Elementary Bodies are mixed so that a simple unmixt Body is not to be found The Air wherein we live and which we breath is full of little Bodies separated from different Substances and contributes to our Health and Sickness If then one breath a thick and gross Air if he drink thick and rough Wines that are not fine muddy Waters of Lakes into which several Brooks empty themselves or such as Petrifie other Bodies or Snow-water which contain matters that being frequently drank may lessen the motion of the Humours if he eat a great deal of unleavened Bread Water-fowl Curds Pap Old Cheese hard Eggs stony Fruits that are tart and not fully Ripe as Quinces Medlars Pears if he feed on Beer Pork or the Legs and Feet of Animals Eels Salt and Spiced Meats or if he frequently make use of Medicines which cause the more subtile parts to transpire as Sudorificks and Diureticks If he bestir himself too violently at any time and especially after eating The long use or the excess of these things will be the cause of the Stone as likewise too much idleness and sleeping too long upon the back because the Earthy parts of gross Food may meet together in several places and disturbing one another stop the passage If those who take the greatest care of their Health are not exempted from Living on Food which contains slimy parts as strong Broths what may we think must befall them who to excess eat and drink indifferently of all things or indeed but to Moderation since our Victuals participate of a Terrestrial Matter mingled with a kind of Salt and Chymistry teaches us that in the Body of Man there are some Juices which dissolve and liquifie our Food and others again that thicken it whence it may be concluded that if the one of these Liquors by mingling with our Food renders it fluid but then being confusedly hurried away and conveyed by streighter passages it may be that the same Liquor does escape and more easily glide away than the Nourishment that is retained in and does Nourish the part or even destroy it according to the proportion or disproportion of the Humours which in general may be called Alimentary It is much the same if a Terrestrial Juice remain with the Food after Chylification for being circulated through all the parts of the Body if it transpire not it will clog and obstruct and many parts of the same Nature joyning together will there produce a Stone CHAP. IV. Of the Consequences that are drawn from the foregoing Chapter and how the Stone is defined THE Blood is carried to all the parts of the Body but if its motion be more rapid than is usual it may distend the Capsules and Ureters and make some drops of Blood fall into the Bladder or other gross Particles mingled with the Urine which will then be red bricky and gravelly People do not always make water so soon as the Serosity is separated from the mass of Blood If there be a small Stone in the Kidney it may ulcerate it It descends towards the head of the Ureter and when it is rough or of an excessive bigness in respect of the narrowness of the passage it stops it or by the impulse and force of the Urine that follows making a great dilatation it opens a passage for it self unto the very Bladder the patient in the mean time suffering most violent Nephritick Colicks which sometimes are the cause of his Death On the contrary every soft part having a peculiar sense of feeling if the Kidneys have no exquisite feeling and the Urine or small Stones have by little and little dilated their passages the Glandules will separate and retain but a very small matter all that was contained with the Blood will pass through and as through a Seive several sorts of grain may pass after that the holes are enlarged so Gravel and little Stones may be conveighed into the Bladder with the Urine and the Patient hardly feel any pain or trouble It is to no purpose to alleadge that the dryness or close Union of the parts that compose the Kidneys does contribute to the forming of the Stone because in the Dead Bodies of those that have been troubled with the Stone it is to be observed that the Kidneys are moyst and soft and it is certain that in living Bodies they are continually moistened with some Liquor And besides it cannot be said that their Bladder is narrow and dry although Stones are more frequently formed there than in any other part of the Body It is unjust to accuse our Parents to make us bear more patiently the pains we suffer because in every body the causes of the Stone may be sufficiently evinced without imputing them to those to whom we owe our life and without blaming of them reason may be given why we see Children subject to the Stone whose Fathers and Mothers enjoy perfect health We are to conclude that Age and Excesses render the parts weak whose Fibres being relaxated give occasion to obstructions in Old People as well as in Children because the abundance of humidity slackens the motion and the earthy slimy and superfluous matters that are not evacuated occasion several diseases as well as the Stone Many distempers are bred according to the diversity of the food that one takes Thus a man shall be afflicted with the Stone if he feed on course food and which may easily coagulate in the Body There are not wanting sad instances of this persons of different Ages Sexes and conditions are subject to it and most of those who are troubled with the Stone and who are to be seen in the Hospitals of Paris come from the Country where most part of their food is terrestrial and course and many little Children who live in that manner are cut there Stones are formed in all the parts of the Body and according to their dimensions that which stops the passage takes the name of Sand Gravel or Stone experience confirms this for Stones are found in the Lungs the Liver the Gall the Spleen the Kidneys c. Paraeus lib. 25. Chap. 15. reports that he took one out of a mans Knee Some are found in the Heart those which are found in the Nerves are by Paulus Aegynaeta named nodosae nervorum concretiones knotty concretions of the Nerves It is likewise observed that Stony crusts are formed about the Teeth I know a man that above twenty years ago voided one by the Navel it was of the bigness of an Olive Stone and the man is still alive Stones are bred most frequently in the Kidneys and Bladder because these parts are appointed for separating and containing the serosity which always carries along with it an earthy Sediment that accompanies the Urine and the Stones of the Kidneys and Bladder give greater pains to the Patient because they stop the emission of Urine or irritate the parts whose use is frequent and the sense more exquisite than that of many others
that have the Colick and then they vomit more Pituitous and Corrupt Matter than those that have the Stone They are more bound and break no wind neither upwards nor downwards The Colick seems often to move and take up more place and sometimes it encreases in diverse parts but the Stone Colick torments in the same place without intermission And though pain that afflicts a place higher than the scituation of the Kidneys be always produced by the Colick yet it does not follow that that which is fixed in the region of the Kidneys is an evident sign of the Stone that scituation signifies nothing at all to distinguish it because with these marks the Urine must also be examined Those that are subject to the Stone in the beginning render a clear and pure Urine and in the following days something troubled is to be observed which subsides to the bottom and at length it becomes all Sandy and Gravelly which happens not to those who being free from the Stone are tormented with the Colick because if they render any gross excrements one would say that there were Flatuosity in them and many times they swim on the top of the water being of a Consistency like to the Urine of an Ox. Moreover these great pains of the Colick are much sooner eased by laxative Glisters than if they proceeded from the Stone It happens sometimes that the Colick ceases by the voiding of some cold humor and then it is a remedy that not only eases but cures and discovers the desease In a word as the one is cured by voiding of cold Humors so the other is delivered from their distemper by voiding the Stone with the Urine and at the same time we may know what part suffers We have said that the Matter of Stones are all kinds of Slimy and Terrestrial Substances linked together according to the Proportion of more or less that forms a hard Body That Stones forced against the side of the Bladder cause pain Inflammation Ulcers and make one void Purulent matter in the same Manner as the Acrimony of Humors of Urine and Abscesses Little Stones may come out with the Urine Sometimes they stop in the Sphincter or Vrethra they hurt the nerves of the neck of the Bladder which terminate in the circle or crown that is the beginning of the Glans they may in like manner if they be bigg lay upon and press the Intestinum rectum and cause an extraordinary weight because these parts are only appointed by nature to bear the burden of liquid things which are less ponderous than the Stone When they have Asperities or are covered with a coat they are detained in the wrinckles of the Bladder Now if they be very light and without adherence they float a long time in the water but because of that weight they have they descend towards the Vrethra and the smaller they are in bigness or the less unequal in their Surface the more they close the passage because the small Stones slide easily into the Vrethra and the Urine may run down between the Asperities of the Stone That Obstruction hinders the passage of the Urine and obliges the Patients to lye upon their backs they hastily and with violence turn themselves to make the Stone change its scituation that so they may facilitate the excretion of the Urine and because pain makes the Spirits move towards the neighbouring parts these are so distended that Men and young Boys are fain to draw out the Yard and Prepuce to appease the pain and therefore they cross their Legs and press their Thighs together Moreover if the Stone change its place a little clear Urine or mingled with slime comes out According to the same principles it may stop the passage which obliges those that are subject to the Stone to have often a desire to make water They are commonly dry because the Spirits and Humors are dissipated and spent by labour pain and watching By these observations we may judge that there are several Diagnostick signs which are equivocal as the Yard and Prepuce drawn out by the hands of the Patient tormented with Inslammation pain and voiding of Purulent matter by sharpness of Urine and gravel because Sandy matter or little Stones having caused their symptoms may be evacuated with the Urine nevertheless when that hath a sediment mingled with Sand and thick Slime when there is any shell of a Stone within or squeezed out of the Yard it is a pregnant presumption which commonly serves for a certain sign The univocal Diagnostick signs may be drawn from the same observations as a sudden and fixed pain in the loins towards the one or the other side and sometime towards both in the region of the Kidneys after which the Urine looks reddish and Sandy or sometimes Crude Clear and Watry a numness of the Thigh on that side where the pain is when the Stone is bigg There is a Flitting and restless Itching towards the Pubis and in the end of the Yard accompanied with a frequent and sudden suppression of Urine a pain and heaviness in the Perinenm with a continual heat of Urine and immediately after the making of water a fresh desire to do it again It may be observed why there are such violent strainings for a stool and why the Urine stops all of a sudden when one is standing which happens not in another posture One of the surest of all the Diagnostick signs is the thrusting of the finger into the Rectum of Men. The Chirurgion will feel a hard body betwixt his finger and the Pubis or a little higher If the finger be not long enough they make use of a hollow Probe called a Catheter which is introduced through the Vrethra into the Bladder And then is felt something that is hard making a dry sound and noise as if one touched a Stone this is the most certain of all Diagnostick signs It is very necessary to make an Experiment of this in dead Bodies by opening the Bladder and putting Stones therein and then having stitched up the Parts to introduce the Catheter by the Yard The Catheters that are made use of to know if Women have the Stone are of another Figure they shall be represented with those of the other Instruments When the Stone is skinned over by a peculiar Membrane or when it is formed betwixt the Membranes of the Bladder or that there be an old excrescencie of flesh called a Sarcoma which are rare Distempers or if there be a fungous Body it is not easy to discern it because the Symptoms of these Diseases in those Parts are much alike but the Stone is much more frequent there and one is not often mistaken provided he be attentive in sounding or searching What we have said of the external Causes of the Shapes and Figures serves us for Signs to foretell the plurality of Stones on which we see the markes of Collision when during the time of the Cure a Stone is taken out
if they be shut close when they are in the Bladder because it is wrinkled and the sides of its Body or Bottom may be laid hold on without the Stone or with it The Symptoms that follow the Operation in the Cure by Lithotomy are a painful tension of the Belly the retention of Urine Watchings Inflammation in the parts affected Looseness Diarrhaea Worms Ecchymoses Fluxions Abscesses Excoriations Itchings and Putrifaction Ulcers in the Scrotum and the Neighbouring parts Ulcers and Putrifaction of the parts of the Bladder to great or too long Suppurations voiding of Purulent matter by the wound or with the Urine by the Yard Feavers universal or particular Consumptions or Marasmus's Hemorrhages as in the time of Operation Syncope's Convulsions Vomitings Lightheadedness or Deliriums and Shiverings The painful tension of the Belly is caused by an inflammation that attracts a Fluxion because the Ligaments which suspend the Bladder and the other parts to which it adheres have suffered violence The Feaver and Restlesness proceed from the Intemperies of the chief parts agitated by the passions of the mind And the Hemorrhage from the Incision or Erosion of the Vessels The retention of Urine is occasioned by coagulated Blood or the inflamation of the parts during suppuration or by some little Stone fallen down from the Kidneys or a fragment remaining after the Operation The inflammation comes from a circulat motion of the Humours the Scourings looseness of the Belly and Worms in Children through the abundance of Phlegme the Ecchimasis is an effect of extravasated Blood the Abscess is produced by a collection and continuance of Humours in the interstices of the parts the too great and too long suppuration by the quantity of the matter whereof the Abscess is formed or by the Ulcerated Kidneys and by the liquefaction of the Humors of the whole Body of which part do suppurate whilst the rest are dispersed by Transpiration or Looseness which causes at the same time a Marasmus or extenuation of the whole Body The Ulcer of the Bladder is caused by contusion and suppuration of its parts which excites the running of Purulent matter by the Yard or Wound Fungous carnosities by a superfluity of ill concocted and too serous Blood the Itching and excoriation are the effects of the sharpness of Urine or of too strait bandage the Putrifaction of the Ulcer comes from the corruption of the Humors and of the Air or from the too great humidity of Medicines and the Virulence from the Acrimony of the Humors and Medicaments The Vomiting happens after the Operation because many nervous Fibres of the sixth pair are distributed and inserted into the Ventricle There are other accidents occasioned by the distribution of the Nerves which pass through the holes of the Os sacrum common to the Sphincters of the Bladder and Anus which have been bruised or lacerated by the Forcipes or by the asperities of a great Stone especially when the Operation hath been hard and laborious The Fainting or Syncope is occasioned by a great Flux of Blood and the dissipation of the Spirits The Convulsion happens by Vomitings the Diarrhea Hemorrhage which hinder the Nerves from receiving a sufficient quantity of Spirits The Delirium and Light-headedness Superveens when there has been so great a dissipation of the Animal Spirits that the Brain retains not enough for it self and for supplying the whole Body with a quantity sufficient for performing the functions of its several parts In a word Fate puts and end to all these accidents by destroying the Machine that is to say by abolishing of Motion at the instant when the Soul is separated from the Body If any be surprized that we have spoken nothing of Pain they ought to consider that that is a Symptome or rather an essential property of all diseases of the parts that are capable of feeling since it always happens where there is an Intemperies with a solution of continuity of the soft parts and by consequence it is more sensible in Lithotomy than all the other accidents that we have been speaking of These Symptoms have their causes their Diagnostick and Prognostick signs some are the cause and the signs of others and all the Symptoms in general are caused by Pain Fear Hemorrhage Contusion and Dilaceration of the parts The Prognosticks are taken from the time the violence and the state of the subject in which the accidents happen The Symptoms that appear at first are not so dangerous and those which last long or happen in a Cacochymick Body are more to be feared An Operator who is expert in performing the Operation will avoid many concomitant Symptoms There are some nimbleblades who have the knack of feigning that they have extracted a Stone and convey one though they have found none The Symptoms that follow the Operation are either by themselves apart or many together according to their Nature corrected by various Medicins The first care is to asswage Pain by Imbrocations and Fomentations a Hemorrhageis sometimes to be feared and therefore astringent topicks are to be employed for preserving the treasure of life The loss of Blood ceases commonly through the weakness of the Patient because the Medicins that are applied to this part are dissolved by the Urine and besides no other bandage but the contentive can be used when in other parts one may put his Finger upon the Orifice or opening of the Vessel or cut it in two apply to it a Button a Ligature Pledgets and Compresses It is commonly observed that the first dressing be kept on for the space of Twenty four Hours at most it is tenderly to be taken off leaving a Pledget upon the place out of which the Blood does Issue if it can be known and if the Hemorrhage recurr recourse is had to astringents CHAP. XIX Of the Method of curing those that are Cut and removing their Symptoms WE come insensibly to the cure by Lithotomy the method of which is either general or particular Having spoken of the Causes Kinds Signs and Prognosticks of the Symptoms it is now proper to give you a notion of those things which ought to be observed from the time of the Operation until the perfect cure of the Patient By that means we may treat in particular of the remedies against accident since they happen whilst the Patient is in the Chirurgeons hands By the general cure by Lithotomy we understand that wherein no Symptoms happen which are of the Nature of a cause And by the particular cure that which is attended by troublesome accidents such as cause the methods to be changed of each of these we shall speak apart Supposing that the Chirurgeon hath succesfully performed his Operation he must dress the Wound and endeavour by the help of Medicines to cure it The first thing that is to be observed after the Operation whilst he that is cut is still in posture and that with all expedition he is a clearing of the Ligatures if any have
for Men to use it a right the Girdle is to be put about the Patients Body and one end of it being carried within the Collar and both ends tied one of the ends of the Tail of the T. is to be taken betwixt the Thighs and making it pass obliquely upon the dressing it is tied to the Girdle in the opposite side to that from whence it is taken the same is to be done to the other end fastening them together by a kind of a knot called the Mariners knot having a care not to stop up the passage of the Anus Fainting Convulsion and Vomiting go often hand in hand together but the last appears more frequently than the others it is remedied by Wine and by cordial Potions made of Treacle the Confection of Hyacinth Alkermes Coral prepared Pearle Powder of Vipers Syrup of Pomegranats in Balm Water and Scorzonera Water Carduus benedictus and Woodforell c. according to the various indications these Medicines and the Dose of them are to be chosen and determined according to the advice of a Physician giving them at first in a small quantity often renewed because of the debility of the Stomach When the Vomiting is stopt the Convulsion ceases and the fainting is cured by succulent nutriment such as good Gellies strong Broths new laid Eggs which strengthen the Patient if they stay with him the reason is evident because inanition is the cause of these two Symptoms and the Animal Spirits being but in a small quantity prick the Nerves which contract and draw towards their Origination The Wound does sometimes foul and by too great suppuration according to Guy of Chauliac it is observed to degenerate into a sordid Ulcer and most commonly virulent because of the Acrimony of the Urine and irritated Humours that grow mordicant and biting These kinds of Ulcers are never without Inflammation Itching and Excoriation of the part for such accidents we are to make use of diverting restraining and local Medicines applied according to the Temperament of the part and the counsel of the same Author in the Chapter of Wounds with Hemorrhage When many Symptoms appear together the same Rule is to be observed and to have regard to the order the urgency and the cause and especially to that which is most urgent amongst other things carefully observing the effects of topical Medicines wherein Chirurgery does most consist For curing of Diliriums and Light-headedness strong broths are given minced meat made with Veal Pullets Partridges cut small and put into an earthen then Pot glazed without water well luted and digested in Balneo Mariae hearty food that is full of good Juyce and of easie Concoction for speedy repairing of the inanition and tempering the Animal Spirits the truth is a Dilirium with cold in the Extremities are of such affinity one with another that they may be put into the same rank and a Dilirium after Lithotomy is as it were the last degree of the Disease the strugling of Nature and the forerunner of Death CHAP. XX. Of the Ischuria or suppression of Vrine THE Bladder is a Membranous part that may be distended and enlarged by the quantity of matter contained therein and when it is full or stimulated that which is within opens the Sphincter that it may make to it self a passage into the Vrethra When all things are in a natural state Man suffers no inconveniency because the things contained within are in due time evacuated but congealed Blood or coagulated Pus condensed Seed a Stone a Fungous Body gross Humours or Phlegm with Sand one or more of the inferiour Vertebraes Luxated hardened Excrements a Child dead in the Mothers Womb a Carnosity or Callosity sometimes stop the Sphincter of the Bladder or a place of the Vrethra it is the same when a Viscous Humour causes a Numness of the Bladder or when a Patient is in a dull and drouzie fit which is occasioned by a diversion of sensation an extasie in the Brain or a convulsion of the Nerve which goes from the Os sacrum to the Sphincter of the Bladder and by Malignant Feavers Besides those causes of suppression of Urine which we have reckoned up we are to take notice of the shrinking or flagging of the Vrethra to which Old Men are subject the Compression of the Neck of the Bladder caused by the falling down or inflammation of the Matrix or the Prostates and Parastates the internal Hemorrhoide Veins or by a great quantity of Urine which distends the Fibres of the Bladder as is related by Pareus L. XVII of a Young Man who having kept his Urine too long fell into a suppression though he had no Stone and was cured by the Catheter Fabrit Hild. says L. de Lith Chap. 3. Col. I. that that excellent Mathematician Tycho-brahe being in a great assembly at Prague where being forced to keep his water very long he fell into so violent a Suppression that he could not be cured but died of it The retention of Urine from what cause soever it proceed produces a violent Pain and insupportable inflammation in all the Neighbouring parts of the Bladder from whence a suppression is occasioned because the Urine is not voided and that it is continually augmented in quantity In that case Patients are all over in a heat their eyes look red their face burning have an Oppression Restlesness Feaver a hard painful and very large Swelling above the Pubis bilious Vomitings and all these troublesome Symptoms reduce them to such a state that without speedy help they expect nothing but death The Chirurgeon will know that it is a clot of Blood that is the cause of the Suppression if the Patient hath been lately Wounded in the Kidneys or hath pissed Blood if an Ulcer in the Kidneys has preceded and the Patient hath made Purulent water he may conjecture that a collection of thick and viscous Pus is the cause of it if the signs of the Stone have appeared he is to acquaint the by-standers with it he may discern it from a Fungus by the Catheter unless the Stone be wrapped in a Coat he may know if it be a Carnosity or Callosity by means of the Catheter or a searing Candle I say nothing of the Patients manner of living whose excesses may have been the cause of sharp Humours or a great inflammation nor shall I neither speak of other causes which manifest themselves Now if many causes of Suppression joyn together the diversity of Symptoms will serve for a sign to make the Prognostick by The Patient cannot for many days endure a Suppression without being much weakened and in danger When it is caused by a falling down of the Matrix there is no more to be done but to reduce that part when the Hemorrhoides press the Neck of the Bladder they must be opened with a Lancet or Leeches the Numness of the Bladder is remedied by a grain of Salt or Nitre put into the passage of the Urine or with a composition
A TREATISE OF Lithotomy OR Of the Extraction of the Stone out of the Bladder Written in French by Mr. Tolet Lithotomist in the Hospital of the Charity at Paris Translated into English by A. Lovell LONDON Printed by H. H. for William Cademan at the Popes Head in the Lower-walk of the New-Exchange in the Strand M.DC.LXXXIII To the Ingenious and Expert Chirurgeon Mr. Tho. Hobbs Lithotomist in the Hospital of St. Bartholomew in London SIR I Confess it is but a weak Apology for my Confidence in prefixing your Name to this Book to tell you that I can more easily satisfie the World than your self in making this Dedication though indeed it be all that I have to say for my self for this Trouble I give you The truth is Sir since most Books now adays do court what but a few deserve I mean Protection as I would not be singular in Publishing this Translation without a Patron so I durst not be so unjust to the intrinsick value of the Treatise as to send it into the English World no other ways provided than with the Credentials of a specious recommendation to the train of some great Man who perhaps after all would not admit it into his Family without your Approbation It was therefore in imitation of the Ingenious Author of this Book who gave me a Precedent for Dedication that following the guidance of Universal and therefore least erring Fame I was led to your Door there to leave this Foreign Child which I have taught to speak I hope intelligible English to be by you disposed of in the World according as you shall think it deserves as you are pleased to give it a Character If it may be able to serve those that serve you in that Famous Hospital where you successfully Operate or prove Useful to any that profess Lithotomy that laudable but difficult and dangerous part of Chirurgery you are in the judgment of most men the fittest Judge so that the Publick I make no doubt will justifie my Conduct in submitting it to your Censure But Sir how you your self will Interpret this attempt of mine I dare not affirm seeing Fortune hath not encouraged me to it by intitling me to those freedoms that mutual Conversation long Friendship do allow However Sir I will not despair but that the kind Acceptance my endeavours shall meet with in the World will so far interceed for me that what is intended and really found to conduce to Publick Good will not be thought by you to want any private Motives to commend it to your Patronage I shall say no more lest by seeming to know you better than indeed I do I should spoil my own Plea and appear to be an Intimate Friend when in reality I am Sir Your Humble Servant A. Lovell London Sept. 23. 1682. A TREATISE OF Lithotomy OR Of the Extraction of the Stone out of the Bladder CHAP. I. What is meant by Lithotomy LIthotomy according to the Etymology of the word signifies Cutting of the Stone It had been a more proper way of speaking to have used a term that might have expressed the part which is opened by the edge of the Instrument because the division or cutting of the Stone happens contrary to the intention of the Artist however I shall make use of the word Lithotomy which is in vogue and understood by all that are skilful in the Profession That we may dive into the meaning and give the definition of the thing it is an Operation in Chirurgery practised for the Extracting of Preter-natural hard Bodies which are retained in the Bladder By Preter-natural Bodies is to be understood all things that are retained within the Body of Man contrary to the ordinary course of Nature And seeing sometimes there are several things in the Bladder which require the opening of it we have put in the definition Preter-natural Bodies rather than the Stone and for clearer distinctions sake we have subjoyned that Lithotomy is only practised for such as are hard and retained in the Bladder CHAP. II. Observations upon the Parts of the Body of Man THE Vessels and Pores of the Glandules are the usual Conduits through which the Corpuscules or little Bodies pass and are filtrated when their bigness and figure makes them fit to be received there but if there be no proportion betwixt the Conduit-pipes and the Liquors which should pass through them they stop On the contrary if the Humours have a very rapid motion they distend the passages and many times break them Whatever the impulse of the Humours may be their motion abates the more that they communicate it they make no sensible attempt to get out when they are moved on every side in a place that can stretch and be enlarged to a certain bigness as the Bladder and the Basons of the Kidneys But when the place wherein they are contained is full if they be not evacuated they are the causes of several Diseases for the Humours consisting of parts of different figure or bigness it follows that sometimes they cannot glide through one and the same passage It is true that Bodies of the like or different extent may pass through one and the same Channel the contrary is not impossible and may give a beginning to those Tumors which swelling outwardly higher than the surface of the Body go by the Name of Abscesses after the same manner as the internal collections have other appellations And if the same Humours be composed of unequal parts and meet together in a narrow place that is full of windings some of them joyn together and by their conjunction form a Body that in respect of the rest is solid This Body by its continuance there and the apposition of other Corpuscules becomes more sensible to us it hardens according as the rough parts closely embrace one another and the other separate and continue their motion After the same manner as it is in Brooks and Rivulets where the small stones separate and retain the Mud so is it in the Glandules through which the Humours are filtrated And in the Pipes where Water runs in great quantity though they be streight Earth and other Sandy substances mingled with the Water cleave close and stick together and there form a stony Crust which in time hinders the passage of the Waters CHAP. III. Of the Causes of the Stone OUR Food liquified is not destroyed and the diversity of Aliments makes it apparent that they have parts different in Bigness Figure and Number the most Nourishing as Jellies and strong Broths have all these qualities seeing the Juices of Animals which are the basis of them are taken from the soft and hard parts of the Bodies with which they were assimilated or being still within the Vessels and amongst the Glandules tended to that assimilation or from those Bodies that were to be retained or voided by Physicians called Retenta or Excreta Other kinds of Food contain also parts of a different Nature because
In a word we may conclude that the Stone is a preternatural hard body begotten of the terrestrial and slimy parts of our Food We have put in the definition the word slimy to distinguish it from Viscous because Viscous things do not harden in a place where there is moderate heat and humidity but such as are slimy like the White of an Egg by little and little grow hard and incorporate with the earthy parts they contain when they have long continued in luke-warm Liquors This proposition may be confirmed by the experience of those who render an Oyly and Fat Urine and who are not troubled with the Stone and because unctuous and viscous Medicins such as Turpentine give ease to those that are afflicted with Gravel Moreover clear and slimy Urine is reckoned among the signs of the Stone in the Bladder Authors are divided about the deciding of the question whether or not the Stone be a disease if all their reasons be considered it may take the name of a disease as well as that of a cause CHAP. V. How Stones are formed and grow in the Bladder THere needs no more but a grain of Sand or any hard Body to serve for a Center or Foundation for monstrous Stones which cause terror in those that behold them and most frequently death to those from whom they are taken The Sand and other things that are mingled with the Urine sometimes are not wholly voided out their continuance within gives time to what remains to gather together in some place and after that one hath made Water if there be still in the Bladder a little sand and slimy substance like the white of an Egg preternatural heat and the separation and evacuation of the humidity make them joyn together in the same manner as the Saline and Tartarous parts of Wine and the Urine of those that are troubled with Gravel which distills into the Bladder being mingled with other Terrestrial parts furnishes matter that joyning with that which remained there before forms and augments the Stone Experience informs us that Stones are sometimes found which are in a manner like a mixture of Sand with the Whites of Eggs having so little Solidity that one cannot avoid the breaking of them betwixt the Teeth of the Forceps If a little Sand may be the Center or Kernel of the biggest Stones a hard body got into the Bladder and remaining there may likewise be as we have seen in an Italian Souldier who to ease himself of a pain that he felt thrust into his Yard the Tag of a Point about Two Inches long which slipt into his Bladder and there continued Eight Months In the Spring of the year 1677 he came to the Hospital of the Charity at Paris where without much minding the relation he gave of his condition I was assured by the catheter that he had a Stone in the Bladder he was cut and the Iron Tag taken out about which a Stone was formed that hindred not but that it might be seen in several parts Parêus lib. 25. chap. 15. Reports a like case Fabritius Hildanus L. de Lith c. 3. col 2. writes that one of Geneva having for the space of Twenty Eight years complained of the Stone at length died and that he was found to have a Stone the Kernel of which was a Leaden Bullet petrified which he had received by a Musket-shot and retained all that while Joseph Covillart Obs VII of his operations assures us that he had seen a Stone the Center whereof was a Musket Bullet which a Gentleman had received in the Bladder Five years before he was cut of it I had in cure a young man who had been cut at the Age of Four years Old and who was troubled with a Fistula since that time he had discharged Urine unto the Scrotum where by degrees a Stone was formed about the bigness of a little Pullets Egg ending in a point like the Stalke of a Pear It cannot be determined how long time the Stone is in forming and growing that depends upon the conjunction of the parts of the Sand and the sudden and quick secretion that is made of it in the Bladder besides it may be the Stone continues at a certain Size because new Corpuscles do not always cleave and stick to it I know one that hath had one for several years seated in the beginning of the Perineum near the Scrotum without any sign of dilatation or sense of Pain The growth of Stones in the Bladder happens not without alteration of that part which becomes weaker according as the Stone increases This remark affords us a reason why the Bladder of those that are troubled with the Stone is thicker than naturally it should be which is only caused by the debility of the part because not being able to send back the superfluous part of the Blood it swells therewith as the womb in Women when they are with Child and the parts where there hath been a Fracture a great Contusion or a Wound and in the same manner as by Suppuration or the Transpiration of Wounds Fractures and Contusions or the Evacuations that happen after a Woman is brought to bed the parts return to their natural thickness so the Bladder being discharged of the burden that incommoded it and besides assisted by Medicins and a regular Diet is restored again to its former state Bev. c. 4. de Cal. Ren. Vesic CHAP. VI. Of the differences of Stones THE most considerable difference in Stones is in respect of their magnitude The least Stones of Children of Three Four or Five Years Old are like great Pease or of the bigness of Cherries Those of Seven Nine Twelve to Fifteen Years Old have them a little bigger In men grown up who are of Middle age and in Old men to the last period of life Stones are found of the bigness of a Hens Egg. I pretend not to determine the exact Size of the Stones of every Age there is no rule for it and it is sufficient to remark what is commonly observed for sometimes smaller Stones are cut from Children and Men and at other times some of such a bigness that with relation to the subject they are called Monstrous The thing contained gives sometimes the Figure to that which environs it but Stones rather take than give it The Bladder the Urine or the Pressure and Justling of other Bodies are the causes of many differences do not we see that water hollows Rocks though it fall drop by drop It may be observed when the Stone is formed by minute Bodies that have Angles the Urine or the Salt of it blunts the points of them and the wet Sand not having firmness enough lyes slat by the sides of the Bladder when there is little Urine in it and forms a flat and smooth Stone approaching to the Oval Figure of the Cavity of the place but if the minute Bodies of the Stones are Round they Roll in the Bladder from one
the length of the bending of that Catheter and the smalness of the Bladder the Operator continued to search the Stone which not being felt was found with another Catheter whose bill from the beginning of the bending was not so long and therefore that Catheter turned easily in the Bladder This observation instructs us what Catheters are to be chosen for voiding of Urine whose bill ought not to be so long as those that serve for making of the incision and which are Channelled or Furrowed There are some Men who have very narrow Vrethra's which require small Catheter like those for Children and of a sufficient length Catheters that do not easily bend or bow are likewise to be chosen and that depends on the Work of the Artist that makes them When the Stone is in the Neck of the Bladder it is not necessary that the Catheter should be introduced so far as the bottom of it because the Stone may be felt provided the Catheter be onely introduced as far as the bottom of the Vrethra When there is a Carnosity which hinders the Catheter to slide into the Bladder the Operator must put a finger into the rectum and if there be a Stone he will find a hard and ponderous Body towards the Pubis if there be a great inflammation it is the opinion of Fernelius that no search should be made in that case one should observe to search gently and seldome because otherways it may be the cause of pain inflammation excoriation a gangrenous Ulcer in the Sphincter nay and even a Supression of Urine or a peircing of the Vrethra Besides these Diseases one cannot sometimes search because of a Phymosis and of a Stone in the Vrethra something must be said as to that as much as is necessary to be known upon the account of Lithotomy CHAP. X. Of a Phymosis and of the Stone in the Urethra MAny Children have a Phymosis to search them we must hold the Yard betwixt the little finger and the ring finger the back of the hand being towards the Belly and with the other fingers pull back the Prepuce as if one intended to skin the Glans the thumb on one side and the fore-finger and middle-finger on the other gentlely pressing with these three fingers towards that part of the Nut or Balanus where one Judges the end of the Glans to be seated that by that means the Orifice of the Vrethra may be the more dilated then the Catheter is to be entroduced gentely searching for the perforation of the Glans one may know that he is in the Vrethra if the Catheter enter easily and by feeling with the fingers of the other hand along the Vrethra on the under side of the Yard If the Prepuce be so strait that the Catheter cannot be introduced or if one cannot hit upon the Orifice of the Vrethra there is no danger to dilate a little the Prepuce sideways with the point of a common Bistori or a pair of sharp Cissars Observe that before the introducing of the Catheter it will be fit to squeeze the yard with the fingers along the Vrethra and so to try if one do not feel some hard Body which stops the passage as Carnosities or Stones When it is a Stone the Catheter is to be drawn out and if before searching it was known to be a Stone and that it stuck in the middle of the Yard between the Glans and the Testicles there is no searching but having onely pressed the Yard with the fingers from the Pubis to the Stone the Operator shall take a Curette or Extractor oyled and having introduced it by little and little and passed it beyond the Stone he may therewith draw it out of the Vrethra The Curette or Extractor is like an ear-picker made of Steele because it is less apt to bend than if it were made of another Metal the Operator must have of them of several sizes in bigness four or five inches long the figure of it you may see in the lower end of the second plate of Instrments The extremitiy of the Vrethra may be dilated in the upper part of the Glans when stones are extracted with the Curette and when being brought as far as the Orifice they cannot pass without pain The Urine serves for a Remedy and if there hath been a Contusion and Pain it is enough to foment the Yard with the oyl of Roses and cover the Nut or Balanus with a little pledget dipped in the liniment of Arceus dissolved with a little mel rasatum moderately expressed out with the Nucial or Cross bandage open in the middle and the band with three heads to wrap it up in and it is not to be forgot if there be need for it to put a girdle about the Child to which the band may be tied nay and a Collar hanging about the neck like a Chairmans Strap the lower part of which is to be fastned to the girdles that it may not sink lower than one would have it That Bandage serves for other Distempers of the Yard begininng to apply it upon the Glans and then bringing it nearer to the Belly with slight coulings and circumvolutions to keep the Medicine fast to the part and near to the Pubis an indifferent hard knot is to be cast then the two heads at the other extremitie of the Band or Truss are to be â—ied to the girdle The precise length and breadth of all the parts of that bandage cannot be determined because it depends upon the Judgment of the Chirurgeon to make them so long and so narrow as that they be not Cumbersome There is still another way of extracting the Stone out of the Yard when it is at a distance from the Sphincter of the Bladder And that is this having drawn back the skin of the Praepuce as much as one can towards the Nut of the Yard Ligature is made betwixt the Stone and the Pubis or otherways one may with the fingers compress the Yard and the â—kin be fore and behind the place where the Stone is observed to stick and afterward make Incision upon the Stone a little side-ways in the Vrethra that so the Stone may be taken out by means of the Curette or Extractor introduced into the Orifice of the Incision the Ligature being removed and the Skin losened the Incision stops and is cured by the Balsom of the Urine without other Medicine If one be unwilling to make Incision in the Vrethra or if the Stone cannot be got out with the Extractor it will be fit to give Diuretick Medicins to force it forwards to the Glans thereby to facilitate its Extraction CHAP. XI Of the time of Searching and Cutting of the Instruments of the patients Diet and of the first Preparation A Patient may at any time be searched or probed to make him render his Water and to discover the Disease if one find himself extreamly troubled with the Stone cutting is not to be delayed without danger
but since some diseases requires a speedy Operation we shall not speak of the time which is called the time of necessity but onely of that of Election which is laid hold of when the distemper is in such a Condition as to give opportunity to do things in order and without precipitation The Spring is the most temperate season of the Year wherein Vitriol the father of all Productions gives verdure to Plants and contributes to the vigour and strength which men find renewing in themselves at that time then do men undertake what was interrupted by the excessive cold or heat of other seasons that in the Atumne they may enjoy the fruit of their past labours With great reason then men choose the Spring time for many Operations and amongst others for Lithotomy In this Conutry we must expect till the impression of the Winter cold and the frequent Rains be over Though the Spring begins on the eleaventh of March nevertheless according to the temper of the Air the Operation of the Stone is accelerated or retarded but commonly it is performed in the Month of May Next to the Spring the Autumne is to be preferred before the other seasons Though Liquors and Menstruums for dissolving of Stones were in use yet must we of necessity speak of the Remedies of Chirurgery which are Instruments of Iron or other Metalls proper for Lithotomy Take here their figures and the names of their parts 1. A Rasor to shave off the hair from the privy parts 2. Common Cizars for ordinary Incisions 3. A Hollow sound or probe called a Catheter for searching of men and making them render their Water and its Stilet or Wire to cleanse it 4. A Catheter or Staffe for making Incision in men furrowed in the back from A. which is the bill or bec to the place marked B. without any cavity in its length page 56 page 56 1 2 3 4 5 6 7 8 9 10 11 6. A Streight Catheter or Staffe and hollowed or furrowed from the bill to the place marked C. which is sometimes made use of for making Incision at the Orifice of the Vretha of Women It is requisite to have always in the Catheter case a part a little piece of a Spunge moderately moistened with Salad-Oyle because sometimes it may be wanting when there is need of it to anoint the Catheters 7. A Bistori that opens like a Lancet with a point and edge like the same onely the point blunter at the head whereof there is a flat tayle to keep it firm against the handle when it is opened 8. A Languette or roller to mount the Bistori it is slit at the end a finger broad and a foot and half long 9. A Bistori mounted that is to say armed with the Languette or Roller 10. Conductors or Probes whereof a pair serves for the Operation that which is next to the Bistori mounted is forked and the other has a line in the length of its cavity for guiding and conducting the former Nevertheless that alone which is remotest from the Bistori may be used for conducting the forceps or tenette 11. Another kind of Conductor composed of the two above described it turns with an elbow about the midle and has a Spring betwixt the branches near the rings it was invented by Joseph Covellart 1. Another kind of Conductor called in French a Gorgeret more commodious and more in use It is hollow tapers and grows narrower at the end where there is a bill that is introduced into the furrowing of the Catheter whilst it is held by the other end shaped like a T. There are some who doe not approve of this Conductor saying that it dilates the parts too much and that it occasions Fistula's but without ground for it is narrower than the forceps which is drawen out with the Stone and possesses more room and the Fistula is onely occasioned by the consequences of the Operation as shall be explained in its proper Place 2. Sreight and crooked Forcipes or Tenettes A. their Teeth B. their Branches C. their Rings 3. A Dilatatory for Men. It is named a Compound or great Dilatatory D. the bill or bec of the Dilatatory E. the handle 4. A simple Dilatatory for Women The extremities of it are blunt and very small the Branches are joyned in such a manner that closing the one end the other opens It represents the letter X. 5. Another Dilatatory that may serve for Women and little Boys It hath a spring near the handle and can dilate but moderatly It may be used when one fears that some Fibres have been left in time of the Incision 6. A Hook or Crochet to pull out the Stones that are in the Passage either in the lesser Operation or otherways some cause them to be made with little Teeth in the cavity of its bending but there is no necessity for it 7. A Button a Scoope About ten Inches long and as big as a quill F. the part properly called the Button G. the body of the Button H. the other end which is hollow called the Curette or Scoop of the Button I. a slight line to conduct the Forceps 8. A hollow Tent Pipe or Canula having rings at one end called the Head the other end is called the Point where there are two holes called the eyes of the Tent. 9. A Languette or Fillet for mounting the hollow Tent introducing it into the Slit and putting the two ends of the Fillet through the rings of the Tent then it is called a Tent mounted That Fillet or Languette is to be two foot long and a finger broad page 62 1 2 3 4 5 6 7 8 9 10 11 12 13 11. An Extractor or Curette for extracting Stones out of the Yard 1. A Chair used in the Hospital of the Charity at Paris on which the Patient is set for the more commodious performing of the Operation There are behind two bars or rods of Iron in form of Butteresses they are hooked that so they may enter into the rings of the Chair and sharp at the end to stick firmer in the Floor because the Patient struggles and uses violence in the time of the Operation The Chair should be placed a little obliquely for the light to come upon the right hand of the Chirurgeon that he may see the better when he is about his Operation Instead of that Chair the Patient may be seated upon the side of a Bed or on a Table with a Mattress or Quilt whereof one part covers the back of a common Chair reversed about half a foot distant from the edge of a Table in a sloaping manner That Chair is to be made fast with many strong cords if there be no Matteress or Quilt it will be sufficient to lay a Pillow or any other thing to make the place soft and a folded Sheet over it 2. A Sheet folded length-ways with many folds to cover the Chair that hath been described or the Matteress in the time of Operation
Bed then lay upon the Tent a thick Pledget covered with Astringent a little Plaister another moderate Compress and over that the Triangular Plaister covered likewise with Astringent and another Compress still upon the Plaister a Truss to bear up the Cods and the Frond or double T. with the Thigh-band as hath been described The bandage that is only contentive hinders not but that a little Urine may come out nevertheless when the Patient hath rested and taken refreshment he is to make Water through the Tent without pulling of it out In dressing the Patient the Chirurgeon is to examine if it be a Fungus which caused the suppression and he may know that by the Finger or the streight Catheter by inspection into the matter that is voided with the Urine or by the injection of warm barly Water Detersives and the other Medicaments that are used in dressing such a Patient If a Stone be felt it is to be extracted with the Scoop the Hook or the Forceps Fungus's are fetched off by injections if it be an Ulcer proper remedies for cleansing it are to be used An inflammation is more easily cured than any other distemper because many times it is kept in being by the retention of the Urine When the cause of the suppression is removed the intention of the Artist ought to be the reuniting of the parts And therefore the Tent is drawn out and the Patients are dressed like those that are cut of the Stone according to the general cure if no accidents appear or the particular method by remedying every Symptome page 153 This Trocart may be made of various kinds of Metal excepting the point which ought to be of Steel it is seven or eight Inches in length that it may be the more commodious for use and as big as an ordinary quill in the shape of it several things are to be considered for the end of it which is of Steel is of a Pyramidal and Triangular Figure This point is about a Fingers breadth in length in one side of it there is a furrowing that reaches from the point or very near it to the other end of the Trocart and because of that furrowing the Instrument in its length represents a streight Catheter for making Incision because it is hollow on the one side and round on the other which is the out side of it The Pyramide of Steel tapers and grows smaller from the basis till ye come to the point but from that basis to the other end of the Trocart it is alike in bigness The Wire or Stilet is straight indifferently small of the same bigness all along and supple and pliant about eight Inches long proportionable to the furrowing of the Trocart The mounted Tent that is used in this Operation may be crooked for the high and straight for the lesser Operation in the Punction of the Bladder long and small in proportion to the Grossness and Age of the Patient that so the end may be thurst into the Bladder without making too great a Solutio Continui it is to be observed that the end of the Tent where its eyes are ought to be proportioned to the middle part of the Pyramide of the Trocart that it may easily enter into the Orifice of the Punction and that the body of that Tent be of a Conick Figure growing bigger and bigger by degrees as it comes nearer the head where the Rings are though the extremity of the Tent were smaller yet it might suffice for conveighing of the Urine but it would be useless if some more thick and viscuous matter were contained in the Bladder In using of these three Instruments when the Patient is situated in the posture that hath been said the Cods are lifted up and having marked the place where the Punction is to be made in the Perineum on the side of the Seam or Suture the Trocart is thrust in and sinking the end by which it is held the slit or furrowing being upwards the Pyramide is to be thrust on forwards towards the Body of the Bladder which being much distended is therefore easily opened So soon as the Trocart is within the Urine will come running out by the furrowing and the Wire is to be taken and conducted into the Bladder by the same furrowing afterward the Trocart is drawn out in place whereof holding the Wire in one hand the Tent mounted is to be taken and passing the Wire into its Cavity it is to be made to slide along the same When the Tent is near to the Perineum the Wire is to be taken by the end and the Tent at the same time conducted into the Bladder we may know that it is in when the Urine comes out at its Cavity And then the Wire is pulled out and as much Urine suffered to be voided as may be thought convenient other things being to be performed as in the other manner called the great Operation This Trocart has one thing that is singular which is that so soon as the extremity of its slit is in the place where the Water is the Urine is voided without any danger of being thrust too far in There are some who make use of another Trocart for the same Operation this has a solid and round point of Steel about a Fingers breadth in length others cause it to be made Triangular or a little slat and two-edged but still proportioned to the Tent or Pipe the instrument in its length is streight and hollow and has two openings near the basis of its point that Instrument is passed into the Tent and in that posture the punction is made the opening of which is always less than the Orifice of the Tent and it cannot be introduced without great pain to the Patient besides this Trocart must be Thrust deeper in than the other before the Urine can be perceived to come out All men are free to examin and try those things and to choose what pleases them best These Trocarts may serve for other Operations as in a kind of Hydrocele where the Waters are gathered together without being stilled into the very substance of the Membranes in the Parakentesis or even in making perforations through the Skin and passing the Silk and Stones because about three or four fingers breadth from one end of the Trocart that was first described a hole may be made like the eye of a great Needle through which the Silk may be passed Every time that it hath been used it must be new set for the Urine blunts the edges very much It is good to practise such kind of Operations upon dead Bodies for that end one must with a Syringe Squirt as much matter as possibly he can into the Bladder then tie a Ligature about the Yard and make the Punction as hath been described and then make a dissection of the Bladder to observe what hath been done that so he may take his measures for another time We may avoid offending the Rectum by conducting
the point of the Pyramide towards the Bladder which then is much distended and we need not fear to open it in the Body because these Wounds are not absolutely Mortal And though they are said to be harder to consolidate in the Membranous part thereof nevertheless we should banish such apprehensions because we see by experience that they are cured and that the business is to save the life of a dying Man They to whom Fistula's do remain after the Punction of the Perineum make use of a Tent which they cause to be opened and stopt now and then for the voiding of the Urine they may be made to stop with a Screw for greater security The ends of the Linnen Cloth or Languet of the Tent are tied the one before and the other behind to a Girdle held up by a Collar like those which have been described when we spoke of the bandage of the Yard for a Phimosis Chap. X. If some Symptom of Lithotomy succeed the Punction of the Perineum it is to be remedied according to its kind and when none appear or if they be cured the Patient and Chirurgeon may have good hopes and both doing their duties with external assistances the Lithotomy and Punction of the Perineum are brought to a perfect cure Nevertheless what care soever the Chirurgeon may have and how obedient confiding and quiet so ever the Patient may prove assisted as he ought to be by those who attend him and the administration of proper Medicines yet sometimes he hath the trouble to be incommoded by the other distempers contained in the following Chapter CHAP. XXII Of diseases that happen after cutting for the Stone and of the way of curing them GVY of Chauliack in his second Treatise says that if there be no Metastasis of the Humours into Apostemes they are terminated by Discussion Suppuration Obduration and putrifaction and afterward he speaks of the manner of treating and curing them This shews that there is a difference betwixt their term their curing and their cure the end of one disease may be the beginning of another the cure hath an uncertain end though healing be that which is proposed according to Art we see but too many instances of this in those that are troubled with the Stone that evil is terminated by the extraction of the Stone and that Stone taken out or that the distemper ended by the Operation produces a Wound or other accidents the cure of which is necessary and which nevertheless do not always terminate in a cure but sometimes in a new Stone a Fistula in the Perineum an involuntary spilling of the Water a preternatural voiding of excrements or in many diseases together they have each of them their Causes Differences Signs Prognosticks and Ways of Curing We shall say nothing as to the Stone which may be observed after that the Patient hath been under cure we must only take notice that the cause of it may be this that there is a Quarry in the Kidneys which from time to time furnishes the Bladder with Stones and then the Operation ought to be delayed unless the Patient be fully recovered in strength the season be favourable or that the accidents be remedied And above all the Patient had need of a very great stock of resolution to endure a second cutting The Fistula in the Perineum whereof of we speak is a Sinuous Ulcer below the Scrotum with a Callosity along the length of it by which the Urine issues out It is caused by the Chirurgeons fault or by the Patients by the supervening of accidents or indeed by many things concurring when the Chirurgeon and Patient do not do their duties and that bad and violent Symptoms appear in the time or a little after the Operation By the fault of the Chirurgeon when in the beginning he suffers the Lips of the Ulcer to be to soon joyned together before he be certain that the Bottom of it is detersed and agglutinated or because no accidents appearing he hath dilated the Bottom of it to much and that he hath not had care after the first eight or ten days at most were over moderatly to Compress the bandage and to make use of small and very narrow Compresses laid upon the two sides of the Incision On the part of the Patient when his Urine being too sharp corrodes the Vrethra and hinders the reunion or that he lies not still as he ought not observing Directions and not suffering himself to be treated according to the rules of Art to which must be added his being emaciated the abundance of Urine and if he moderate not his passions or exceed in his food the superfluities whereof causes a too long suppuration The most remarkable accidents that contribute to the Fistula are a Putrifaction which causes great loss of substance in the Vrethra and adjoyning parts an Ulcer in the Bladder or Kidneys the suppuration whereof requires that the parts be kept dilated The differences of these Fistula's are drawn from hence that some of them are even and straight from the Skin to the Vrethra without any other profound or superficial sinuosity and are apparent on the side of the seam others have their Orifice in the Rectum some are accompanied with great loss of substance others have one or more sinuosities in the Vrethra and in the neighbouring parts or otherwise they happen in a bad subject and these differences are discovered if it be observed in time of dressing the Patient that thirty or forty days after the Operation the Ulcer cicatrises except one or more little passages or a small Lump or Tubercle which is named the Pullets rump on the side of the seam through which the Urine escapes or if the Patient being much extenuated the superveening accidents have caused a great loss of substance in the Vrethra or that new Flesh cannot breed the issuing of the Urine by the Anus makes it apparent that the Orifice of the Fistula is in the Rectum All Fistula's in the Perineum are not alike hard to be cured for the first kind may be taken into cure provided there be no great loss of substance and that the subject be good the rest being commonly incurable some of those who are troubled with Fistula's have this comfort that they do not always run If the subject be good not too lean and the Ulcer filled with well conditioned Flesh the cure of the Fistula may without interruption be undertaken but if the Patient be extenuated or if there be great loss of substance in the Vrethra with Callous Flesh the cure is not to be attempted until the strength be restored that it may be tryed if new Flesh can be procured In that case he must be comforted giving him hopes that at another time he may be cured Those that have their Orifice in the Rectum are sometimes less troublesome and they are not to be tampered with For curing of the Fistula we shall not speak in this place of
the universal regiment we suppose that to have been observed either whil'st the Patient was under cure for the Stone or since but we shall only treat of the particular management of that cure Authors speak of Potions and many Topical Medicines for the cure of Fistula's but since my design is only to describe what I have observed to have been successful I can affirm that many have been cured by the following means which consists in introducing into the Bottom of the Fistula a Catheretick Trochisque described in the last Chapter next the falling off of the Escar is to be procured by Basilicum and then the Patient is to be dressed like one that hath been cut of the Stone after the seventh or eighth day some make use at the same time of a desiccative Wax Candle which they thrust into the Yard up to the bottom of the Fistula others cure them without the use of Wax Candles when any accident appears it is to be remedied as hath been said Chap. XIX If those that are fistulous are to be pitied they who are troubled with an unvoluntary emission of their water by the Vrethra ought also to be ranked amongst the Miserable as those also who piss not at all But they from whom the gross Excrements drop against their will surpass the rest in Misery What may be said then if one should suffer many of these Inconveniences at the same time The spilling of the Water is caused by a Palsie in the Sphincter of the Bladder by the Incision of its Fibres or by a great Dilaceration when a big and rough stone hath too much widened the Passage and hath caused a Suppuration of long continuance The Kinds and Differences are taken from the Greatness or Smalness of the Emission the Signs of it are visible or rather most sensible and uneasie to the Patients because Shame and Vexation hinders them sometimes from seeking a Remedy from whence the Prognostick may be made That all of them are extreamly hard to be cured the most part incurable and that the Cure most commonly is but palliative Women are not subject to Fistula's but only to this spilling of their Water which is more uneasie to them than to men because of the Conformation of their Vrethra and that their Sex which hath Modesty for its Property obliging them to a greater reservedness hinders them from seeking relief and this makes them to have Clouts or Spunges about them to receive the Water or to employ something else that Necessity and Uneasiness suggest to them When the Spilling of Urine remains with men they may have recourse to a little Engine such as I saw in the Possession of a Person whose Character and Quality allows me not to name him I have heard him say that it was very useful and commodious for him That Engine is made of Steel Iron or any other convenient Metal It is composed of two parts each about three Inches long and a Fingers breadth wide one of the two pieces bends a little in its Longitude and the other is straight these two pieces joyn together at one end with a turning joynt like a Compass and at the other end both are bent backward to fasten within one another so that pressing with the Finger they may be opened and shut These two pieces are covered with Linnen as much or as little as one pleases afterward the Yard is put into that Instrument observing to keep the crooked part uppermost and when one hath made water it is shut the Compression may be made as slightly as one pleases covering or facing the Engine more or less that it may be suffered without Pain letting the Urine pass through which in some manner supplies the action of the Sphincter of the Bladder I have seen some who have made use of Boxes of White Lattin or other Vessels of Leather made in form of an Urinal tied to a Girdle and wherein the Nut always hung which is not done without Pain and Trouble There is another Instrument much like to a Truss for ruptures it is made like the Steel Trusses having a Girdle of the same Fashion and on the left side in stead of a Bolster the end of the Girdle bends Elbow-ways downwards and terminates in the shape of a small Iron Plate which is covered with Felt Leather or Cork sufficiently waxed over that it may be of a convex Figure like an Olive and indifferently hard that it may exactly answer to the Vrethra above and near to the place where the Incision hath been made When the Bandage is applied the little Eminence presses the Vrethra below the Cods and to keep it firm it is made fast by the other end where there is a strap of Leather of the same fashion as in the Steel Trusses for Ruptures and besides if a man were troubled with a falling down of the Intestines one of these Trusses might be made on purpose for him where there might be a Bolster for the Rupture and the little eminence for compressing the Vrethra and hindring the shedding of the Water Though this Bandage or Truss be in effect only for a palliative Cure of this Distemper yet it may sometimes serve for a real Cure because hereby the parts gather strength and are corroborated There is another kind of Bandage still the Girdle whereof is made of Fustian and that part which is to pass upon the Pubis of a piece of Wood of the length and bigness of the Patients Finger covered with Fustian and Wax betwixt which and the Pubis the Yard being compressed lyes along looking upwards that Posture hinders the spilling of the Water The same Bandage hath Points fastned to the fore part of it that they may be carried betwixt the Thighs and tied side-ways to the Girdle that so the Bandage may not rise too high Involuntary voiding of the Excrements is caused sometimes by the Chirurgeons Fault if in time of Lithotomy he make the Incision too low and if he cut the Rectum especially in the lesser Operation if he take not good heed most frequently the violent Motions of the Patient contribute to it but much more Putrifaction Abscesses or other Accidents that follow the Operation Their Kinds Signs and Prognosticks are taken from the more or less Ejection of the Excrements by the remaining Fistula which is far more uneasie than the spilling of the Water or the Fistula alone The Cure of this stercoral Excretion is impossible when it is caused by Incision of the upper part of the Sphincter of the Rectum or when there is great loss of Substance if any pretend to take such Patients into Cure they are to observe the Method of curing Fistula's in the Anus We need not enlarge to prove that these kinds of Distempers may have several Causes concurring at the same time when many of these Indispositions happen together we must have our recourse to the Method of curing complicated Distempers as well for the Prognostick Part
as for the order of the Complications CHAP. XXIII Of Medicines to prevent the Stone for avoiding of the Stone and of Medicaments for dressing those that are cut THough we promised to enquire into the Medicines that may prevent the Stone we must however confess that it is very difficult and perhaps impossible to determine precisely wherein they do consist because the most learned in natural Discoveries speak only in general of the Figures of Bodies and Microscopes have not been able to make known the particular Nature of every one nor yet of all their Pores Possibly we might succeed without observing all these Particularities for though Enquiries into Nature were pursued to that very point yet still there would be causes that did not depend on us and which might form the Stone the Bigness Figure Number and Motion of the Particles of Bodies of which we are composed and of those which serve us for Food are no ways in our power though these things be sufficient to produce in us the Maladies that we fear if the Secretions and Excretions be not performed according to the Course of Nature That we may reap Benefit from the Miseries of others it is to be considered that they who are most subject to the Gravel or Stone live after such a manner as may be avoided or at least corrected by other means and seeing we have spoken of fenny and marshy Places gross and thick Air calculous Food muddy Waters and of the Excesses that may much debilitate the Parts of the Body they are carefully to be avoided using moderately those things that are for our Nourishment following Exercises suitably to our strength without affecting too much Niceness and Delicacy It were better to use a little too much than not enough because Life consists in Action and men love themselves too well not to repose and take their Rest if we be not guilty of Excesses the Parts of our Body continue in good Health ready to resist all attacks Though few things contribute more to the forming of the Stone in the Bladder than continuing long without making of Water yet we must not at first give Diureticks but only gentle Purgatives to empty the Intestines and adjoyning Parts of that kind are Manna Cassia Catholicum duplex Lenitive Electuary Diaprunum simplex a day or two after Turpentine prepared in this fashion may be given in drink Take an Ounce or Six Drachms of the best Turpentine unwashed dissolve it in a Mortar with a little of the yelk of an Egg then add to it two or three ounces of the Water of Winter-Cherries Smallage Pelletory of the Wall or of some other Liquor according to the Nature of the Disease and the state of the Patient Stir all together that it may be exactly mixed and become of so white a Colour that it looks like Cream or coagulated Milk Bever C. XI of the Stone of the Kidneys and Bladder The Bath gives ease to those that are troubled with the Stone and contributes much to the bringing away of little stones that stop in the Kidneys and Bladder The use of the following Ptisanne or Barley-water is very good against the same Distempers It is made with an Ounce of Linseed and the Roots of Mallows and Marshmallows of each two Ounces put into five quarts of water boyled away to four into three Ounces of this Ptisanne may be dropped four or five Drops of the Spirit of Sulphur and it may be made stronger by augmenting the Dose of the Ingredients in the same quantity of water It is approved of for making one void Water mitigating Pain and bringing away Stones The two following Receipts were given me by Monsieur Jonnot the first of which he told me hath often to his Experience been successful in easing Nephritick Pains and those who are subject to void small Stones and that the second never failed him provided the Stone be of a Bigness fit to come out of the Pelvis or Bason of the Kidneys The first Medicine is to be taken in the Spring and Fall every Morning for three days together Take six Ounces of the Water of Pelletory of the Wall an Ounce of the Oyl of sweet Almonds and an Ounce and a Half of the Syrup of Limons in case of necessity it is taken at any time For the second Remedy the Patient must be once or twice blooded and twice purged with two or three Drachms of Sena infused overnight in the Decoction of Dogs-grass Roots of Marsh-mallows and a little bundle of Flax to the Colature of which must be added an Ounce of cleaned Cassia for every Dose The day after he is to make use of the following Limonade and is to continue it three days successively in the waning of the Moon fasting three or four Hours after Take of Argentine or Wild Tansey Water Lentils and Cresses of each one Handful let them boil half a quarter of an hour in a quart of water when it is taken off the Fire add to it the Juice and Rind of three or four Limons let all infuse together for the Space of four Hours then strain it and add thereunto three Ounces of the Powder of Sugar-Candy and twenty Grains of the Spirit of Salt Keep it for the Use aforesaid The Garden-flags or blew Flower-de-luce that grows upon Walls infused cold into what quantity one pleases of White-wine and an Ounce of the Infusion taken for the first time by Children of ten or twelve Years of Age brings away the Stone The Dose is to be increased or diminished according to the Age of the Patient and its Operation giving always too little rather than too much for fear of drawing the Stones in too great abundance towards the Sphincter of the Bladder which would cause a suppression of Urine One may renew it two or three days after and Purge by the Advice of a Physician The use of White-wine Raddish-water and Wine made of the Fruit of Eglantine or Sweet Briar taken now and then is good Paracelsus in the end of the Preface to his second Treatise of his great Chirurgery prescribes for remedying the suppression of Urine the use of the stones that are found in the Heads of Crabs beat into a subtil Powder drank in the Juice or Water of Raddishes and if the Patients do not thereby make water to make a little bag of Saffron and lay it upon the Kidneys or the Belly towards the passage of the Ureters and upon the Perinaeum Or to make a Powder of dried Acorns and give it to be drank in the Water or Juice of Raddishes in what quantity the Physician shall judge fit The two following Medicines are approved of for bringing away of Sand and small Stones In the wain of the Moon the Patient being Purged let him take in the Morning the bigness of a Nut of fresh Butter and swallow it down like a Pill then let him take a four Limon and squeeze out the Juice of it into four Ounces of White-wine