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
side to the other and when they joyn together and are dry they make rough Stones of a Spherical Circumference with very great Pores as is represented by the Figures the Superficies whereof are unequal like to Strawberries or Mulberries On the contrary if they be composed of minute Bodies that draw near to a Triangular Figure the contrary will be found and they will have smoother and less unequal Surfaces A B Gravelly Stones which are the Roundest C D E F G Stones that have no other name then that of the things they resemble as an Almond a Hens Egg c. It is also to be observed that there are many more flat Stones smooth and polished in the Surface than round and rough And this makes it probable that most of them are formed of minute Particles the points whereof are blunted page 20 A B C D E F G The Corpuscles of Stones being small the Stone will have a fine grain and be more polished and smooth the Corpuscles that are bigg and Globular make the grain course and the Stones lighter because their Pores are full of Urine or of some other very subtile matter much lighter than the parts of the Stone hence it is that of two Stones of the same bigness the rougher or less polished shall be the lighter and a dissolving Menstruum will Act much sooner upon those which are Globular and unequal than upon those which are Smoother and more polished in their Surfaces When the Stone begins to be formed by Globular Corpuscles they are in such sort disposed that they contain humidity in their Pores the Stone in a short time growing in bigness that Water or Humidity is by heat rendered more subtile according as the Stone grows harder and then it acquires a motion that may drive the parts from the Center and making to it self a passage bigg enough to transpire through but too little to allow an entry to other Terrestrial Corpuscles that Stone will he hollow at the Center Corpuscles that come nearest a Triangle cement and link the other Particles together because Triangular and Square Figures are more capable to hinder motion than Spherical The Stones whose Pores are full of Humidity are the softer and that softness will be more or less according to the quantity of Aquosity contained betwixt the Center and the Surface and therefore they are called soft Stones if there be much Humidity and hard if there be none and that the parts of the Stone be closely compacted It is certain the hard are heavier than the soft Sometimes Stones are taken out whose Center is Globular and the Surface smooth the reason is because betwixt the Pores of the parts of the Kernel other smaller and less round Corpuscles are placed and form a stony crust which has a finer Grain On the contrary the minute Bodies having formed an equal thickness from the Kernal if many Globular Corpuscles joyn with them before the Stone be hardned it will be unequal and rough in the Surface If the Stone be formed in the Kidney and take its grouth there it will be Sized according to the shape of the Cavities wherein its Branches do extend themselves Hence it follows that a Stone formed and augmented in the Neck of the Bladder will have a Figure Oblong Cilindrical or like a Pear having one end smaller than the other but if the Particles begin to joyn higher towards the bottom of the Bladder it is not repugnant but that at the same time the Corpuscles may be separated without touching one another amongst the Wrinkles and Rugosities of the Bladder and there form Stones which change their place and which by mutual collision become smooth as with two Stones of a moderate hardness and a little Water we may make the experiment and they will have one or more sides flat as is represented in the figures contained in the little space of the former cut This may serve for instruction to those who have not seen the operation often performed because considering the stones they will be able to judge if there be many which are sometimes uniform sometimes unequal in thickness It is rare to find Stones covered with a coat or slimy humor there are some that are sticking like those which have Prickles and Asperities which are called Gravelly Stones to distinguish them from those which are Smooth Round or Oval Some are harder and more ponderous others are gravelly only in the Center or in the Circumference some are found to be hollow within and others again solid as in their Superficies differences are likewise taken from the Scituation because there may be Stones in the Vrethra the Perineum the neck of the Bladder the bottom of it betwixt its Tunicles in the Vreters the Kidneys and other parts of the Body In the gall-bladder some are found of a grayish colour those of the Joints and Phlegmatick Abscesses are Whitish and those of the Kidneys and the Bladder are Reddish Grayish Whitish or of a colournear to these We must not forget the number seeing it is sometimes excessive and that sometimes there have been found in People subject to the Stone to the number of Twenty Fourty or Sixty stones but the number is not to be limited no more than the bigness because many Stones may be formed at the same time or successively and the fragments that break off from them by grating produce other Stones and that is the reason that some are bigger than others If a Stone have several flat sides there will be commonly three Stones there may be also more or only but two Stones that are cut out of Mans body are not so smooth nor so hard as the Pebles of the Earth And there are not so many adherent Stones as is believed if you except those that have a coat or prickles The smoothest are not extracted without pain if they be large and the passage be not sufficiently dilated or if they be not rightly laid hold off by the Forceps or if the Membranous parts be doubled through which they are pulled out It is very hard to judge whether the Stone adheres before the operation CHAP. VII Of the Diagnostick and Prognostick signs of the Stone IF we reflect on the causes of Stones and their differences we may observe the diversity of their signs of which the First discover that there is a Stone the Second if there be many and the Third if the effects and consequences of them will be dangerous The signs that discover to us the Stone or the number are called Diagnosticks and those which make us judge of the consequences are named Prognosticks For facilitating the means to know if the Stone is in the Kidneys and that it descends into the Bladder we cannot cite a better Master than Galen book vi of Places affec chap. 2. who describes the signs of the Stone different from those of other Colicks A straining to vomit and great and frequent vomitings are much more troublesome to those
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
which was not left in the Bladder it is said that Patient hath a Quarry of Stones The figure and bigness of the Stone being considered after the Operation one may judge whither or no the consequences will be dangerous for if it be monstrous the parts have been much dilated and coutused and if it be craggy and pointed there hath been dilaceration or adherence and some times complication the Stones that have many asperities are never so big as those that are even and smooth in their surface and that for two reasons the first is because the minute Bodies that compose those rough Stones are not so closely comparted and some of them may break off and be voided with the Urine the second because those asperities cause a more sudden and pungent pain than other Figures and force the Patient to betake himself more speedily to the Chirurgeon for ease who performs the operation before that it hath had time to encrease to a greater bigness CHAP. VIII What is to be observed by the Chirurgeon before the Operation HYpocrates having taken an Oath never to undertake the cutting of the Stone hath instructed us how necessary it is to observe all circumspection in performing it Wherefore when a Chirurgeon pretends to the cutting of the Stone he ought to frame to himself a Notion or Idea of opening to himself a passage to the Bladder through a convenient place for extracting of the Stone by his Rules and Precepts he will know if he can Operate and then he is to resolve upon it He that is troubled with the Stone is his Subject matter and it is the duty of a skilful Chirurgeon to foresee the consequences to the end he may guard himself with necessary remedies against the accidents of the matter and of the Operation A Chirurgeon that is called to search or cut a Patient ought to make himself be distinguished from Quacks this will be easie for him to doe if he observe what is taught in the Principles of Chirurgie where they treat of the Qualities of the Chirurgeon and of the Servants It is one of his chiefest qualities to have great skill in Anatomy that he may know the formation and fcituation of the Parts that so he may Operate with necessary circumspection being bold but yet not rash he ought to make his prudence appear by making his prognostick and distinguishing between those things that are ineffectual and perilous and those things wherein according to the Rules of his Art he may succeed without exaggerating the least circumstances and events that depend not upon him by an unnecessary stood of words He is to consider the State Strength and Age of the Petient for knowing that a Man is upon the brink of death before that he search or probe him he is to acquaint those that are by that it is no disgrace to him if he cannot search him or if though the Catheter be even introduced into his Bladder if he make but little or no Water by reason of his weakness because a Patient falls sometimes into an apparent suppression when he hath no Urine to render this happened to me about 3 Years ago I was sent for to search Mr. Sartorin an advocate he was very Ancient Hydropical and at the very point of Death and had not made Water for three days I did not search him and he died within an hour after I saw him when he was open'd there was not one drop of Water found in his Bladder his Ureters were so closed up that the Urine would not pass The Chirurgeon ought to be Informed from the Patients own mouth and by those that wait on him of the secret matters and distempers to which he is subject of the excesses that may have contributed to his Indisposition nothing is to be concealed from him because of the Remedies and Instruments which he is to choose Hypocrates in the sixth Aphorism of his sixth Book affirms that old Men are hardly cured of the Diseases of the Kidneys and Bladder and elsewhere he assures us that he never saw any past fifty years of Age Cured because according to Caelius Aurelianus their Bladder is Nervous and they have but little natural heat besides it is seated too high so that Medicines cannot be conveighed to it They are weak and many Excrements fall continually that way Nevertheless several have been cut and cured of the Stone at a greater Age. It is a good presage for the Cure after the operation is performed if the Patient sleep if his respiration is equal his tongue moist and if he be not dry nor do vomit the lower region of the belly little or not at all swelled with moderate pain and a slight Feaver because in that disposition according to Celsus the inflammation ceases most commonly about the fifth or seventh day He ought to know that the Patient oftner dies by the accidents that accompanie or follow the Operation than by the Stones whilst they are in the Bladder If the Patient be too weak he ought to have time to gather strength otherways the Operation would reduce him to evident danger and the Chirurgion ought to give notice of it that he may avoid the blame before the Operation some time is to be allowed for the digestion of the food that the Patient hath taken that so his Body may be in better plight to endure it Celsus observes that most of learned men have a weak stomack and that they are not strong by reason of Watchings and over Studying The Medicines of Pharmarie cannot cure the Stone they only bring relief when the Stones are very small in the Kidneys or Bladder and when they are as yet but a kind of matter easy to be resolved into Powder and to be evacuated with the Urine The Chirurgeon ought to make his prognostick examining if he can the bigness of the Stone with his finger thrust into the Fundament informing himself how long the Patient has complained of it observing the season place and other circumstances directed by the Principles of Chirurgerie Those that have the Jaundice or Dropsie are not strong enough to endure the Operation When one hath discovered the signs of the Stone or Gravel if the Urine after it hath been bloody or becomes full of purulent matter it is a sign that there is an Ulcer in the Kidneys or Bladder caused hy the roughness and asperities of the Stone and that there is no hopes of curing an Ulcer in the Kidneys because hot and penetrating Medcines are required for expulsion of the Stones and the contrary for Ulcers nature sometimes stirred up or assisted by diverting Medicines discharges it self of that load and gives opportunity of easing the Patients of their tormenting pains The Chirurgion ought not to expect a Cure if after the Patient has been cut the Nephritick Colick continue long with pains that are sometimes heavy and dull and sometimes acute and sharp because that is a Sign that there is a big Stone or
one part of it is before and the rest hangs behind 3. A Budget to put in separatly the streight Forcipes in the one side and the crooked with the hook in the other in the bottom the Dilatatory the Button and the Conductor are hid It may be shut lifting up the sides of it where there are Button-holes into which are put the Buttons that are fastened to the places marked C. D. near the strings A Table whereon the Porringer with Oyl is set and the mounted Bistoris laid under which a peice of linnen-cloath folded with many plaits is put cross-ways that their points may not touch any thing It is fit that several Bistories should be mounted though there be but one Operation to be made because the edge or the point are sometimes blunted and it is necessary to have some rags of linnen-cloath and napkins in readiness All the Instruments may be made of Steel or Iron nevertheless the Catheters Conductors Button and Tents are neater when they are of Silver and less subject to rust Of each kind there ought to be several sizes and those well polished It is not enough to have spoken of the Instruments of Chirurgie we must likewise according to the Rules of good method take into consideration what things are necessary before in the time and after the Operation Before the Operation the Patient ought to be prepared for some days by a Diet Blood-letting Glysters Purges reiterated more or less according to the advice of a skilful Physitian and the night before the Operation the Patient must take a laxative or else an astringent Glyster according as need shall require He must have a days time at least to rest in after he hath taken Physick and spiritual Remidies are not to be omitted At the time of cutting the Operator must choose four faithful servants at least a Chamber indifferently warm and in a good Air where the light of day may suffice He must have an Apron and Sleeves and under the Table a tub of warm water to wash the Instruments upon the Table there must be Salad-oyl or oyl of Roses and there he is to lay his Instruments in order for the Operation all these things are called the preparatives Appareil for the Operation the Bandage and Medicines that are made use of to dress the Patient that is cut are called the preparatives for the dressing which ought to be in readiness because they are used immediatly after the Operation The Medicines both Powders and Oyntments ought to be astringent warm Oxycrat and Oxyrodinum The Bandages as well for Men as Women are 1. The Ligature or Colier which is a great band for Blood-letting when the two ends of it are tied together it is of an oval Figure which is put over the Head and comes down as far as the Navil This band may be put about the Patient before the Operation 2. A Bolster or compress of a moderate thickness three or four fingers broad to put upon the wound when the Operation is done and when the Patient is to be carried to bed it ought to be laid upon the Table with the Bistories and the Catheters 3. An astringent Plaster of a sufficient bigness to cover the Belly 4. A Ventriere or Belly-clout which is a great Bolster or Compress to cover the Belly it is to be dipped in warm Oxycrat 5. The Froude or Bandage or Trusse with four Heads A. the Heads which may be called Twins because they begin in the same place and are destined for one and the same use 6. The Truss or double T. or second Trusse B. B. the girdle of the Truss C. C. the Tailes or Straps of the Truss 7. A Pledget Plumacean covered with Astringent 8. Astringent-Plasters of several sizes 9. A Plaster longer than broad to be put some days after the Operation upon the Pledget instead of the former Plasters this Plaster ought to be somewhat longer than the Wound 10. A small square Bolster or Compress indifferently thick and somewhat larger than the Plaster above described 11. Another double compress an Inch broad and a Foot long for Males called a Truss These two Bolsters are to be moistened in war m Oxycrat 12. A Ligature or Farettiere which is a long band to be Swathed about the Thighs that the Patient may keep them within a moderat nearness to one another 13. A Bed covered with a Rowling-Sheet or a Sheet doubled into many folds and laid cross the Bed in the place where the Kidneys and Thighs of him that is cut do Rest There is need of several Sheets or Alaises to shift and make it dry when it is wet it is to be warmed with a Warming-Pan if it be needful it is requisite also to have a good many Napkins in Readiness to put under the Patient when he hath a Looseness that he may be the sooner laid dry and sometimes besides that Sheet a Sere-Cloath or thin Blanket is put betwxit the Sheets the Quilt to preserve it from spoiling and rotting by the Urines but a Sere-Cloath makes the Bed too hard and is not good but when there is a want of Sheets or a Quilt to shift the Patient It is not to be forgot that a cord must be fastned to the top of the Bed or some other place to help the Patient to raise himself There are some Operators that hide their Instruments in their pockets or put the Catheters in their Button-Holes before they anoint them with Oyle others lay them in a Dish nevertheless seeing it makes a noise when the Operator takes them up to Operate with it seemes more commodious to have them in a Pouch or Budget CHAP. XII Of the Posture and Scituation into which Children are to be put when they are to be Cut. ALL things being prepared the Catheters put into Oyle the Bistoris and Tents mounted and laid upon the Table the Tub with warm water underneath it the streight and crooked Forcipes with the hook placed in order in the fore part of the Budget a Conductor the Button and Scoop and a Dilatatory if it be thought necessary in the bottom of the Pouch or Budget the Patient is sent for brought to the place of Operation and set upon the Chair standing a little obliquely that the light from the Windows may dart upon the right side of the Operator who is to keep his Instruments from the sight of the Patient If it be a Child of four five seven ten or twelve years of Age two Servants may hold him by the Hand and Feet on each side whilst another getting up upon something behind the Chair and looking forwards may commodiously lean upon the Patients shoulders placing the Thumb of both Hands towards his Back and the other Fingers upon the Clavicles for the surer hold the Servant who is on the right side of the Patient ought to put his left Hand betwixt the Patients Thighs and take fast hold on his right Hand wrist and that the Child
breaks and moulders and the Forceps easily shuts but then one feels as it were a heap of sand and then the Rings are not to be brought wholly together because then a small matter of gravel would be drawn out and the parts of the Bladder might be hurt the Forceps with what is betwixt the Teeth of it is to be pulled out and this is to be reiterated conducting it upon the Button as often as shall be judged necessary And then a Tent or Pipe is to be introduced as shall be mentioned in the following Chapter When the Operator judges the Stone to be flat and of the shape of an Almond he may endeavour to make one of the Teeth of the Forcipes slide under and the other above though commonly the Stones are taken sideways and when it is taken hold of he is to turn the Forceps again so that the thickness of the Stone may answer to the length of the Incision Sometimes a Stone of the shape of a large Hens-Egg is caught hold of by its two ends which may be guessed by the great distance that is observed betwixt the Rings of the Forceps nay one may see it when the Stone is near the passage to keep it fast the Forceps is to be thrust back into the Bladder the Teeth of it a little opened that the Stone may be loose and it will turn without fail by that means it is afterward taken hold of by its thickness sideways and the passage thereby less dilated If the Stone be adherent and stick very close it were better to delay the extraction of it because suppuration contributes to the separation thereof And if the Operator cannot hold the Forceps fast enough he may make use of a Napkin to wrap the Rings in that his hands may not slip When it is excessively big it is better to let it alone than to expose the Patient to evident Death especially if Age and other circumstances are contrary to the Operation Pareus and Beverovicius advise to break it with Forcipes whose Teeth resemble the Teeth of a great Saw And Tevenin Chap. 121. Of his Operations proposes the introducing of a pretty long Tent or Pipe to hinder that the Stone fall not upon the Sphincter that so the Patient may make his water that Pipe should shut with a Screw that it may be used as need requires When all the Stones have been extracted in an Operation it is not needful to introduce a Tent or Pipe Nevertheless there are some Operators who always use them to void as they say the clots of congealed Blood but they liquifie and come out by the Yard or by the wound without a Tent which hinders the reuniting of the divided parts that still are Bleeding It is true that they who well understand the conduct of that Operation may succeed in it without leaving a Tent or Pipe long in the place but yet it is sometimes necessary to use it for some days when there is an Ulcer in the Bladder that injections may be the more conveniently made into it CHAP. XVII What time the Patient may be kept under the Operation and what is to be done when it is hard and laborious AN Operation is called hard and laborious when by a skilful man it is not performed in a short time In such a case the Patient is not to be held in pain until the Stone or all its parts be extracted Sometimes it so stops the passage that the Conductor or Forceps cannot but with great difficulty enter and therefore an expert Chirurgeon will not scruple to take out his Instruments and with his Finger or the Button thrust back the Stone into the Bladder and will afterwards make use of the Botton and Forceps to continue the Operation It many times happens that after that the Stone hath been often laid hold of it escapes and mounts up again because the Forceps gives way or the Teeth of it are not good or otherways because the Stone is monstrous in respect of the passage or that it breaks when it is held too strait or because it is soft and cannot easily be extracted when it adheres These circumstances are to be observed very exactly and the Chirurgeon ought not to be more careful in his Operation than in considering the strength and Age of the Patient with the time that he has been upon the Chair keeping him under the Operation rather too short a time than too long lest he be surprized by death if he be made to endure too much But if after the Operation hath been methodically carried on nothing is extracted because there was no Stone in the Bladder or that the Stone is small or if fragments remained he may take the Button with a scoop by the small or middle and introduce the scoop or spoon into the wound and so endeavour to extract somewhat and this having been two or three times reiterated he ought to make use of a Tent or Pipe proportionable to the subject and mounted according to Art For introducing it he may make use if he pleases and with more security of the Button put into the Incision and having dipped the end of the Tent in Oyl he may conduct it along the Button even to the Bladder in this manner page 114 When the fragments are but moderately big they may be extracted a Bed and it is good to leave the Tent until one be certain that there is nothing more remaining within which may be known if one observe what came out during the Operation or afterwards with the Medicines Moreover after the Tent is taken out one may introduce a Catheter crooked at the end or a big Wire through the cavity of the Tent without taking it out and by several little joggs or motions search as far up as can be done without Pain One may likewise make use of a Feather to clear the Tent of Blood or of Slime and Purulent matters that are formed in the Bladder The injection of warm Barley Water is proper and after the first day one may gently press the Belly with the hand in time of Dressing CHAP. XVIII Of the Symptoms of Lithotomy THE Symptoms of Lithotomy are divided into those which accompany the Operation and those that follow it the first called Concomitant and the others Subsequent Accidents which accompany the Operation are Hemorrhage or Bleeding the length of time which makes it to be called Laborious the Bruising and Breaking of the Stone the difficulty of extracting it or the impossibility the number and fragments which cannot be extracted because of their bigness numerousness or weakness of the Patient sometimes also nothing is found though the Patient hath been searched and examined before A contusion Superveens if the Forceps be thrust too rudely or too frequently when it is in the Bladder Excoriation or even a Rupture of the Bladder or other parts as well by the bigness and asperties of the Stone as by the Teeth of the Forcipes
been used is to put upon the Incision a square dry Compress about three or four Fingers breadth in bigness and indifferently thick and holding it on with one hand to take the Patient about the Body and with assistance and help to carry him to Bed We have already said that the Collar may be put on before the Operation afterwards taking a Frond or Truss suitable to the Patient it is to be laid upon his Back above the Buttocks that so the two heads or straps called the twins and which may be then called the superiour may serve for a Girdle the Body or middle of the bandage in the mean time declining towards the place where the Incision hath been made which hinders the stopping up of the Anus Before the two superiour straps of the Frond or Truss he tied together for making of a Girdle Imbrocation is to be made upon the Belly and the Cods with the warm Oyl of Roses and Camomile to prevent the painful tension of the Body and to cure it and an Astringent Plaster is to be applied to the Belly with the Ventriere or Belly peice soaked in warm Oxycrat then must the two superiour or upper straps of the Truss be tied together towards the Patients right side the one of them passing under the Collar Afterwards the Compress which was put upon the Wound dry and is since the Operation steeped in Blood is to be taken off and Medicines applied to the place If there be a Hemorrhage Astringent Powders and Pledgets are to be made use of and when there is no Hemorrhage an indifferent thick Pledget covered with Astringent is to be put upon the Wound with a Triangular Plaster covered with Astringent and the Cods are to be kept up with a Truss whose ends pass along the two Groins and afterward a small Square Compress dipped in warm Oxycrat as the Truss ought to be is to be put upon the Plaster holding all the dressing of the Wound with one hand for one must be ambidexter and with the other hand taking hold of the Bandage betwixt the Thighs by the end which is near the Anus it is to be brought over the little square Compress that is upon the Wound and carried along the left Groin declining betwixt the Thigh and the Hand that holdeth on the dressing and that end is to be left upon the Girdle still holding the dressing fast then one must take the other end which is more remote from the Anus and giving it a turn outwards towards the Body of the bandage to make an equal compressure it is likewise to pass over the Square Compress that is upon the Wound and disengaging the Fingers wherewith it is held it is to be carried along the rite Groin making but a very slight compression then the hand that held on the dressing is to be removed and with the help of both hands this last end is conveighed under the girdle before and on the right side and then tied with the knot called the Mariners knot the same is done to the other end on the left side or otherwise if both ends be long enough after they have been brought under the Girdle they are tied together by the Collar towards the left side during the whole time that the bandage is used a Ventriere or Belly peace is to be applied to the Patient and care had that the ends of the bandage keeps on the dressing of the Wound for the Body of the bandage must not descend lower than the left Buttock afterwards the Thighs must be made fast and kept at a moderate distance from one another with the garter or thigh band tied together under the Knees with the knot on the outside towards the Thighs If it be a Woman that has been cut the dressing is to be put upon the Belly as to Men and the Pledget covered with Astringent upon the Orifice of the Vrethra with a Plaister Compress and the Frond or double T of which a Girdle is to be made as with the Truss and the other ends which make the tailes of the T passing betwixt the thighs and crossways upon the dressing will hold it fast and press it as little as one pleases When the Patient has a mind to make water the bandage is to be taken off they are not subject to so many accidents and they are sooner cured than Men. In Men the first dressing may be removed within twelve hours after the applicat on renewing the Imbrocation with the same Astringent and the same Belly piece for four or five days at least or more if the Belly be Swelled or Pained one may likewise make use of Fomentations of the Belly with rough Wine and Red Roses and sometimes they are to be reiterated four or five times a day The Wound is to be dressed with the Liniment of Arceus half Melted to make it Penetrate the more with the Finger or Feather of a Quill introduced to the very bottom of the Wound as gently as may be then a little flat Pledget dipped in the same Liniment is to be applied upon the Lips of it with a Trianglar Plaister soaked in warm Oyl of Roses using a Compress and a Truss moistened with warm Oxycrat and a clean dry Frond or bandage to be changed at every new dressing as at first for the following days the Patients are to be dressed twice every four and twenty hours duly changing the dressings except that of the Belly which may serve for the first days and ever now and then the Patients are to be made dry which is observed to be done when they are a dressing not forgetting to make them clean for avoiding a Gangrene They are to be dressed with all speed and diligence and the Wound kept open as little as may be having a fire always in the Room to correct the badness of the Air. After five or six days there is no more use made of Oxycrat nor Astringent nor of the Triangular Plaister but only of a dry Belly piece and in the Incision three or four drops of the Liniment of Arceus with a Feather or the Finger and a flat Pledget upon the Lips of the Wound The Balsam of Peru and of Capivei which is called natural white Balsam are Sovereign remedies for Agglutination that of Capivei is excellently good from the beginning to the very end Some take equal parts of the Liniment of Arceus and the Oyl of Eggs others make use of the Liniment of Arceus during the whole cure others again of Capivei some there are that make a Mixture of equal parts of Basilicum of Venice Turpentine and Oyl of Eggs or the Liniment of Arceus and the success is alike provided the Operation hath been fortunate and no bad accidents superveen Upon these Medicines a Pledget is put and a Plaister of Diacalciteos a little longer than the Wound and of a breadth proportionable to the subject a dry Truss to bear up the Cods a Compress and a bandage upon
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 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
let him drink that Potion a quarter of an hour after that he hath swallowed the Butter This may be reiterated two or three days after according to its effect and then Purge again For the same effect take a little white Onion cut it into small pieces infuse them over Night upon hot Embers in four Ounces of White-wine and strain it having taken the same quantity of fresh Butter in the manner above directed a quarter of an hour after drink of this Infusion it is more violent than the former The Butter is taken first that the Stomack may not be stung or too much pricked by the Wine the Limon-juice or the Onion And it is to be observed that if the Patient should but once take a greater quantity than these Doses prescribed instead of giving ease it would expose him to a suppression again because these Medicines are very Diuretick and carry rapidly along with them what they meet with in their way They say that Jet hath so much Vertue that it is enough to hang it about the Arm or to carry it in ones Pocket to obtain ease of Nephritick pains and to bring away the Gravel and Stone The cold infusion of Nephritick Wood is Excellent put what quantity of that Wood you please into water to which it will give a Tincture take of it two Glasses in the Morning and one at Night or at any other hour of the day if the Stomack be empty this Medicine asswages the pain and brings away Sand. Pareus Book 17. Chap. 37. describes the following Broth and says that he hath by Experience found it to be of marvellous Essicacy for hindring the forming and confirming of the Stone Take a Cock and a Knuckle of Veal boyl them in water with a handful of Barley Parsley-Roots Sorrel Fennel Sichory Butchers-broom of each an Ounce the four cold Seeds bruised of each half an Ounce towards the end add Sorrel leaves Purslain Lettice Mallowtops and March Violets of each half a handful and then keep the Broth of which the Patient for four Mornings together fasting shall take about half a Pint with a little of the Juice of a Limon making it boyl one turn over the fire every time before it be taken you will quickly see says he a wonderful Operation and it is a Medicamental Aliment In the same place he gives the Receipt of a rare Powder against the Stone â„ž Nucleorum mespil Unc. 1. Pul. elect Diatrag. frigidi Dracn 2. Quatuor seminum frig majorum mundatorum glycyrisae rasae ana drac 1. Sem. Saxif dr 2. Seminum milii solis genistae pimpinellae brusci asparagi ana Scrup. 1. Seminis Altheae dr 1. semis Sacchari albissimi Vnc. 6. fiat pulvis This Powder is to be taken the first days of the New Moon and First Quarter of the Full Moon and Last Quarter and so for all the Months after to the quantity of a Spoonful in the Morning three hours before eating For the same Effect he prescribes the following Powder â„ž Coriand praep scrup 4. Anisi Marathri granor Alkekengi Milii solis ana drach 2. Zinzib Cinnamomi ana scrup 2. Turbith Elect. drach 1. Carvi scrup 2. Galang Nucis moschatae lapid Judaici ana scrup 1. Foliorum Senae mundatorum ad duplum omnium Diagredii dr 2. Semiss misce fiat pulvis Dosis erit ad drach 1. Cum vino albo Capiat ager tribus horis ante prandium Glysters for asswaging Nephritick pains are to be made of the Decoction of Lettice Scariole Purslain the Flowers of Violets and Nenuphur Melilot Camomile Dill the leaves of Mallows Marsh-mallows Bran and Linseed and in the Colature is to be dissolved cleaned Cassia a little Sugar yolks of Eggs and Turpentine which is a Soveraign Remedy Beverovicius speaks of a great many Medicines but seeing he may be consulted we shall here wave the Description of them and speak only of Medicines that are used after the Operation and for Remedying the Symptoms They have nothing that is particular but that they ought to be more moistning and humectant than for the other parts Every Chirurgeon makes his Astringent Powders and other Medicines to resist Putrifaction and breeding of new Flesh Sometimes the Rumps of Pullets are dryed with a little Rock Allom Calcined and scraped Lint or else there is added to it the Powder of Burnt Lead malaxated with a very little Diapalma or de minio A very good Epulotick is made with an Ounce of Pompholix half an Ounce of the Plaister de minio two Drams of Rock Allom Calcined all incorporate together In like manner a very good Desiccative may be made of Bole Armoniack and the Litharge of Gold of each an Ounce the Salt of Saturn and Crollius his Medicamental Stone of each a Dram all being reduced into a Powder they are to be made into an Unguent with a sufficient quantity of the Oyl of Roses To remove the Callosity of Fistula's one may make use of the Powder which is found at the bottom of Sphagedenick Water You may take what quantity you please of that Powder let it dry in the shade and then grind it upon Porphyry-stone or Marble add thereto a little Water in which Gum Arabick hath been dissolved and make it up into long and small Trochisks of divers shapes A more violent and efficacious Catheretick for the same purpose may be made of equal parts of Corrosive Sublimate and Rock Allom Calcined a little Opium and Saffron all must be pounded together and to give it a Body add as much Gummed water as is necessary and make it into Trochisks according to Art We ought not to forget the Description of the Liniment of Arceus which in Dressing serves for a Digestive Thus it is doscribed â„ž Gummi Elemni terebinthinae abietinae ana Vnc. 1. Sem. saevi castrati antiqui liquefacti Vnc. 2. Pinguedinis Porcinae Vnc. 1. Misce ad ignem Linimentum facito Arceus in his first Book of the good Method of Curing Diseases says that this Medicine is of so great Vertue that with half an Ounce of it one may Cure the greatest Wounds provided no Accident supervene sometimes they add to it as much of the Oyl of St. Johns-wort as is thought convenient according to the intention that is had in using it Pareus gives the Description of the Oyl of Eggs pag. 752. Take the Yolks of hard Eggs rub them betwixt your Hands and fry them in a Frying-pan over a gentle fire stir them with a spoon until they become red or tauny and the Oyl come from them then put them into a Hair-cloath and press out the Oyl as that of Almonds and keep it for Use Here we may subjoyn the Description of Harts-horn Jelly which is Excellent against the Looseness that happens to those that are cut of the Stone it is made of two Ounces of the shavings of Harts-horn and as much of Ivory which are to be boyled in a quart