the Wound as has been before described pressing it a little harder than in the beginning the Jarretiere or Thigh band is used till the cure be perfected After the first days are over it is proper to advertise the Patient to press with his hand a little upon the dressing that he may more freely make water in his Urinal Though the Wound of it self requires consolidation yet care is to be had that the Lips and Teguments thereof turn not inwards and after some days when the fluxion is over or if none have happened with the help of little and very narrow Compresses the Lips are to be kept equally raised and a little distant only at the Orifice of the Incision for that purpose several Compresses are to be put near the Lip which is on the side of the left Thigh to the end the bottom may consolidate before the Cicatrice be made When one is sure of the bottom then he is to use desiccatives upon a little Pledget and several Compresses unequal in thickness and indifferently narrow one on each side and a Plaister to cover them and over that another little Compress transversly at the upper part of the Wound and over these three two others of unequal breadth to keep the bandage by that means the faster If there grow up any fungous carnosities they are to be consumed with calcined Alum or with Lapis infernalis There are some Patients that by reason of a good constitution of Body are cured in eight fifteen or twenty days but the ordinary time of curing Lithotomy is thirty or forty days It is prudence in a Chirurgeon to observe the alterations that happen to the Patient that he may discover the bad Symptoms that we have mentioned which change the method of the general cure and which require to be prevented or corrected by a particular method contrary to their Nature This is performed by Diet Chirurgery and Medicines the Diet until the seventh or eighth day consists in abstaining from Wine unless the Patient be very weak he is to use a Tisanne made of the shavings of Harts-Horn and Ivory or with a little Lint Seed and the Roots of Mallows and Marsh-mallows or at least in time of need he is to drink of Chalybeat Water or of the Tincture of Red Roses yet not according to his Thirst but a little less for fear of a Looseness it is enough that in four and twenty hours he take five or six messes of Broth and very few Eggs Blood-letting and cooling and Anodyn Glysters are good if he have a feaver and pain in the lower Belly but all by the advice of a Physician And after the first seven or eight days are over and that the Symptoms have ceased his food is to be made stronger beginning with Porrage or Panadoes then a little Meat and Bread after that he hath been Purged which is commonly to be done about the fourteenth or fifteenth day after the Operation Chirurgery is necessary when Blood letting is to be reiterated abscesses and their Sinus's opened places where there is a disposition towards putrifaction scarrified sometimes Cizars are made use of to clip off Membranes and other parts that are wholly corrupted Medicines are changed to discuss tumors and ripen Abscesses the Ulcers of the Scrotum and Bladder are cleansed by Injections and other Medicines that resist mortification and putrifaction Extraordinary Symptoms appear before one another or many together which make a complication we ought therefore to speak of the remedying of every one of them in particular It hath been said that Pain is mitigated by Oxyrrhodinum upon the Belly the Groins and the Cods Hemorrhage by Astringents a Feaver by Blood-letting especially if the Patient hath not lost much Blood in the time of the Operation or after and if he have strength restlesness is conquered by cooling Apozems Emulsions and Soporificks after the first days the inflammation of the parts after suppuration is extinguished by the Ceratum of Galen or by Nutritum fragments and small Stones are voided with the Urine and by the injection of warm Barley water or they are extracted with the hook the Extractor Forceps or the Scoop of the Button The too great retention of Urine is cured by passing the Womans Catheter into the Wound and then by a Tent or Pipe left in it for some days Gripings and Looseness are stopped by Anodyn and Carminative Glysters and by Juleps of Red Poppy the Oyl of sweet Almonds Plantane Water and Harts-Horn Jelly Worms and Vermous matter the cause of their generation are brought away by Medicines and Physick which help digestion as those into whose composition enter Rheubarb Wormwood Tamarinds Aquila Alba in a small quantity c. The Ecchymoses Fluxion and moderate Tumors are dissipated by resolutives and discussing Plaisters by comfortative Cataplasmes and Anodynes according to the degrees of the evil and the rules of Art observing to apply more comfortatives than simple Emollients and discussives because of the Humidity of the part Abscesses are formed commonly above the Incision and many times pressing the head of the Tumor with one Finger and the sides with other two the Purulent matter is Evacuated by the Wound but if it be perceived that the skin is very thin and the matter ready to burst forth in a torrent they are to be opened to the very bottom of the Sinus and the cure performed according to Art Detersive injections are made use of to mundifie and cleanse the Bladder and Emulsions are given to the Patients that the purulent matter may the more easily be evacuated Excoriations and Itching are cured by Nutritum Vnguentum album Rhasis the Cerat of Galen Pompholyx dissolved in the Oyl of Roses and other desiccative Anodynes taking heed not to compress the bandage for some days and if the Excoriations and Itching possess a great space the Patient might for some time be dressed without applying the Frond or Truss but only the Triangular Plaister covered with convenient Medicines upon the Medicaments of the place where the Operation hath been made making always use of the Thigh band to keep the Thighs at a convenient distance one from another The same thing is to be practised when the Scrotum or Testacles are much swelled and in pain and on that occasion Anodyn and emollient Cataplasms c. spread upon Linnen Cloath cut in the shape of the Plaister called the Plaister for the Scrotum are to be made use of with a bandage or suspensory which is applied as in other distempers of the Cods or Testicles Patients that are cut are subject to other accidents when they have lain long upon their Backs they are to be remedied according to their kinds and degrees and when they abate the common bandages are made use of such as the Truss Frond or double T. which is more proper in the end than in the beginning because it compresses more easily and it is more commonly made use of for Women than
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