Notes on Biliary and Intestinal Sand

Physician to the Bristol General Hospital. I have recently attended two patients both of whom passed gallstones , and both of whom noticed a quantity of fine gritty sand in their stools for several days and even weeks during the time that the stones were passing. The stones were of the ordinary type, facetted, varying in size from a hemp seed to a pea, and composed almost entirely of cholesterin. I learnt that several table-spoonfuls of sand were passed in one case, but much less in the other. There was no pain or other special symptom attending its passage. The clinical history is briefly as follows:? Dr. A. is a medical man of middle age, engaged in active practice, and has always enjoyed good health. In October, 1909, he had an attack of biliary colic, which lasted an hour or two, and was accompanied by vomiting. In December another attack came on one Sunday evening while he was at church, and a slight one followed on the Tuesday. In January the colic returned with slight jaundice, vomiting and some pyrexia, and in February a final attack, after which three calculi the size of a pea and others smaller were passed. The calculi were somewhat soft, and broke when handled. During this last attack the sand was noticed sinking slowly to the bottom when the stools were mixed with water. It disappeared about a week after the last stone was found. There has never been any colitis, and the bowels have always been regular with a slight tendency to looseness .