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
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
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
of Mel Rosatum and the Powder of Hiera or the Oyl of Scorpions when there is congealed Blood Purulent Matter or thick Phlegm in the Bladder we may make use of an injection of Oxymel with the Oyl of sweet Almonds in the Flagging of the Vrethra hollow Wax Candles are imployed if there happen any Carnosity or Callosity in it they are incided and eaten off and afterward a Leaden Pipe introduced into the place When one hath kept his water too long if he be afraid of being searched bags of Pellitory of the Wall moistened with the Oyl of Capers or of Turpentine are to be laid upon the Pubis and if he do not find ease upon that he is to be perswaded to suffer the intromission of the Catheter The inflammation of the Rectum the Matrix and Prostates is allayed by Blood-letting and Glysters of Oxycrat Pellitory Water or the Decoction of it with Mel Rosatum and a Bath of warm Water For all suppressions of Urine when there is no other apparent disease it is of singular advantage to let Blood give cooling Glysters and Bath because commonly they are caused by meer inflammation and the weakness to which the Patient is reduced does often laxat the parts and make way for the Emission of Urine the retention whereof puts him in danger of Death Galen 13. of the Meth. before Pareus L. 17. C. 37. advises not to give Diureticks nor strong purgatives before Blood-letting because they may accelerate the motion of Humours or of Praeternatural Bodies towards the Bladder and fill it fuller whilst the obstruction of the Sphincter hinders the evacuation of the Urine But though all remedies have been used yet sometimes the Patient is not eased in that case if he cannot be searched and the distemper be very urgent it is better without delaying several days to bring him to consent to be cut if he be troubled with the Stone And if it be only Urine retained through an inflammation of the Sphincter or by a thick and viscuous matter it will be necessary to Prick or Tap the Perineum CHAP. XXI Of the Puncture or Tapping of the Perineum IT is to be supposed that the Patient hath found no ease from all the Medicines that have been administred unto him and that the suppression continues with such Symptoms as give ground to a sad Prognostick and call for speedy relief to the Patient The great relation that there is betwixt Lithotomy and the Pricking or Tapping of the Perineum gives us ground to propose three ways of Practising it and seeing they have no proper names we shall distinguish them by those of the various Methods of Lithotomy to wit the Hight the Great and the lesser Operation Though it hath been said that the High Operation is not in use nevertheless it would seem that the great Tumor above the Pubis caused by the suppression of Urine especially in an extenuated Patient might render the Operation easie without any fear of hurting the parts of the lower Belly and that for that purpose having Prickt the Tumor with a Lance as deep as the Bladder without Tying the Patient it will be sufficient to introduce a Wire or Stilet that may serve for a conductor to a crooked and convenient Pipe passing it into its cavity The High Operation of Tapping the Perineum may likewise be practised by means of a Trocart with which the Punction may be made in the Tumor above the Pubis it may be certainly known when the Bladder is open then a Wire is to be passed into it and having pulled out the Trocart the Wire will serve for a Conductor to the Pipe just so as to the Parakentesis or Tapping of People in Dropsies We shall give the description of this Trocart and of the manner of using it when we come to speak of the third way of Pricking and Tapping the Perineum The second way that is in use is the great Operation as I have seen it practised by men of great skill and reputation whose method I have followed There needs no more but a Pipe or Canula mounted a small Tent proportionated to the Cavity of the Pipe two Plaisters and two Compresses the one a little bigger than the other All things being in readiness and the Patient seated in posture and held as for Lithotomy to be more assured of the way that must be taken in making the Incision the furrowed Catheter is to be passed into the Vrethra as far up as it can go without forcing any thing if the inflammation be moderate or if there be no carnosity nor other obstacles it is to be introduced into the Bladder A Servant or the Chirurgeon himself may hold the Catheter and he is to observe all circumstances as in cuting for the Stone making the Incision lower than for Lithotomy and shorter upon the slit or furrowing into which he is to thrust the Bill of the Gorgeret to introduce it the more easily into the Bladder It is fit that the furrowing continue like a gutter without any thing to stop it at the Bill or Extremity of the Catheter the voiding of Urine is a certain sign that the Gorgeret is in the Bladder and then the Catheter is to be disengaged and softly pulled out The Chirurgeon is to hold the Gorgeret in one hand and in the other the Tent or Pipe mounted with the end dipped in Oyl and he is to conduct it into the Bladder by means of the Gorgeret or in defect of that if it be come out of the Bladder he may take the Button with a Scoop and use it as hath been said already If there be no Button one may make use of a big Wire which being introduced into the Bladder will serve for a conductor to the Tent or Pipe Though one could not pass the furrowed Catheter into the Bladder before the Operation yet it will easily enter after the Incision because that little Blood that is spilt will dissipate the Spirits which caused the inflammation and tension in the parts Tavenin Chap. 121. of his Operations proposes not to introduce the Catheter but the Patient being put into a posture to make the Incisio with a Bistory betwixt the Anus and Scrotum on the side of the Seam or Suture in the same place that it is made in for Lithotomy being come says he near the Bladder it is to be opened thrusting the Bistory or Lancet boldly up until that the Urine come out then the Tent is introduced and so the Operation is accomplished It is not convenient to evacuate all the Urine if it was excessive in quantity because too great evacuations are always hurtful according to Hippoc. Book 2. of his Aphorisms but having voided as much as may consist with the strength of the Patient with a little piece of Linnen Cloth one may stop the Orifice of the Tent or Pipe and having put a Compress upon it some Body is to hold his hand thereon assisting the Patient to