining the nature of the stone. If the physician was ignorant, he could aggravate the patient’s suffering and even harm him. Smith cautioned,

To this difference in the constitution of calculous matter it is owing that both the strong and the weak acids have sometimes been used with eminent benefit; and yet the indiscriminate prescription of acids would frequently produce the most serious injury.

Smith even warned against the fashion of drinking soda water to increase health, as experiments had shown that soda increased the speed of deposited phosphates in the body, leading to stones.

After examining the literature, Smith suggested magnesia in cases “which need alkaline remedies.” In those cases in which there was already a lack of acid, Smith recommended using the “the carbonated alkalies” because they would prevent phosphate from building up in the bladder; however, this treatment would not work well in the stomach. The editor, Benjamin Silliman, here added the correction, “We presume that the writer intended to restrict this remark to the uric-acid, for it is notorious that the carbonate &c. neutralize and remove acids in the stomach.”

Smith then went on to cite empirical cases, most notably his own self-treatment. Though Smith remonstrated against a physician needing experience to treat the stone, he privileged his own experience because it confirmed his chemical ideas. Recounting an experience in 1817, Smith turned himself into a character in his article. He first gave a history of the stone forming and its potential causes. He recounted that he lived in a “sedentary manner,” closely confined in a “new brick building” (possibly the new chemistry building at South Carolina College) which was neither “well ventilated nor warmed.” He had “paroxysms,” but he treated himself with wine, which removed his symptoms. He also had “violent, flatulent cholic” with “frequent shooting and lancinating pains down the right thigh urethra, &c.” Smith self-administered enemas and “embrocations” (lotions). ⁸⁶ Exposure to the cold seems to have exacerbated his symptoms. After consulting a fellow physician in Columbia, the physician thought that Smith’s fluids were in a state of “acrimony,” and if he did not solve his fluid problem, it would surely result in a urinary stone. In the article, Smith sought the chance to call for the revival of humoral theory. He argued that the return of humoral pathology could demystify the phenomena of the stone, as even his own stone seemed to be caused by troublesome, “acrimonious” fluids. Humoral theory, according to Smith, might have been given up too quickly:

The extravagance of theorists, in almost any department of science, has sometimes carried them so far beyond the bounds of rational induction, as to involve in one common condemnation both truth and error; and this perhaps, has been the fate of the Humoral Pathology. Very lately this subject has been ably treated by Professor Cooper, of Philadelphia in his ingenious discourse upon the connection of chemistry with medicine, and in which it has been plainly shewn that the application of chemical science throw much light upon the reprobated doctrine. ⁸⁷

Smith referred back to his work in his dissertation concerning substances conveyed unchanged in the body’s circulation. The unfolding of Smith’s theory was that humoral pathology was important to understanding how substances could travel through the body, which could be useful to the physician in manipulating acidic and alkaline fluids to prevent the stone. Through empirical and close chemical analysis, Smith attempted to merge the new chemistry with the old humoral pathology, just as he had been doing his entire career.

Smith argued that chemistry is useful and crucial to the physician’s healing art but that the physician must be careful about which chemical interventions to use. Doctors needed to know chemistry, as it was through chemistry that physicians could perceive changes occurring in the body and the potential formation of stones. The “progress of medical science,” he emphasized, must focus on the judicious selection of alkaline remedies. A transatlantic conversation also developed between Smith and Alexander Marcet focused on how to use chemistry to treat illnesses, especially those involving stones. Marcet was a Genevan physician who immigrated to Britain after imprisonment as a political prisoner during the Napoleonic wars. ⁸⁸ Marcet, like Smith, had turned away from medical practice to investigate chemistry full-time. In 1817, he published much of his clinical and chemical observations in An Essay on the Chemical History and Medical Treatment of Calculous Disorders. ⁸⁹ The essay explained why different types of stones formed, what populations were affected, treatments, and recommendations for chemical analysis of stones. Smith was able to comment on Marcet’s work based on a review he had read. ⁹⁰

Smith was particularly interested in Marcet’s work on analyzing the ages, sex, and location of calculus suffers. Smith commented that, according to Marcet, women suffered from stones comparatively less often than men. He presented the idea that women suffered less frequently than men do because they were more restrained in diet but at the same time that they should suffer more from the stone because they live more sedentary lives than men. Smith was skeptical that any anatomical differences could account for the “disproportion” of male suffers of the stone compared to women. ⁹¹

Smith concluded with speculation on other precursors to stones. Climate might influence the living systems that produced calculous material. He reflected that stones are rare in countries that are very hot or very cold. Diet or sedentary lifestyle might influence calculous productions. Finally, he proposed that chemicals that modify fluids could also be useful in preventing stones, but further research would be necessary.

Conclusion

Returning to the case that opened this article, Smith was able to remove the stone by the use of forceps and bring the child back to health. After the events of 1811, Smith saw the child again, and he was as a “stout and ruddy boy.” ⁹² The case was a prime example of Smith’s use of humoral theory in medical practice. Smith knew that the child's bodily fluid (urine) was blocked, and Smith removed the blockage to return the child back to proper health. Humoral theory had ceased to be an effective medical theory, but it was still useful in the medical practice of physicians like Smith at the turn of the 19th century.

New advances in chemistry, starting in the late 18th century with the so-called chemical revolution, allowed physicians like Smith and others to argue for the usefulness of humoral theory, emphasizing the fact that the analytical precision of chemical theory could improve medical understanding of the body’s fluids. Physicians could analyze urine and other fluids on the chemical level and explain formerly unanswerable questions related to humoral theory, like how drugs work in the body. Smith further linked chemical analysis with humoral medical practice when he applied chemical analysis to so-called “healing waters.” If physicians could analyze nature and its proven remedies chemically, he believed, they might gain further medical insights.

Smith saw the new chemistry as improving medical practice. Involving more chemical analysis in medical practice made medicine into more of a science and prevented it from relying too much on empiricism. With changes in chemistry at the turn of the 19th century, Edward Darrell Smith and other medico-chemists reintegrated humoral theory into medical practice.