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
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-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
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
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