CHAP. I. What is meant by Lithotomy.

LIthotomy, according to the Etymology of the word, sig­nifies Cutting of the Stone. It had been a more proper way of speaking, to have used a term that might have expressed the part which is opened by the edge of [Page 2]the Instrument, because the division or cutting of the Stone happens contrary to the intention of the Artist; however I shall make use of the word Lithotomy, which is in vogue, and understood by all that are skilful in the Profession. That we may dive into the meaning, and give the definition of the thing; it is an Ope­ration in Chirurgery, practised for the Extracting of Preter-natural hard Bodies which are retained in the Bladder.

By Preter-natural Bodies is to be un­derstood, all things that are retained within the Body of Man contrary to the ordinary course of Nature: And seeing sometimes there are several things in the Bladder which require the opening of it, we have put in the definition Preter-na­tural Bodies, rather than the Stone; and for clearer distinctions sake, we have sub­joyned that Lithotomy is only practised for such as are hard, and retained in the Bladder.

CHAP. II. Observations upon the Parts of the Body of Man.

THE Vessels and Pores of the Glandules are the usual Conduits through which the Corpuscules or little Bodies pass and are filtrated, when their bigness and figure makes them fit to be received there; but if there be no pro­portion betwixt the Conduit-pipes and the Liquors which should pass through them, they stop: On the contrary, if the Humours have a very rapid motion, they distend the passages, and many times break them.

Whatever the impulse of the Humours may be, their motion abates the more that they communicate it; they make no sensible attempt to get out when they are moved on every side in a place that can stretch and be enlarged to a certain big­ness, as the Bladder and the Basons of the Kidneys: But when the place wherein they are contained is full, if they be not [Page 4]evacuated, they are the causes of seve­ral Diseases; for the Humours consisting of parts of different figure or bigness, it follows that sometimes they cannot glide through one and the same passage. It is true that Bodies of the like or different extent may pass through one and the same Channel; the contrary is not im­possible, and may give a beginning to those Tumors, which swelling outward­ly higher than the surface of the Body, go by the Name of Abscesses, after the same manner as the internal collections have other appellations: And if the same Humours be composed of unequal parts, and meet together in a narrow place that is full of windings, some of them joyn together, and by their conjunction form a Body that in respect of the rest is solid. This Body by its continuance there, and the apposition of other Corpuscules, be­comes more sensible to us; it hardens ac­cording as the rough parts closely em­brace one another, and the other sepa­rate and continue their motion.

After the same manner as it is in Brooks and Rivulets, where the small stones [Page 5]separate and retain the Mud; so is it in the Glandules through which the Hu­mours are filtrated: And in the Pipes where Water runs in great quantity, though they be streight, Earth and other Sandy substances mingled with the Wa­ter cleave close and stick together, and there form a stony Crust, which in time hinders the passage of the Waters.

CHAP. III. Of the Causes of the Stone.

OUR Food liquified is not destroy­ed, and the diversity of Aliments makes it apparent, that they have parts different in Bigness, Figure, and Number; the most Nourishing, as Jellies and strong Broths have all these qualities, seeing the Juices of Animals which are the basis of them are taken from the soft and hard parts of the Bodies with which they were assimilated, or being still within the Ves­sels and amongst the Glandules, tended to that assimilation; or from those Bo­dies that were to be retained or voided, [Page 6]by Physicians called Retenta or Excreta.

Other kinds of Food contain also parts of a different Nature because 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, [Page 7]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 [Page 8]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 [Page 10]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 [Page 11]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 [Page 12]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, [Page 13]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 [Page 15]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, [Page 16]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 [Page 18]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. & Ʋesic.

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 [Page 20]Roll in the Bladder from one 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.

As the Surface and thickness of Stones are not always uniform, so their Par­ticles are variously Figured or disposed. Indeed there is as little reason to affirm [Page]

[Page] [Page 21]that all kinds of food are of the same nature, as that all the things whereof the Stone is formed, are alike: And though it were granted that the Stony Corpus­cles were of one and the same Figure; yet the difference of their bigness, and of their modification and site by reason of the inequality of their Angles, which would entangle them one with another, must needs give place for greater Pores, than if they were disposed in the man­ner most suitable to their nature for mak­ing a smaller bulk: And besides, betwixt the great Pores of Globular Corpuscles, other little Bodies of a different shape may enter, which may diminish the greatness of these Pores.

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 [Page 22]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 [Page 23]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 [Page 24]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 [Page 25]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 Ʋrethra, the Perineum, the neck of the Bladder, the bottom of it, betwixt its Tunicles, in the Ʋreters, 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 [Page 26]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 [Page 27]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 [Page 28]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 [Page 29]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 Ʋrethra; 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 [Page 30]light, and without adherence, they float a long time in the water; but because of that weight they have they descend towards the Ʋrethra, 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 Ʋrethra, 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 [Page 31]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 [Page 32]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 Ʋrethra 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. [Page 33]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 [Page 34]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 [Page 36]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 [Page 43]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 [Page 38]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 [Page 39]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, [Page 40]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 [Page 41]that is a Sign that there is a big Stone, or many little ones, which still remain and take growth in the Kidneys.

A Patient labouring under a suppres­sion of Urine, cannot be cured after the third day, if he be taken with a drow­zie fit, and if he can hardly fetch breath. The Hicket is a mortal symptom.

The Gout happening to those who are troubled with the Stone, may some­times cure them; the contrary also, through the abundance of humors does also happen.

When the Stone is Adherent, or co­vered with a Coat, or if we meet with a fungous or sarcomatick Body, the se­paration of them is gradually to be at­tempted by injection and moderately de­tersive Medicines.

Children are sooner and more easily cured by this Operation, because they have a more sedate Mind, and less trou­bled with Passions, being nearer the source of Life, than those that are strucken in Age.

Whilst all things are preparing, it is the Chirurgions part to comfort the Pa­tient, [Page 42]ordering likewise that he have Spi­ritual and Ghostly helps Administred un­to him.

CHAP. IX. Of the Method of Searching.

WOmen are least troubled with the Stone, because their Ʋre­thra is shorter, wider, and more direct; and therefore is not so obnoxious to Dis­eases as that of a Man: but seeing all sorts of Persons are subject to the Stone: having first inquired into the Signs, the Patient is to be put in a convenient po­sture to be searched, that so the causes of their Pains may be discovered. If it be a Woman, she is to be laid upon her Back, her Buttocks a little raised, and having chosen a Catheter, bending onely at the end, and anointed with Salade-Oyl, or some other sweet Oyl, she is to be made to open her Thighs a little. Then the Operator is to open and sepe­rate the Nymphae, with two Fingers of the [Page 43]same Hand, that the Orifice of the Ʋre­thra may appear beneath the Clitoris; afterward the Catheter is to be thrust in gently with the other Hand, and so a search to be made whether there be any Stone or not.

It is no great matter whether the ben­ded part of the Catheter be turned to­wards the Pubis, or the Vagina, because of the conformation of the Ʋrethra, and it is convenient not to be just oppo­site to the hollow of the Catheter; for fear of the Eruption of Urine.

For the more easie searching of Men, they ought to lean a little back, or to be laid upon their Backs; and the Chi­rurgion having made them open their Thighs, he is to raise the Yard, and hold it streight betwixt the Thumb, and the fore and middle Fingers of the same Hand, Skinning and taking the Prepuce off of the Glans, afterward with the other Hand he shall gently thrust an oyled Catheter to the very bottom of the Ʋrethra, holding it by the end where the rings are, like a Pen betwixt his Fingers, with this difference, that the [Page 44]rings of the Catheter are be hid with the same Fingers, his Hand being half open, turned toward the Pubis, and the bending or bill of the Catheter towards the Anus; then must the Catheter and Yard be moved towards the Groyn that is remotest from him that searches, and in the mean time he is to turn betwixt his Fingers the Catheter, and the bill of it towards the Pubis. Observe that the fore and middle Fingers touch the Cathe­ter on the one side, and the Thumb on the other, answering exactly to the space betwixt the Fingers; at the same time the Chirurgion is to press a little more with the fore Finger, which is higher than the middle Finger, so that the Cen­ter of the motion be upon the Thumb; by that means the handle of the Cathe­ter is covered, and the bill or bending of the Catheter raised, that it may press the Sphincter, and enter into the Bladder; this is the Figure of it.

Whilst the Chirurgion is turning the bill of the Catheter towards the Pubis, he is to pull the Yard a little up, that the Ʋrethra may be extended and free [Page]

[Page] [Page 45]from wrinckes; because it being a Mem­branous Part, the Plicatures thereof may hinder the Catheter from slipping down.

Sometimes, when the Catheter is in­troduced to the very bottom of the Ʋre­thra, and when the bill of it is turned towards the Pubis, the Chirurgion is obliged to let go the Yard, and to put a Finger into the Anus, and by a light compression of the Vectum, and the Ʋre­thra, the Catheter is conducted into the Bladder; which being done, he is to draw out his Finger, and hold the Yard no longer.

The Wire or Stilet is taken out of the Catheter before it be introduced, and when it is in the Bladder, it is held by the rings betwixt the fore and middle Fingers, having the Thumb upon the hollow of the Catheter, and the back of the Hand turned towards the Patients Belly: then the Chirurgion is to give some easie Jogs, moving the bill a little to the right and left, without turning the Catheter fully round. The rings are lowred, that the bending may mount towards the bottom of the Bladder, and [Page 46]sometimes they are inclined near the Belly, without forcing the Catheter out of the Sphincter, and by these kinds of motion, if one be very attentive, when it is a Stone, one shall hear a little sound as of two small Stones that touch one another, or at least something is to be felt that makes a collision with the Ca­theter, as if it were rubbed with a Stone, if it float, it may be felt when there is Urine in the Bladder; And that requires that the Operator should stop the hollow of the Catheter with his Thumb; but if nothing be felt, the Urine is to be let out by the Catheter, and then diligent search to be made.

There is another way of searching Men; the Yard is to be raised and mo­derately pulled up, laid upon the Groyn, and the rings of the Catheter inclined towards the Belly; so that the bill be turned towards the Anus.

There are Ungosities in the Bladder that sometimes deceives him that search­es; but they may be discerned, because then, one finds onely something that is soft or but moderately hard, which makes [Page 47]no noise by the touch of the Catheter, the Bladders of Children have no Ungo­sities like to those of Men.

In the Hospital of the Charity at Paris, about the beginning of a cutting in the year, 1681. Two Children were presen­ted to be cut; but the Stone not being felt, they were put to Bed again; not­withstanding, after many others had been cut, they were examined the se­cond time, the Stones discovered, and immediatly cut out, because they were prepared. This makes it appear that one should not be too hasty to give his Opi­nion, if sometimes the Stones are not felt though the Signs seem evident, be­cause they may be small or change their place. At the same time a Man was searched with a Catheter, used to make Patients void Urine. After that the bill had been inclined to the right side, and several times thrust towards the bottom of the Bladder, the rings were pressed down towards the Belly, as if there had been a design to bring out the Catheter; but when the bill of it was judged to be near the Sphincter of the Bladder, it was [Page 48]turned to the left side, which could not have been done sooner, because of the length of the bending of that Catheter, and the smalness of the Bladder; the Operator continued to search the Stone, which not being felt, was found with another Catheter, whose bill from the beginning of the bending, was not so long, and therefore that Catheter turned easily in the Bladder.

This observation instructs us what Ca­theters are to be chosen for voiding of Urine, whose bill ought not to be so long as those that serve for making of the incision, and which are Channelled or Furrowed. There are some Men who have very narrow Ʋrethra's, which re­quire small Catheter like those for Chil­dren, and of a sufficient length. Cathe­ters that do not easily bend or bow, are likewise to be chosen; and that depends on the Work of the Artist that makes them.

When the Stone is in the Neck of the Bladder, it is not necessary that the Ca­theter should be introduced so far as the bottom of it, because the Stone may be [Page 49]felt, provided the Catheter be onely in­troduced as far as the bottom of the Ʋrethra.

When there is a Carnosity, which hin­ders the Catheter to slide into the Blad­der, the Operator must put a finger in­to the rectum, and if there be a Stone he will find a hard and ponderous Body to­wards the Pubis, if there be a great in­flammation, it is the opinion of Fernelius, that no search should be made; in that case one should observe to search gently and seldome, because otherways it may be the cause of pain, inflammation, ex­coriation, a gangrenous Ulcer in the Sphincter, nay and even a Supression of Urine, or a peircing of the Ʋrethra.

Besides these Diseases, one cannot sometimes search because of a Phymosis, and of a Stone in the Ʋrethra; some­thing must be said as to that, as much as is necessary to be known upon the ac­count of Lithotomy.

CHAP. X. Of a Phymosis, and of the Stone in the Urethra.

MAny Children have a Phymosis; to search them, we must hold the Yard betwixt the little finger and the ring finger, the back of the hand being towards the Belly, and with the other fingers pull back the Prepuce, as if one intended to skin the Glans, the thumb on one side, and the fore-finger and mid­dle-finger on the other, gentlely pres­sing with these three fingers towards that part of the Nut or Balanus, where one Judges the end of the Glans to be seated, that by that means the Orifice of the Ʋrethra may be the more dilated; then the Catheter is to be entroduced gentely, searching for the perforation of the Glans; one may know that he is in the Ʋrethra, if the Catheter enter easily, and by feeling with the fingers of the other hand along the Ʋrethra on the under side of the Yard.

If the Prepuce be so strait that the Ca­theter cannot be introduced, or if one cannot hit upon the Orifice of the Ʋre­thra, there is no danger, to dilate a lit­tle the Prepuce sideways, with the point of a common Bistori or a pair of sharp Cissars.

Observe that before the introducing of the Catheter, it will be fit to squeeze the yard with the fingers along the Ʋrethra, and so to try if one do not feel some hard Body which stops the passage, as Carnosities or Stones. When it is a Stone the Catheter is to be drawn out; and if before searching it was known to be a Stone, and that it stuck in the middle of the Yard between the Glans and the Testicles, there is no searching, but hav­ing onely pressed the Yard with the fin­gers from the Pubis to the Stone, the Operator shall take a Curette or Extract­or oyled, and having introduced it by little and little, and passed it beyond the Stone, he may therewith draw it out of the Ʋrethra.

The Curette or Extractor is like an ear­picker, made of Steele, because it is less [Page 52]apt to bend than if it were made of a­nother Metal, the Operator must have of them of several sizes in bigness, four or five inches long; the figure of it you may see in the lower end of the second plate of Instrments.

The extremitiy of the Ʋrethra may be dilated in the upper part of the Glans, when stones are extracted with the Curet­te, and when being brought as far as the Orifice, they cannot pass without pain.

The Urine serves for a Remedy; and if there hath been a Contusion and Pain, it is enough to foment the Yard with the oyl of Roses, and cover the Nut or Balanus with a little pledget dipped in the lini­ment of Arceus, dissolved with a little mel rasatum moderately expressed out with the Nucial or Cross bandage open in the middle, and the band with three heads to wrap it up in, and it is not to be for­got, if there be need for it, to put a girdle about the Child, to which the band may be tied, nay and a Collar hanging about the neck like a Chair­mans Strap, the lower part of which is to be fastned to the girdles that it may [Page 53]not sink lower than one would have it.

That Bandage serves for other Di­stempers of the Yard, begininng to ap­ply it upon the Glans, and then bring­ing it nearer to the Belly, with slight coulings and circumvolutions to keep the Medicine fast to the part, and near to the Pubis an indifferent hard knot is to be cast, then the two heads at the other ex­tremitie of the Band or Truss are to be [...]ied to the girdle.

The precise length and breadth of all the parts of that bandage cannot be de­termined, because it depends upon the Judgment of the Chirurgeon to make them so long and so narrow as that they be not Cumbersome.

There is still another way of extract­ing the Stone out of the Yard, when it is at a distance from the Sphincter of the Bladder. And that is this; having drawn back the skin of the Praepuce as much as one can towards the Nut of the Yard, Ligature is made betwixt the Stone and the Pubis; or otherways one may with the fingers compress the Yard and the [...]kin be fore and behind the place where [Page 52] [...] [Page 53] [...] [Page 54]the Stone is observed to stick, and after­ward make Incision upon the Stone a little side-ways in the Ʋrethra, that so the Stone may be taken out by means of the Curette or Extractor, introduced into the Orifice of the Incision, the Li­gature being removed and the Skin lose­ned, the Incision stops and is cured by the Balsom of the Urine; without other Medicine.

If one be unwilling to make Incision in the Ʋrethra, or if the Stone cannot be got out with the Extractor, it will be fit to give Diuretick Medicins to force it forwards to the Glans thereby to facilitate its Extraction.

CHAP. XI. Of the time of Searching and Cutting; of the Instruments; of the patients Diet; and of the first Preparation.

A Patient may at any time be search­ed or probed to make him render his Water, and to discover the Disease; [Page 55]if one find himself extreamly troubled with the Stone, cutting is not to be de­layed without danger; but since some diseases requires a speedy Operation, we shall not speak of the time which is cal­led the time of necessity; but onely of that of Election, which is laid hold of, when the distemper is in such a Conditi­on as to give opportunity to do things in order and without precipitation.

The Spring is the most temperate sea­son of the Year; wherein Vitriol the father of all Productions, gives verdure to Plants, and contributes to the vigour and strength which men find renewing in themselves at that time, then do men undertake what was interrupted by the excessive cold or heat of other seasons, that in the Atumne they may enjoy the fruit of their past labours. With great reason then men choose the Spring time for many Operations, and amongst o­thers for Lithotomy. In this Conutry we must expect till the impression of the Winter cold, and the frequent Rains be over. Though the Spring begins on the eleaventh of March, nevertheless accord­ing [Page 56]to the temper of the Air, the Opera­tion of the Stone is accelerated or retard­ed; but commonly it is performed in the Month of May, Next to the Spring, the Autumne is to be preferred before the other seasons.

Though Liquors and Menstruums for dissolving of Stones were in use, yet must we of necessity speak of the Reme­dies of Chirurgery, which are Instru­ments of Iron or other Metalls proper for Lithotomy. Take here their figures and the names of their parts.

1. A Rasor to shave off the hair from the privy parts.

2. Common Cizars for ordinary In­cisions.

3. A Hollow sound or probe, called a Catheter, for searching of men, and making them render their Water, and its Stilet or Wire to cleanse it.

4. A Catheter or Staffe for making Incision in men, furrowed in the back from A. which is the bill or bec, to the place marked B. without any cavity in its length.

5. A Hollow Catheter and onely [Page]

[Page] [Page]

[Page] [Page 57]crooked at the bill for searching of Wo­men, and its Wire for cleansing it.

6. A Streight Catheter or Staffe and hollowed or furrowed from the bill to the place marked C. which is sometimes made use of for making Incision at the Orifice of the Ʋretha of Women. It is requisite to have always in the Catheter case a part, a little piece of a Spunge moderately moistened with Salad-Oyle, because sometimes it may be wanting when there is need of it to anoint the Catheters.

7. A Bistori that opens like a Lancet with a point and edge like the same one­ly the point blunter, at the head where­of there is a flat tayle to keep it firm against the handle when it is opened,

8. A Languette or roller to mount the Bistori, it is slit at the end, a finger broad, and a foot and half long.

9. A Bistori mounted, that is to say, armed with the Languette or Roller.

10. Conductors or Probes, whereof a pair serves for the Operation, that which is next to the Bistori mounted is forked, and the other has a line in the [Page 58]length of its cavity, for guiding and conducting the former. Nevertheless that alone which is remotest from the Bistori may be used for conducting the forceps or tenette.

11. Another kind of Conductor com­posed of the two above described; it turns with an elbow about the midle, and has a Spring betwixt the branches near the rings; it was invented by Jo­seph Covellart.

1. Another kind of Conductor cal­led in French a Gorgeret more commo­dious and more in use. It is hollow ta­pers and grows narrower at the end, where there is a bill that is introduced into the furrowing of the Catheter, whilst it is held by the other end shaped like a T. There are some who doe not ap­prove of this Conductor, saying that it dilates the parts too much, and that it occasions Fistula's, but without ground, for it is narrower than the forceps which is drawen out with the Stone and posses­ses more room, and the Fistula is onely occasioned by the consequences of the Operation, as shall be explained in its proper Place.

2. Sreight and crooked Forcipes or Tenettes. A. their Teeth, B. their Bran­ches, C. their Rings.

3. A Dilatatory for Men. It is named a Compound or great Dilatatory. D. the bill or bec of the Dilatatory. E. the handle.

4. A simple Dilatatory for Women. The extremities of it are blunt, and ve­ry small, the Branches are joyned in such a manner that closing the one end, the other opens. It represents the letter X.

5. Another Dilatatory that may serve for Women and little Boys. It hath a spring near the handle, and can dilate but moderatly. It may be used when one fears that some Fibres have been left in time of the Incision.

6. A Hook or Crochet to pull out the Stones that are in the Passage, either in the lesser Operation or otherways, some cause them to be made with little Teeth in the cavity of its bending; but there is no necessity for it.

7. A Button, a Scoope. About ten Inches long, and as big as a quill. F. the part properly called the Button. G. the [Page 60]body of the Button, H. the other end which is hollow, called the Curette or Scoop of the Button. I. a slight line to conduct the Forceps.

8. A hollow Tent, Pipe or Canula, having rings at one end called the Head, the other end is called the Point, where there are two holes called the eyes of the Tent.

9. A Languette or Fillet for mounting the hollow Tent, introducing it into the Slit, and putting the two ends of the Fillet through the rings of the Tent, then it is called a Tent mounted. That Fillet or Languette is to be two foot long, and a finger broad.

10. Two Ligatures by the French, called Scarffs for persons grown up; they are made of silk and wooll mixed together, each of them is four or five ells long, and four or five fingers broad. If the Chirurgeon want Ligatures or Scarffs; when he is making his Prepara­tion, he may cut bands of strong linnen-cloath, and make use of them. There is nothing lost in that, for he may after­ward cut them to serve for a Truss or [Page] [Page]

[Page 61] Froude, and for dressing the Patient.

11. An Extractor or Curette for ex­tracting Stones out of the Yard.

1. A Chair used in the Hospital of the Charity at Paris, on which the Patient is set, for the more commodious performing of the Operation. There are behind two bars or rods of Iron in form of Butte­resses; they are hooked, that so they may enter into the rings of the Chair, and sharp at the end to stick firmer in the Floor, because the Patient struggles and uses violence in the time of the Operation. The Chair should be placed a little obliquely for the light to come upon the right hand of the Chirurgeon, that he may see the better when he is about his Operation.

Instead of that Chair, the Patient may be seated upon the side of a Bed, or on a Table, with a Mattress or Quilt, where­of one part covers the back of a com­mon Chair reversed, about half a foot distant from the edge of a Table, in a sloaping manner. That Chair is to be made fast with many strong cords, if there be no Matteress or Quilt, it will [Page 62]be sufficient to lay a Pillow or any other thing to make the place soft, and a fol­ded Sheet over it.

2. A Sheet folded length-ways with many folds, to cover the Chair that hath been described, or the Matteress in the time of Operation: 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 cross­ways, 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 [Page 63]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, Blood­letting, 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 [Page 64]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. [Page 65]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 [Page 66]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 [Page 67]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 [Page 69]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 be not hurt, the sleeve of his Shirt may be pulled down to co­ver his Hand; after that the same ser­vant with his Right-Hand shall lay hold of the Leg on the same side by the Foot and Anckle. The Servant on the Patients Left-Hand shall do the same, taking hold of the Left-Arme with the Right-Hand, and with the Left-Hand of the Left-Leg near to the Foot.

In this posture the Childs Hands must almost touch his Heeles, and if he but any way hold fast, his Thighs spread, the Lithotomist has Room to Operate, and because Children do extreamly Struggle and Strive, two other servants may like­wise [Page 70]keep their knees a sunder; but it is cheifly to be observed in this posture, that the Patient lean half backwards accord­ing to the shape of the Chair, or for want of that, near the Beds side, or the Table, covered with a Quilt or Mat­teress, so that his Fundament may be seen, and that his Feet do not rest upon any thing, so that he have less force to stir or move himself. Hear is the Figure of it.

There are some Operators who choose a strong Man, and make him sit upon a pretty high common Chair, or upon the end of a Bench, who having a Cushion against his Belly, and a Sheet over it, takes the Child, who is to be cut, upon his Knees joyned together, the Man ha­ving his Knees close, puts his Hands be­twixt the Childs Legs, and so takes hold of his two Wrists; by this means the Child is put into a convenient posture to be cut, take here the Figure of it.

Besides the Man that holds, it is re­quisite that some other persons lean up­on the Childs Shoulders, open his Knees, and keep his Feet steddy.

Nevertheless, seeing the Operation is sometimes laborious, and that the Man who holds may be weary, it is better to make use of the first way.

CHAP. XIII. Of the different ways of Extracting the Stone, according to the Custome of the Egyptians.
The Practice of the high Operation

SOmetimes the Chirurgion cannot in­troduce the furrowed Catheter, be­cause of pain or inflammation, occasioned by too frequent searching before, or be­cause there may be fear of putting the Patient to too much pain, or that there may be a Carnositie or Callositie in the Part, or because the Stone is in the Peri­neum, or in the Neek of the Bladder.

These different dispositions oblige the Operator to consider how and in what manner the Operation is to be perform­ed. The first which is not in use, is cal­led [Page 72]the high Operation. The second and third are daily practised, and are called the lesser, and the great Operation.

We pretend not to comprehend the two Methods, mentionded by Prosper Alpinus, in the fourteenth Chapter, of his 3d. Book of the Medicine of the Egyptians, where he relates their Practise of extracting the Stone of the Bladder, without making Incision, but only by Dilatation of the Ʋrethra by blowing into the Yard.

When I lived in Egypt, says he, a cer­tain Arabian named Haly, in great Re­putation for Extracting Stones without Incision, took out several in my presence from Horam Bey, a Turkish Comman­der, in this manner he set about it; he made use of a wooden Pipe eight fingers long, and about the thickness of ones Thumb; having applied this to the pas­sage of the Yard, he blew into it with great force; at the same time with the other hand he pressed the extremity of the Privy Part towards the Perineum, to hinder the Wind from entring into the Bladder; then he stopt the mouth of the Pipe, to make the Ʋrethra swell [Page 73]and stretch. This being done, a Ser­vant put his Finger into the Anus, and brought the Stone by little and little to­wards the neck of the Bladder, and the beginning of the Ʋrethra: and then the Operator perceiving that the Stone was near the Perineum, he suddainly and with force drew back the Pipe from the pas­sage of the Yard, and so dextrously Ex­tracted the Stone, which was about the bigness of an Olive-Stone. I was pre­sent at this Operation which he perfor­med upon that Turkish Commander; and afterwards I saw him Practise it up­on two Jews, one of which was a little Boy, from whom he took 8 small Stones, and the other was grown up, from whom he took one as big as an Olive. This Arabian made use of the same Method to draw Stones out of the Bladder.

In the same Chapter he speaks of a Letter written to him by Octavius Pove­retus, a most learned Physitian in Egypt, for the Common-wealth of Venice.

Some Months agoe, says he, an Ara­bian of Sidon, a Christian, Extracted a Stone without Incision from another [Page 74]Christian named Cophtus, and it was done in this manner. The Arabian had many Pipes of different sizes, much of the shape of Flutes, or Pipes which are musical Instruments. They were made of a Cartiliginous matter, which would easily streatch: he introduced the smal­lest into the Ʋrethra, and thrust it for­ward as far as the Bladder: immediatly thereupon, he blew in it with all his strength to make it swell; then he pul­led out that Pipe, and put in a bigger, blowing in it after the same manner, and so continued charging the Pipes until he put in the fourth, which was the big­gest; and when he thought by this means that he had dilated the passage sufficiently to make way for the Stone; he placed the Patient in a convenient posture, and put one Finger into the Anus, to bring it towards the neck of the Bladder where the end of that great Pipe was, into which he endeavoured to make the Stone enter. This being done, he put his mouth to the other end of the Pipe, and sucking with all his strength, he did what he could to draw [Page 75]the Stone towards him, which broke often when it was too big, as it hapned to this Man named Cophtus; for he fetch­ed from him but a part of it, and the rest being a big and large fragment could not be got out.

This way, saith Kovoretus, is easie to be learnt, and perhaps a skilful Chirur­gion might have better Success in the Practise of it, which is a thing to be desired by those who are troubled with the Stone. Beverovicius makes mention of those two ways taken from Prosper Alpinus. But it is more pertinent in this place, without examining the circum­stances of those two ways, to give the descriptions of those which are called the high, the great, and lesser Opera­tion.

De Franco was the first that practised the high Operation, which is so called, because it is performed in the Hypogastre, and though he does not advise the doing of it, yet if there were a necessity for it, it does not seem impracticable in this manner. Let the Patient be laid and held fast upon a Matteress or Quilt, then let [Page 76]a Servant thrust his fore-finger and midle finger one after another into the Rectum, to make the Stone rise as high as one can; at the same time the Operator is to make Incision gently above the Groyn and on the side of the Linea-alba (the white line.) The Bottom of the Bladder may without doubt be opened withoutuhrting the Parts of the lower Belly, because it is scituated between the Duplicature of the Perito­neum, and the fuller that it is of Urine, the more Apparent it will be: by means of the Urine the simple Dilatatory may be conducted, and then the but­ton, which after the Dilatory is taken out, may serve for a Conductor to the Forceps. Mr. Jonnot told me, that Mr. Bonnet a Chirurgion who heretofore Practised Lithotomie in the Hotel Dieu of Paris assured him, that he had cut in that manner. Mr. Petit a Master Chi­rurgion of that Hospital told me that he had seen Mr. Bonnet Practise it upon a young Girl.

The Cure is to be performed as of sim­ple Wounds in the lowor Belly, or o­therways the Method may be changed [Page 77]according as Symptoms happen to fol­low. Experience teaches us that the Wounds of the Bladder are not allways Mortal.

If any one would Practice the High Operation, it would be necessary to try many Experiments on dead Bodyes, af­ter the Water is taken out of the Bladder De Franco in the same place, Chap. XXXIII. Proposes another way of cut­ting, which is immediately after the In­cision to put in a Tent, unless the Stone present it self at first, and some days af­ter when the pain is ceased to pull out the Stone. But this way is onely Practised when the Operation is Laborious; and instead of a Tent, a Pipe is made use of.

CHAP. XIV. The Practice of the lesser Operation for Men.

THE lesser Operation hath been so called because the Practice thereof requires but a few Instuments; it was invented by Celsus, and described in the seventh Book, twenty sixth Chapter, [Page 78]as it was heretofore Practised; but if the Stone be not towards the neck of the Bladder, and that it be felt in the Peri­neum near to and under the Scrotum, the manner of extracting it is different.

That I may give a clear Notion of the thing, I shall here Observe what hap­pened in many Lithotomies in the Year one thousand six hundred and eighty, in the Hospital of the Charity of Paris. Though I had my share in those Operati­ons that were Laborious, yet I shall onely mention one that happened to Monsieur Jonnot, the Circumstances whereof agreed exactly with other Operations which I performed in his presence: this Relation will give ground for making two kinds of lesser Operation for men.

There was brought to him a Boy of seven Years of Age that had been cut the Year before. He needed not make use of the Catheter to assure him of the destemper, for with two fingers one might feel the Stone towards the midle of the Perineum above the former Cica­trice.

To hold it fast, it was needless to [Page 79]put the fingers into the Anus, because the Stone being too high it could not be compressed, as is usually done, when it is in the neck of the Bladder; but hav­ing caused the Scrotum to be lifted up, and the Skin held strait, Monsieur Jon­not turning the inside of the left hand to­words the Cods, he pressed the Tumor with his Thumb and fore-finger on both sides of the Suture where he had obser­ved the Stone; at the same time he made the Incision on the side of the Suture upon the Tumor, and having opened a passage, with a midle sized Hook, he extracted the Stone; afterwards feeling with one finger that there were others still remain­ing, he was obliged to keep the place dilated with the same finger that intro­duced the Hook, and that the Stone might not shift its place, he held it fast with the fore-finger of the Left-Hand put upon the upper part of the Wound, and with the Thumb on the lower part. By that means he happily finished that Operation, that he might cut the same Pa­tent by the great Operation; for having pulled out all the small Stones and Frag­ments [Page 80]that were in the Perineum, he in­troduced by the Yard a furrowed Cathe­ter werewith he found another Stone in the Bladder, and upon that Catheter he continued the Incision with the other Circumstances whereof we shall speak in the great Operation. I was necessitated to do the same to a young Man of twen­ty two Years of Age.

I remember that before Monsieur Jonnot made use of the Catheter to cut him by the great Operation, be intro­duced into the Yard a great streight Wire or Stilet to force down some Frag­ments that stuck a little higher than the Incision, whilst he compressed the Ʋre­thra underneath, and then putting his Thumb below the Wound, he drew them out with a smal Scoop without any trouble.

This ought to serve when one cutteth the Stone out of the Perineum, because at the same time we must search if there be none in the Bladder; and that it may be done with less pain and trouble, a Catheter that serves to make Women void their Unrine may be introduced [Page] [Page]

[Page] [Page]

[Page 81]by the wound. This I saw practised upon one who had contracted a Fistula upon cutting, and had a Stone in the Bladder, who endured the great Opera­tion after that the Catheter was taken out.

It is not needful to make the Patient jump before he be cut by the lesser Ope­ration; if he be a little Boy, and the Stone in the Neck of the Bladder, it is enough, after that he is put into a po­sture, and held fast by the Servants, that the Chirurgion dip his fore-finger and middle-finger into Oyl, the nails being pared; and if one Finger be not suffii­cient, that he thrust them one after ano­ther into the Fundament, as far as pos­sibly he can, that they may reach beyond the Stone, and press it down to the Neck of the Bladder, betwixt the Rectum and the Os Pubis, a Servant in the mean time lifting up the Scrotum with one hand, and with the other armed with a Compress leaning upon the Belly, to make the Stone come down; then the Chirurgion is to dry the Perineum, and stretch the Skin very strait with his o­ther Fingers, as it is represented in this Figure.

The Tumor that the Stone covered with Teguments makes, renders the In­cision [...] on the side of the Suture, which may be made long enough for extracting of the Stone; care neverthe­less must be had, to avoid the Rectum, the Hemmorhoid Veins and the Cods. One must not fear the spoyling of the edge or point of the Bistori, for eve­ry time that it is to be used of new, it must be set again.

So soon as the Incision is made, the Stone appears, and then the Operator lays aside the Bistori, and takes the Hook or Crochet; he is to hide it in his Hand as much as he can, the end of its Handle being towards the little Finger, and the fore-Finger covering the length of its Body: without drawing the Fin­gers out of the Rectum, the Hook is to be slipt in betwixt the Pubis, and the Stone in this manner.

When the Hook is behind the Stone, and that the Operator intends to pluck it out, the Handle of it ought to be in the Hand with the end resting upon the Thumb, that it may be used with greater

The Fingers are not to be taken out of the Anus before the extraction, ne­vertheless when the Stone breaks because of its softness or shape which is some­times crooked like a Cressant, if the rest cannot be extracted with the Hook or a little Forceps, the next course is, to remove the Fingers out of the Anus, and introduce the Button into the wound for searching of the Stone, and having felt it, conduct a Forceps upon the But­ton to lay hold of it, and gently draw it out.

By what Operation soever an Opera­tor may cut, when the Stone breaks, though many Stones have been taken out, it is still necessary to introduce the Button to search and examine if there be no more fragments remaining.

When those that are of Age and grown up, are cut by the lesser Opera­tion, it is not necessary to make the In­cision so high as in the great Operation, because one cuts exactly upon the Stone, and it is also easier to avoid hurting of the Rectum.

If a Patient hath been already cut; [Page 84]the Incision is to be made upon the Cicatrice or the Fistula.

CHAP. XV. The manner of both the lesser and greater Operation for Women.

WOmen and Maids are cut by the lesser Operation, introducing the fore-finger and middle-finger into the Vagina Ʋteri, if it can be done with­out Violence, or into the Rectum, for feeling of the Stone, and holding it firm, whilst with the other hand the Opera­tor presses the lower Belly to make the Stone come down. Then he is to make use of the hollow streight Catheter, which being introduced into the Ʋre­thra, is to be held by a Servant, and the Orifice of the Ʋrethra is to be dilated by a simple Dilatatory, conducted in the Cavitie of the Catheter: it is not to be dilated too far forward, because the pas­sage is short, and that the dilaacerted Fibres may not hinder the unvoluntary [Page 85]emission of the Urine, the dilatation be­ing made, the Catheter is taken out with the Dilatatory, and the Fingers being still in the same place into which they were introduced, the Stone is pul­led out with the Hook or a Forceps, in the same manner as from little Boys.

Women and Girles may be excused from the violence which they sussex by the lesser Operation, because the great Operation is more convenient for the better succeeding in it, the Patient is to be placed upon the Chair, or upon the end of a Matteress, and that Conductor which is shaped like a Sword, and hath a bill, is to be introduced into the Ʋre­thra, then a small simple Dilatatory; and having made a moderate dilatation, whilst the Dilatatory is still open, the Chirurgion according to his own discre­tion and the bigness of the Stone, may cut a little sideways to the right and left, the external Orifice of the Passage, then draw out the Dilatatory, and in­troduce the Forceps along the Conduct­tor, to take hold of the Stone, and to extract it in the usual manner, its scarce [Page 84] [...] [Page 85] [...] [Page 86]credible how much the Ʋrethra may be dilated both in Men and Women.

There are some Operators who having introduced the streight hollow Catheter, th [...] thrust in one of the Conductors, shaped like a Sword that hath a bill; and the Catheter being drawn out, they slip easily in the other Conductor, which is sorked, because the first has a line that directs the second. Between those two Conductors which they press betwixt the Fore-finger and Middle-finger of the left Hand; they thrust in a Forceps to continue the Operation. Others succesfully make use of a narrow Gorgeret which serves for a Conductor to the Forceps. Mr. Jonnot makes only use of a hollow streight Catheter, or of a large Probe or Stilet for conducting the Forceps.

CHAP. XVI. Of the Practice of the great Operation for Men, and of circumstances during the time of the Operation.

JOannes de Romanis a Physician of Cre­mona, in the year 1520. Invented and Practised at Rome, the great Opera­tion, so called, because it requires more Instruments than other Methodes do.

Men who are cut by the great Ope­ration occasion more trouble, not only in respect of the Operation, but likewise in respect of the Cure; because their Ʋrethra is crooked, long and narrow, and their way of living renders that Part many times subject to more Diseases than those Parts in Women.

When the Patient is prepared and ready, he is set upon the Chair, or other ways laid up the side of a Matteress or Quilt, placed upon a Bed or a Table of an indifferent length, his Buttocks a little raised, his Head and Body incli­ning backwards, and leaning upon [Page 88]the back of a common Chair re­versed, and so ordered that the hinder Feet be near the Patients shoulders, and that he may continue still in a good Po­sture, two Scarffs are made use of in this manner; having laid them both toge­ther long ways, there is a knot tied in the middle of them, and they are put about the Patients Neck, the knot be­hind. If they be too long, they are shortned by tying a knot upon them, and a noose made of the same Scarffs is let hang down behind. This being done the Master taketh the Scarffs on the right side, and a Servant on the left, then both of them stand before the Pa­tient, and make him set his Feet against them, each side of the Scarffs being dou­ble, the Master and Man each on his side makes one end of them come before upon the Clavicles, and the other end upon the Shoulder Blades, and then bring both crosways under the Armpits: there they twist them together, giving them two or three turns: after that they bring the Patients Knees as near as they can to his Belly, & at the same time draw [Page] [Page]

[Page 89]one of the Scarffs betwixt the thighs, and the other on the outside of them, and they joyn both together underneath, giving them one cast over another, in like manner the Patients Heels are raised near to his Buttocks, whilst in the same fashion they tye his Leg; after that they make him put his four Fingers under his Soul of his Foot, and the Thumb below the external An­kle-bone, as if he were to take hold of his Heel. In this posture they tye the Wrist and Hand to the Leg and Foot, bringing the ends of the Scarffs under the Foot like a Stirrop, and then they draw them betwixt the Feet and the Thumbs, because the Ligatures must be made indifferently strait, which would hurt the Thumbs if they were tyed un­derneath, to which the Patients strug­lings would not a little contribute. Here you see the Figure of it, in which there is but one Servant represented leaning upon the Knee and Foot, keeping the Legs asunder, and supporting the Pa­tient that the Rowlings and Swathings may be seen; for there ought to be a [Page 90]Man on the other side, and sometimes two on each side when the Patient is strong.

This posture is somewhat terrible to the Patient, and therefore since there are some Men of a strong Resolution and invincible Courage, if they be un­willing to suffer these Ligatures; it will be sufficient to bind their Thighs and Legs in the manner described, and cause their Arms to be held by two Men; or perhaps they may like it better to have their hands tied a part by themselves, making them lay their wrists one upon another which being tied together by the midle of a Bandage wrapped two or three times about them and two indiffe­rent hard Knots, the two ends are to be brought about the the neck and tied, together with a running knot, so that the hands rest about the pit of the Sto­mach or the Cartilago Ensiformis.

I saw a Genteleman who had had his Leg cut off, cut at Mr. Jonnots. his Arme was tied on the same side with his Thighs and the want of his Leg was supplied by the number of Servants who held [Page 91]him fast if one or both his [...] had been cut off, he [...] have [...] mas­tered by the number of Men who could have held him by the Arms and Stumps, whilst others leaned upon his Shoulders, without any use of Ligarures.

Women ought to be Situated in the same posture.

Whilst the Scarffes are applying, it is fit that the Chrurgion should speak to the Patient, but in few words, that he look upon him and encourage him with discourse, shuning every thing that is undecent, because one must be very re­served, to oblige those that are present to be silent and with respect to be at­tentive, which wonderfully comforts a Patient; calling to mind, that to laugh at the disease, the infirmity, or expres­sions of a Patient, is to insult over a man in affluction. Neminem riseris ne miserum ririseris.

It were better to have but a few spec­tators, because a great many may incom­mode the Operator, frighten the Pati­ent, and put a bad construction on the accidents that sometimes accompany the [Page 92]Operation: it is fit, as much as conve­niently may be, that a Church-man should be present to talke now and then to the Patient, that may help to divert his pain, and encrease his Patience dure­ing the Operation.

When the Patient is seated, the Chi­rurgion, is to place his People to sup­port him and make him spread open his knees, lean upon his shoulders, and to lift up the Scrotum or hold the Catheter, if a Servant present a Bistori, he is to be on the right side of the Operator, who is to cut with the right hand; and he shall hold it in this fashion.

With the Right-hand in which he hides the Blade of the Bistori. The Operator when he takes it, is to put his hand up­on the handle, the other Servants are placed in the same manner for the lesser, as for the great Operation; but they hold the Patient in a different manner, as it hath been represented by the Fi­gures.

When there is a Hernia or burstness the Scrotum is to be lifted up very high, [Page]

[Page] [Page 93]and care is to be taken in making the In­cision not to hurt the Testicles nor the parts which cause the Hernia.

Before the Operation there is sometimes a Procidentia or falling of the Anus occa­sioned by the straining of the Patient: if the falling be considerable, the Opera­tor may endeavour to thrust it up with­out violence, and then lay a Bolster up­on the Anus, which a Servant is to press hard: but if the Servants hand hinder the Operator, there is nothing to be put upon the Rectum; for after the Opera­tion is over it is reduced, and many times returns again of it self.

if the Patient have been cut already, the Incision is to be made upon the ci­catrice, or the fistula, as hath been said speaking of the lesser Operation one may cut on the Right side as well as on the Left, taking heed not to cut the suture, because it does not so easily cicatrice, and is also attended by many accidents.

The Incision in Children is made at least two fingers breadth in length; in men 3 or four fingers breadth or there­abouts, according as the Stone is thought [Page 94]to be of bigness, and according to the Grosness of the Subject. Not that it ought to be made too large, for when the Stone is in the passage, if the Inci­sion be too small, recourse may be had to a Cut with the Bistori, or with a pair of Cizars in a convenient place. The Incision of the Skin and Membrances is easily made, but many times the Ʋre­thra is not sufficiently opened unless one press the Bistori hard in the furrow of the Staff; Incision is never made in the neck of the Bladder, but always in the Ʋrethra, and experience convinces that a great Incision in that Operation is as soon cicatriced as a small one.

The Patient being set in a posture and bound with the Scarffes, his Arms and Legs are held by two strong Men, and, if need be, two others take care to keep his knees asunder, a Servant gets up be­hind the Chair to press upon his shouldi­ers, during the time of the Operation, which is performed, if it be possible, by the lesser Operation, or at least in the great (which is commonly made use for Men and litttle boys) by introducing a [Page 95]furrowed Catheter, wherewith the Oper­ator searches, and is certain if there be a Stone or not.

If nothing be felt with the furrowed Catheter, it is necessary to introduce a Catheter, whose bill is not so long, mak­ing the Patient void his Urine; and if there be a Stone it will by that means be more easily found, because when it Floats, being little and smooth, it will follow the course of the Urine; and the Catheter will turn better in the Bladder. When the Stone is found the furrrowed Catheter is again to be introduced.

If the Patient hath been cut, it is hard­er to introduce the Catheter, and there­fore one is to be taken of a size that would suit with a younger Subject, and sufficiently long, according to the age of him that is to be searched.

There are some Operators who hold the Catheter themselves when they make the Incision: others cause a Servant to hold it, who is placed at the side of the Chair, opposit to the Groyn whereon the Operator is to make the Incision; for example, the Chirurgion performing his [Page 96]Operation on the left side of the suture, the Servant shall be on the Patients Right-hand, and having wiped and dried the Scrotum and Perineum, he shall lift up the Cods with the Left-hand, and shall rest his other hand upon the Rings and end of the the Catheter, inclining the furrowing a little towards the Patients left side, and he must take care not to make it come out of the Bladder, which he may avoid: if he bring not the Rings of the Catheter too near the Belly. The Chirurgion ought to mind first bidding him hold fast and not waver, and caus­ing others to lean upon the Patients shoulders, because at that very time the Operator ought to pull the suture to­wards the right side, placing the Thumb of his Left-hand near the Anus, and his other fingers near the Scrotum having felt with the fore finger of the Right-hand, and observed the place where the back of the Catheter is in the same manner as one does to find the Vein before blood letting) pulling still the suture to the Right, with the Right-hand he is to take the Bistori mounted, which the Servant pre­sion [Page 97]in the place designed, as you see represented by this Figure.

In making incision he is to search for the furrowing of the Catheter, into which he is to thrust the point of the Bistory, he is to press hard, swathing a­bove towards the Cods, and below sink­ing the Wrist, that the point of the Bistory may be always directed into the furrowing underneath the Catheter that the Urethra may be exactly cut, avoiding the Scrotum, the Rectum and the Hemor­rhoide veins; then he shall return back the Bistory. And take the Gorgeret to introduce it into the furrowing; after that with the left hand he shall lay hold on the Catheter by the end which the Servant held.

To prevent the Fingers of the Opera­tors left hand from sliding during the time of the Incision, he may make use of a very narrow compress, to help him to presse and pull the suture towards the patients right side.

If in making Incision the Operator himself hold the Catheter, the Servant who extends the Perineum may upon the [Page 98]same account put very narrow Com­persses betwixt his Fingers and the Skin, that so he may hold the two sides of the suture firmer towards the Thighs; by that means the Humidity will not hinder him to press upon them as much as is necessary.

Monsieur Ruffin a sworn Chirurgeon of Paris, one of the ablest of his time, per­formed the Operation in this manner in the Hospital of the Charity.

After that he had introduced the Ca­theter, and was sure of the Stone, he caused a Servant placed on the Pati­ents right side to lift up the Cods, and having dried the parts that were wet, the same Servant holding his hands al­most open, put his right hand upon the suture pulling it to the right, and the Skin to the left with the other hand which he rested towards the left Groyn, lifting up the Cods with both his hands: The Operator inclined the Ca­theter a little towards the Belly, and pressed upon the Rings with the left hand, whilst with the right fore-finger he mark­ed the place of Incision; then was the [Page] [Page]

[Page 99] Bistory presented to him, and during the time that the Servant held the Pe­rineum, stretched to the right and left without the use of Compresses, he made the Incision as in the other way: This is the Figure of it; the Servant may also with one hand lift up the Scrotum, whil'st with the other that is extended he presses hard upon the Perineum, hold­ing between two fingers the place where the Operator intends to make the Inci­sion. The Servant may likewise do o­therways, it is enough that he hide his two thumbs in his hands, and with the two fore-fingers he may extend the Peri­neum for the same purpose.

The furrowing of the Catheter being discovered and the Bistory returned back, he took a Conductor with an elbow to­wards the middle which is composed of two in the form of a Sword, he thrust the Bill of it into the furrowing still holding the Catheter, and when it was introduced into the Bladder, he drew out the Catheter, and conveighed his Forceps betwixt the Branches of the Con­ductor to introduce it into the Bladder: [Page 100]the Conductor being taken out he con­tinued the Operation.

These two ways are very good, and have both their advantages, because when the Operator himself holds the Catheter he is sure what place it is in; but also after the Incision, sometimes it is hard to find the furrowing because of Fat, Membrans and Blood that hide it; it is true that after Incision the point of the Bistory may be left in the furrowing, and may be held by some body whilst the Chirurgeon slides the Bill of the Gorgeret along the Bistory, but when a Servant holds the Catheter, after that the Incision is made and that the Ope­rator hath given back the Bistory, as we have Just now described, he may put the Nail of his left Thumb into the Wound, and having found the slit or fur­rowing, thrust therein the Gorgeret which ought to be hid in his right hand, so that the right fore-finger cover the length of it, suffering nothing almost to appear but the Bill: So soon as the Bill is in the furrowing, he takes the Catheter by the rings in the left hand, as is here represented.

And now there is great care to be tak­en in introducing the Gorgeret into the Bladder, for if the Patient push hard he may make the Catheter to come out, and then bad accidents happen; for if one thrust forwards the Gorgeret and then the Forceps, when they are not in the Bladder, a space is made betwixt the Urethra and the Rectum. To avoid mistakes the Operator ought to have an attentive mind, and not talk. And then having passed the Bill of the Conductor called the Gorgeret into the furrowing of the Catheter, he is to hold them fast, keeping the Bill always in; And as if one intended by guiding and making it slide along and under the furrowing, to thrust the Bill upwards; by this means one is sure to introduce it into the Blad­der, and holding it with his right hand the Catheter must be disengaged from the Gorgeret by turning it with the left, and then softly and easily drawn out of the Yard. A certain sign that the Gor­geret is in the Bladder, is the emission of Urine along the Conductor; that is, if there be any in the Bladder.

When the Gorgeret is in the Bladder, and the Catheter drawn out, it is taken hold of with the left hand, and a con­venient Forceps with the right, which is to be thrust upon and along the same Gorgeret in this manner.

Though the Gorgeret or Introductor be put into the Bladder, yet it may be forced out again by the Patients strug­ling, which may be prevented, by cau­sing some to press upon his shoulders, and others to hold him fast by the hands and feet; the Operator in the mean time who then holds his Gorgeret with the left hand that he may take a Forceps in the right, must not forget to take no­tice if any of that which he hath intro­duced come out again; for if he per­ceive it much without the Incision, it must not be thrust forwards to make it enter again as before, nor yet wholly drawn out, because perhaps it may not be out of the Bladder, and if it were, it would be too great a risque, because the Urethra and other parts falling together again, a space would be made betwixt the Bladder and the Rectum, as hath been [Page] [Page]

[Page 103]already said; but having taken a Forceps of an indifferent size rather small than too great, he is to pass it along the Conductor, without forcing any thing; if he find any resistance when the thrusts it gently forwards, the Conductor is to be drawn out; if he cannot but with difficulty open the Forceps, he may be sure that he is not in the Bladder, and then without speaking, the Forceps is to be taken out, and whil'st it is a washing in warm Water, and making dry, the Chirurgeon shall take the button with his right hand, and if need be lift up the Cods with the left that he may pass it into the Wound, turning it towards the Yard, and conducting it upwards towards the Bladder, in this manner.

The Button being blunt hurts not the parts in passing, and when it is in the Bladder (which may be known, be­cause then it may be easily turned every way) the Stone is softly to be search­ed for by gently jogging and moving the Instrument; which being felt, the Chirurgeon is to take the Button in the left hand, conducting with the right the [Page 104] Forceps close upon the Button into the Bladder, this is the Figure of it.

If it be a crooked Forceps, whilst it is introducing, the Bill being turned to­wards the Yard, the rings are more to be raised, as may be observed in this last Figure, in a manner different from the former Figure, Page 92. which re­presents the streight Forceps conducted upon the Gorgeret with the right hand bending lower upon the left. The Crooked Forceps is made use of, when the Stone is thought to be very near to the Groyn; but most commonly the streight Forcipes are sufficient, and both the one and the other ought to be laid upon the line of the Button, so that it touch on both sides.

When the Forceps is in the Bladder the first thing to be done, is to open it for dilating of the passage, then having joyned the Rings almost together, it is to be gently turned and moved every way to search for the Stone, whilst the Forceps is in the Bladder, the Teeth are not to be joyned again, for fear of of­fending some part, and then the Patients [Page]

[Page] [Page 105]thighs may be brought a little nearer to­gether, and not kept at such a distance during the rest of the Operation as they were before the intromission of the Catheter.

It is to be observed that as often as one would change a Forceps, or introduce it, there is a necessity of making use of the Button, except immediately after the Incision is made, when the Conductor is introduced, on which the Forceps is thrust forwards.

Remember that after the Incision is made, and the Conductor introduced in­to the furrowing, when one would dis­engage the Catheter, or that it is out of the Yard, the Patient sometimes strugles before the Conductor be in the Bladder; or other ways when the Ure­thra has not been cut enough towards the Bladder, or that the Bill of the Con­ductor be not dextrously thrust into the Slit or Furrowing, instead of entering into the Bladder, a space is made betwixt it and the Rectum. Then must the Con­ductor be drawn back; and if afterwards one cannot introduce the Button, it will [Page 106]be necessary to take the same furrowed Catheter, or one somewhat smaller and less Furrowed: For better passing it into the Bladder, making use of the Second way of searching Men, described in the Ninth Chap. by that means the Cathe­ter is gently introduced into the Urethra, without turning of it any way, lest it should come out at the Incision, and when it is passed into the Bladder, the furrow­ing is to be searched by the Wound with the Bill of the Gorgeret, that so the Operation may be continued.

When the Gorgeret is in the Bladder, if it be feared that the passage is not open enough, a close dilatatory is to be tak­en, and held in this manner that one branch of the handle pass upon the thumb betwixt the right fore-finger which the Chirurgeon is to extend a long the dila­tatory, and the other three fingers un­derneath, that it may be held fast; it is introduced along and upon the Con­ductor, and without turning it any ways, the bottom of the Incision is dilated in length, as much or as little as it is thought sit, making the branches of the handle [Page]

[Page] [Page 107]to come near one another in this manner.

There is as little use of this made as can conveniently be, nevertheless if ne­cessity require it is used; after which it is pulled out, and without parting from the Gorgeret, the Operator takes a close Forceps conducting it into the Bladder to search for the Stone, where it must be gently turned and jogged every way, as hath been said.

It is to be minded also that it hath been said, that so soon as the Forceps is in the Bladder, it may be moderately opened with both hands to dilate the passage a little, and at the same time to bring the Rings almost together, and afterwards with one hand it may be thrust and moved gently to the right and left, up and down where the Sphincter of the Rectum is, to feel the Stone, sometimes turning the Forceps so that one of its Rings be higher than the o­ther, thereby endeavouring to lay hold of the Stone, which may be flat, or lye hid at one side of the Bladder.

When it is found, the Forceps is to be opened with both hands, to gripe what has been felt. The Operator is sometimes so fortunate as to take good hold of the Stone in a small time; which is to be known, because after that the Forceps hath been opened, the Rings cannot be made to meet again, and some hard matter is to be felt betwixt the Teeth: This is the surest sign, for very small Stones may be taken hold of about the middle of the Forcipes, where they are more bent than else where; which will not hinder but that the Rings may be brought to meet; but still some hard­ness is to be felt. This hath happened to me, and it was thought that there had been nothing; but I felt that hardness in the Forceps, and I have the Stone of that Operation still by me.

When the Stone is laid hold of, one must not at first pull towards him, but it is requisite to turn gently the Forceps to the right and left, holding it with one or both hands according to the convenience of the Operator, that so he may know if the Stone lye right in [Page 109]the Teeth, and disintangle it from a­mong the Plicatures, pulling to him af­terwards without violence: the Rings of the Forceps are to be raised and low'rd alternatly, to make the Stone slide with greater ease. If one have made use of a crooked Forceps, the Bill of it must have been turned towards the Pubis just at the passage of bringing it out; and the Rings be very near the Yard: that one may not be mistaken, it would be necessary to put a mark upon one of the Rings of the Forceps.

When the Stone is in the Forceps, special care is to be had not to turn it quite round, because if the Stone be big or uneven, it will much confuse the parts of the Bladder: If the Stone be soft, it 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 [Page 110]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 [Page 112]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 [Page 113]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 [Page 114]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.

The ends of the Languette or piece of Linnen wherewith the Tent is mounted, may be tied to the girdle that is made with the bandage, one before and the other behind: or otherwise one may carry an end along each Groin of the Patient, and leave them on the Pubis. Next day or some days after, the Tent is to be taken out, and if there remain [Page]

[Page] [Page 115]still somewhat in the Bladder, one may endeavour with the Hook, or the Scoop of the Button, or with the Forceps con­ducted by the Button, to extract the Stone whilst the Patient lyes a Bed; or otherwise he may be placed upon the Chair as at first, yet without useing of Ligatures or Scarfs, because then the Patient is weak, and it would put him in too great fear.

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 [Page 116]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 [Page 117]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, if they be shut close when they are in the Blad­der, because it is wrinkled, and the sides of its Body or Bottom may be laid hold on without the Stone or with it.

The Symptoms that follow the Ope­ration in the Cure by Lithotomy, are a painful tension of the Belly, the re­tention of Urine, Watchings, Inflam­mation in the parts affected, Looseness, Diarrhaea, Worms, Ecchymoses, Fluxi­ons, Abscesses, Excoriations, Itchings and Putrifaction, Ulcers in the Scrotum, and the Neighbouring parts, Ulcers and Putrifaction of the parts of the Bladder, to great, or too long Suppurations; voiding of Purulent matter by the wound, or with the Urine by the Yard, Feavers, universal or particular Con­sumptions or Marasmus's, Hemorrhages as in the time of Operation, Syncope's Convulsions, Vomitings, Lightheaded­ness or Deliriums and Shiverings.

The painful tension of the Belly is caused by an inflammation that attracts a Fluxion, because the Ligaments which suspend the Bladder, and the other parts to which it adheres, have suffered violence: The Feaver and Restlesness proceed from the Intemperies of the chief parts, agitated by the passions of the mind; And the Hemorrhage from the Incision, or Erosion of the Vessels: The retention of Urine is occasioned by coagulated Blood, or the inflamation of the parts during suppuration, or by some little Stone fallen down from the Kidneys, or a fragment remaining after the Ope­ration: The inflammation comes from a circulat motion of the Humours; the Scourings, looseness of the Belly, and Worms in Children through the abun­dance of Phlegme; the Ecchimasis is an effect of extravasated Blood; the Abscess is produced by a collection and continuance of Humours in the inter­stices of the parts: the too great and too long suppuration, by the quantity of the matter whereof the Abscess is form­ed, or by the Ulcerated Kidneys, and [Page 119]by the liquefaction of the Humors of the whole Body, of which part do sup­purate whilst the rest are dispersed by Transpiration or Looseness, which causes at the same time a Marasmus or ex­tenuation of the whole Body: The Ulcer of the Bladder is caused by contusion and suppuration of its parts, which excites the running of Purulent matter by the Yard or Wound: Fungous carnosities by a superfluity of ill concocted and too serous Blood; the Itching and excori­ation are the effects of the sharpness of Urine, or of too strait bandage; the Putrifaction of the Ulcer comes from the corruption of the Humors and of the Air, or from the too great humidity of Medicines, and the Virulence, from the Acrimony of the Humors and Medica­ments: The Vomiting happens after the Operation, because many nervous Fibres of the sixth pair are distributed and in­serted into the Ventricle. There are other accidents occasioned by the distribution of the Nerves, which pass through the holes of the Os sacrum common to the Sphincters of the Bladder and Anus, [Page 120]which have been bruised or lacerated by the Forcipes, or by the asperities of a great Stone, especially when the Opera­tion hath been hard and laborious.

The Fainting or Syncope, is occasi­oned by a great Flux of Blood, and the dissipation of the Spirits: The Convulsi­on happens by Vomitings, the Diarrhea & Hemorrhage, which hinder the Nerves from receiving a sufficient quantity of Spirits: The Delirium and Light­headedness Superveens, when there has been so great a dissipation of the Ani­mal Spirits, that the Brain retains not enough for it self, and for supplying the whole Body with a quantity sufficient for performing the functions of its seve­ral parts. In a word, Fate puts and end to all these accidents by destroying the Machine; that is to say, by abolishing of Motion at the instant when the Soul is separated from the Body.

If any be surprized that we have spo­ken nothing of Pain, they ought to con­sider that that is a Symptome, or rather an essential property of all diseases of the parts that are capable of feeling, [Page 121]since it always happens, where there is an Intemperies with a solution of continuity of the soft parts and by conse­quence it is more sensible in Lithotomy, than all the other accidents that we have been speaking of.

These Symptoms have their causes, their Diagnostick and Prognostick signs: some are the cause and the signs of others, and all the Symptoms in general, are caused by Pain, Fear, Hemorrhage, Contusion and Dilaceration of the parts.

The Prognosticks are taken from the time, the violence, and the state of the subject in which the accidents happen. The Symptoms that appear at first, are not so dangerous, and those which last long, or happen in a Cacochymick Body, are more to be feared.

An Operator who is expert in perform­ing the Operation will avoid many conco­mitant Symptoms. There are some nim­bleblades who have the knack of feigning that they have extracted a Stone, and con­vey one, though they have found none.

The Symptoms that follow the Ope­ration, are either by themselves apart, [Page 122]or many together according to their Na­ture, corrected by various Medicins.

The first care is to asswage Pain by Imbrocations and Fomentations: a He­morrhageis sometimes to be feared, and therefore astringent topicks are to be employed for preserving the treasure of life. The loss of Blood ceases common­ly through the weakness of the Patient, because the Medicins that are applied to this part are dissolved by the Urine; and besides no other bandage but the contentive can be used, when in other parts one may put his Finger upon the Orifice or opening of the Vessel, or cut it in two, apply to it a Button, a Liga­ture, Pledgets and Compresses. It is com­monly observed that the first dressing be kept on, for the space of Twenty four Hours at most: it is tenderly to be taken off, leaving a Pledget upon the place out of which the Blood does Issue, if it can be known; and if the Hemorrhage recurr, recourse is had to astringents.

CHAP. XIX. Of the Method of curing those that are Cut, and removing their Symptoms.

WE come insensibly to the cure by Lithotomy, the method of which is either general or particular. Having spoken of the Causes, Kinds, Signs and Prognosticks of the Symptoms, it is now proper to give you a notion of those things which ought to be obser­ved from the time of the Operation until the perfect cure of the Patient. By that means we may treat in particular of the remedies against accident; since they happen whilst the Patient is in the Chi­rurgeons hands.

By the general cure by Lithotomy we understand that wherein no Symptoms happen which are of the Nature of a cause. And by the particular cure, that which is attended by troublesome accidents, such as cause the methods to be changed: of each of these we shall speak apart. [Page 124]Supposing that the Chirurgeon hath suc­cesfully performed his Operation, he must dress the Wound, and endeavour by the help of Medicines to cure it.

The first thing that is to be observed after the Operation, whilst he that is cut is still in posture, and that with all expedition he is a clearing of the Liga­tures, if any have 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 [Page 126]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 [Page 127]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 Ʋre­thra with a Plaister, Compress and the Frond or double T, of which [Page 128]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 [Page 129]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 [Page 130]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 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 [Page 131]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 Marsh­mallows, 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 [Page 133]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: [Page 134]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, [Page 135]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 [Page 136]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, Ʋnguentum 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, [Page 137]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 for Men: to use it a right, the Girdle is to be put about the Patients Body, and one end of it be­ing carried within the Collar, and both ends tied, one of the ends of the Tail of the T. is to be taken betwixt the Thighs, and making it pass obliquely upon the dressing, it is tied to the Girdle in the op­posite side to that from whence it is taken; the same is to be done to the other end, fastening them together by a kind of a knot called the Mariners knot, having a care not to stop up the passage of the Anus.

Fainting, Convulsion, and Vomiting, go often hand in hand together; but the last appears more frequently than the others; it is remedied by Wine, and by cordial Potions made of Treacle; the Confection of Hyacinth, Alkermes, Co­ral, prepared Pearle, Powder of Vipers, Syrup of Pomegranats, in Balm Wa­ter and Scorzonera Water, Carduus be­nedictus, and Woodforell, &c. accord­ing to the various indications: these Medicines and the Dose of them are to be chosen and determined according to the advice of a Physician, giving them at first in a small quantity often renewed, because of the debility of the Stomach.

When the Vomiting is stopt; the Con­vulsion ceases, and the fainting is cu­red by succulent nutriment, such as good Gellies, strong Broths, new laid Eggs which strengthen the Patient if they stay with him: the reason is evident, be­cause inanition is the cause of these two Symptoms, and the Animal Spirits be­ing but in a small quantity, prick the Nerves, which contract and draw to­wards their Origination.

The Wound does sometimes foul, and by too great suppuration, according to Guy of Chauliac; it is observed to de­generate into a sordid Ulcer, and most commonly virulent, because of the A­crimony of the Urine, and irritated Hu­mours that grow mordicant and biting. These kinds of Ulcers are never without Inflammation, Itching, and Excoriation of the part: for such accidents we are to make use of diverting, restraining and local Medicines, applied according to the Temperament of the part, and the counsel of the same Author, in the Chapter of Wounds with Hemorrhage: When many Symptoms appear together, the same Rule is to be observed, and to have regard to the order, the urgency and the cause, and especially to that which is most urgent, amongst other things carefully observing the effects of topical Medicines, wherein Chirurgery does most consist.

For curing of Diliriums and Light­headedness, strong broths are given, minced meat made with Veal, Pullets, Partridges cut small and put into an ear­then [Page 140]then Pot glazed, without water, well luted, and digested in Balneo Mariae; hearty food that is full of good Juyce, and of easie Concoction, for speedy re­pairing of the inanition, and temper­ing the Animal Spirits, the truth is a Dilirium with cold in the Extremities are of such affinity, one with another, that they may be put into the same rank, and a Dilirium after Lithotomy is, as it were, the last degree of the Disease, the strugling of Nature, and the fore­runner of Death.

CHAP. XX. Of the Ischuria, or suppression of Ʋrine.

THE Bladder is a Membranous part, that may be distended and en­larged by the quantity of matter con­tained therein, and when it is full or stimulated, that which is within opens the Sphincter that it may make to it self a passage into the Ʋrethra.

When all things are in a natural state, Man suffers no inconveniency because the things contained within are in due time evacuated; but congealed Blood, or coagulated Pus, condensed Seed, a Stone, a Fungous Body, gross Humours, or Phlegm with Sand, one or more of the inferiour Vertebraes Luxated, hardened Excrements, a Child dead in the Mo­thers Womb, a Carnosity or Callosity sometimes stop the Sphincter of the Bladder, or a place of the Ʋrethra, it is the same when a Viscous Humour causes a Numness of the Bladder, or when a Patient is in a dull and drouzie fit; which is occasioned by a diversion of sensation, an extasie in the Brain, or a convulsion of the Nerve which goes from the Os sacrum to the Sphincter of the Bladder, and by Malignant Fea­vers.

Besides those causes of suppression of Urine which we have reckoned up, we are to take notice of the shrinking or flagging of the Ʋrethra, to which Old Men are subject; the Compression of the Neck of the Bladder caused by the falling [Page 142]down, or inflammation of the Matrix, or the Prostates and Parastates, the in­ternal Hemorrhoide Veins, or by a great quantity of Urine which distends the Fibres of the Bladder, as is related by Pareus, L. XVII. of a Young Man, who having kept his Urine too long, fell into a suppression though he had no Stone, and was cured by the Catheter. Fabrit. Hild. says, L. de Lith. Chap. 3. Col. I. that that excellent Mathematician Tycho-brahe being in a great assembly at Prague, where being forced to keep his water very long, he fell into so vio­lent a Suppression, that he could not be cured, but died of it.

The retention of Urine, from what cause soever it proceed, produces a vio­lent Pain, and insupportable inflammati­on in all the Neighbouring parts of the Bladder, from whence a suppression is occasioned, because the Urine is not voided, and that it is continually aug­mented in quantity. In that case Pati­ents are all over in a heat, their eyes look red, their face burning, have an Oppression, Restlesness, Feaver, a hard, [Page 143]painful and very large Swelling above the Pubis; bilious Vomitings, and all these troublesome Symptoms reduce them to such a state, that without speedy help, they expect nothing but death.

The Chirurgeon will know that it is a clot of Blood that is the cause of the Suppression, if the Patient hath been lately Wounded in the Kidneys, or hath pissed Blood; if an Ulcer in the Kidneys has preceded, and the Patient hath made Purulent water, he may conjecture that a collection of thick and viscous Pus is the cause of it: if the signs of the Stone have appeared, he is to acquaint the by-standers with it, he may discern it from a Fungus by the Catheter, un­less the Stone be wrapped in a Coat; he may know if it be a Carnosity or Callosity, by means of the Catheter or a searing Candle. I say nothing of the Patients manner of living, whose ex­cesses may have been the cause of sharp Humours, or a great inflammation: nor shall I neither speak of other causes which manifest themselves. Now if many causes of Suppression joyn together, the [Page 144]diversity of Symptoms will serve for a sign to make the Prognostick by.

The Patient cannot for many days en­dure a Suppression, without being much weakened and in danger. When it is caused by a falling down of the Matrix, there is no more to be done, but to re­duce that part; when the Hemorrhoides press the Neck of the Bladder, they must be opened with a Lancet or Leeches; the Numness of the Bladder is remedied by a grain of Salt or Nitre put into the passage of the Urine, or with a compo­sition of Mel Rosatum and the Powder of Hiera, or the Oyl of Scorpions: when there is congealed Blood, Purulent Mat­ter, or thick Phlegm in the Bladder, we may make use of an injection of Oxymel with the Oyl of sweet Almonds; in the Flagging of the Ʋrethra, hollow Wax Candles are imployed; if there happen any Carnosity or Callosity in it, they are incided and eaten off, and af­terward a Leaden Pipe introduced into the place. When one hath kept his water too long, if he be afraid of being searched, bags of Pellitory of the Wall [Page 145]moistened with the Oyl of Capers or of Turpentine are to be laid upon the Pubis; and if he do not find ease upon that, he is to be perswaded to suffer the intromission of the Catheter. The in­flammation of the Rectum, the Matrix and Prostates is allayed by Blood-letting, and Glysters of Oxycrat, Pellitory Wa­ter, or the Decoction of it with Mel Rosatum, and a Bath of warm Water.

For all suppressions of Urine, when there is no other apparent disease, it is of sin­gular advantage to let Blood, give cool­ing Glysters and Bath; because common­ly they are caused by meer inflammation, and the weakness to which the Patient is reduced, does often laxat the parts, and make way for the Emission of Urine, the retention whereof puts him in danger of Death.

Galen 13. of the Meth. before Pareus L. 17. C. 37. advises not to give Diu­reticks, nor strong purgatives before Blood-letting; because they may acce­lerate the motion of Humours, or of Praeternatural Bodies towards the Bladder, and fill it fuller, whilst the obstruction [Page 146]of the Sphincter hinders the evacuation of the Urine.

But though all remedies have been used; yet sometimes the Patient is not eased; in that case if he cannot be search­ed, and the distemper be very urgent, it is better without delaying several days, to bring him to consent to be cut, if he be troubled with the Stone. And if it be only Urine retained through an inflammation of the Sphincter, or by a thick and viscuous matter, it will be ne­cessary to Prick or Tap the Perineum.

CHAP. XXI. Of the Puncture or Tapping of the Perineum.

IT is to be supposed that the Patient hath found no ease from all the Me­dicines that have been administred unto him, and that the suppression continues with such Symptoms as give ground to a sad Prognostick, and call for speedy relief to the Patient.

The great relation that there is be­twixt Lithotomy, and the Pricking or Tapping of the Perineum, gives us ground to propose three ways of Practising it; and seeing they have no proper names we shall distinguish them by those of the various Methods of Lithotomy, to wit, the Hight, the Great, and the lesser Ope­ration.

Though it hath been said, that the High Operation is not in use, never­theless it would seem that the great Tu­mor above the Pubis, caused by the sup­pression of Urine, especially in an ex­tenuated Patient, might render the Ope­ration easie, without any fear of hurt­ing the parts of the lower Belly; and that for that purpose, having Prickt the Tumor with a Lance as deep as the Blad­der without Tying the Patient, it will be sufficient to introduce a Wire or Stilet, that may serve for a conductor to a crooked and convenient Pipe, pas­sing it into its cavity.

The High Operation of Tapping the Perineum may likewise be practised by means of a Trocart with which the [Page 148]Punction may be made in the Tumor above the Pubis; it may be certainly known when the Bladder is open, & then a Wire is to be passed into it; and having pulled out the Trocart, the Wire will serve for a Conductor to the Pipe, just so as to the Parakentesis or Tapping of People in Dropsies. We shall give the description of this Trocart, and of the manner of using it, when we come to speak of the third way of Pricking and Tapping the Perineum.

The second way that is in use: is the great Operation, as I have seen it practi­sed by men of great skill and reputa­tion, whose method I have followed. There needs no more but a Pipe or Canula mounted, a small Tent propor­tionated to the Cavity of the Pipe, two Plaisters, and two Compresses the one a little bigger than the other.

All things being in readiness, and the Patient seated in posture and held as for Lithotomy; to be more assured of the way that must be taken in making the Incision the furrowed Catheter is to be passed into the Ʋrethra as far up as it [Page 149]can go, without forcing any thing; if the inflammation be moderate, or if there be no carnosity, nor other obstacles, it is to be introduced into the Bladder: A Servant or the Chirurgeon himself may hold the Catheter, and he is to observe all circumstances as in cut­ing for the Stone, making the Incision lower than for Lithotomy, and shorter upon the slit or furrowing; into which he is to thrust the Bill of the Gorgeret, to introduce it the more easily into the Bladder. It is fit that the furrowing continue like a gutter, without any thing to stop it at the Bill or Extremity of the Catheter; the voiding of Urine is a certain sign that the Gorgeret is in the Bladder; and then the Catheter is to be disengaged and softly pulled out. The Chirurgeon is to hold the Gorgeret in one hand, and in the other, the Tent or Pipe mounted with the end dipped in Oyl, and he is to conduct it into the Bladder, by means of the Gor­geret, or in defect of that, if it be come out of the Bladder, he may take the Button with a Scoop, and use it as [Page 150]hath been said already. If there be no Button, one may make use of a big Wire, which being introduced into the Bladder, will serve for a conductor to the Tent or Pipe.

Though one could not pass the fur­rowed Catheter into the Bladder before the Operation yet it will easily enter after the Incision, because that little Blood that is spilt, will dissipate the Spirits which caused the inflammation and tension in the parts.

Tavenin Chap. 121. of his Operations proposes, not to introduce the Catheter, but the Patient being put into a posture to make the Incisio with a Bistory betwixt the Anus and Scrotum, on the side of the Seam or Suture, in the same place that it is made in for Lithotomy; being come, (says he) near the Blad­der, it is to be opened, thrusting the Bistory or Lancet boldly up, until that the Urine come out, then the Tent is introduced, and so the Operation is ac­complished.

It is not convenient to evacuate all the Urine, if it was excessive in quantity; [Page 151]because too great evacuations are always hurtful, according to Hippoc. Book 2. of his Aphorisms; but having voided as much as may consist with the strength of the Patient, with a little piece of Linnen Cloth one may stop the Orifice of the Tent or Pipe, and having put a Com­press upon it, some Body is to hold his hand thereon, assisting the Patient to 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 [Page 152]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.

If the Catheter cannot be introduced into the Ʋrethra, or if the Patient will not admit of it, the Operation is more [Page] [Page]

[Page 153]Laborious; nevertheless seeing it is a pressing distemper, for the prolongation of life, there is a necessity of Opera­ting after another manner, to wit, by the high operation that hath been mention­ed, or after that way to which hath been given the name of the lesser Ope­ration for the Pricking or Punction of the Perineum: for that end one may make use of an Instrument called Tro­cart, a Stilet or Wire, and a Tent or Pipe mounted. I invented this Tro­cart above five years ago and this is the Figure of it.

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 [Page 154]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, [Page 155]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, [Page 156]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 [Page 157]two-edged; but still proportioned to the Tent or Pipe, the instrument in its length is streight and hollow, and has two openings near the basis of its point; that Instrument is passed into the Tent, and in that posture the punction is made, the opening of which is always less than the Orifice of the Tent; and it cannot be introduced without great pain to the Patient; besides, this Trocart must be Thrust deeper in than the other, before the Urine can be perceived to come out. All men are free to examin and try those things, and to choose what pleases them best.

These Trocarts may serve for other Operations, as in a kind of Hydrocele, where the Waters are gathered together, without being stilled into the very sub­stance of the Membranes; in the Para­kentesis; or even in making perforations through the Skin, and passing the Silk and Stones because about three or four fingers breadth from one end of the Tro­cart that was first described, a hole may be made like the eye of a great Needle through which the Silk may be passed.

Every time that it hath been used, it must be new set, for the Urine blunts the edges very much. It is good to practise such kind of Operations upon dead Bodies: for that end, one must with a Syringe Squirt as much matter as possibly he can, into the Bladder, then tie a Ligature about the Yard, and make the Punction as hath been de­scribed, and then make a dissection of the Bladder, to observe what hath been done, that so he may take his measures for another time.

We may avoid offending the Rectum by conducting the point of the Pyra­mide towards the Bladder, which then is much distended, and we need not fear to open it in the Body, because these Wounds are not absolutely Mortal. And though they are said to be harder to consolidate in the Membranous part thereof, nevertheless we should banish such apprehensions, because we see by experience that they are cured, and that the business is to save the life of a dy­ing Man.

They to whom Fistula's do remain after the Punction of the Perineum, make use of a Tent which they cause to be opened, and stopt now and then for the voiding of the Urine: they may be made to stop with a Screw for greater security. The ends of the Linnen Cloth or Languet of the Tent; are tied the one before, and the other behind to a Girdle, held up by a Collar, like those which have been described when we spoke of the bandage of the Yard for a Phimosis Chap. X. If some Symptom of Lithotomy succeed the Punction of the Perineum, it is to be remedied ac­cording to its kind; and when none ap­pear, or if they be cured, the Patient and Chirurgeon may have good hopes, and both doing their duties, with ex­ternal assistances the Lithotomy and Punction of the Perineum are brought to a perfect cure. Nevertheless what care soever the Chirurgeon may have, and how obedient, confiding and quiet, so ever the Patient may prove, assisted as he ought to be by those who attend him, and the administration of proper [Page 160]Medicines, yet sometimes he hath the trouble to be incommoded by the other distempers contained in the following Chapter.

CHAP. XXII. Of diseases that happen after cutting for the Stone, and of the way of curing them.

GƲY of Chauliack in his second Treatise says, that if there be no Metastasis of the Humours into Apo­stemes, they are terminated by Discussion, Suppuration, Obduration and putrifaction and afterward he speaks of the manner of treating and curing them. This shews that there is a difference betwixt their term, their curing and their cure, the end of one disease may be the be­ginning of another; the cure hath an uncertain end, though healing be that which is proposed according to Art; we see but too many instances of this in those that are troubled with the Stone; that evil is terminated by the extraction of the Stone; and that Stone taken [Page 161]out, or that the distemper ended by the Operation, produces a Wound, or other accidents, the cure of which is necessa­ry; and which nevertheless do not al­ways terminate in a cure, but sometimes in a new Stone, a Fistula in the Peri­neum, an involuntary spilling of the Water, a preternatural voiding of excre­ments, or in many diseases together; they have each of them their Causes, Differences, Signs, Prognosticks and Ways of Curing.

We shall say nothing as to the Stone which may be observed after that the Patient hath been under cure; we must only take notice that the cause of it may be this, that there is a Quarry in the Kidneys, which from time to time fur­nishes the Bladder with Stones, and then the Operation ought to be delayed, un­less the Patient be fully recovered in strength, the season be favourable, or that the accidents be remedied; And above all the Patient had need of a ve­ry great stock of resolution to endure a second cutting.

The Fistula in the Perineum where­of [Page 162]of we speak is a Sinuous Ulcer below the Scrotum, with a Callosity along the length of it, by which the Urine issues out. It is caused by the Chirurgeons fault, or by the Patients, by the super­vening of accidents, or indeed by many things concurring, when the Chirurgeon and Patient do not do their duties, and that bad and violent Symptoms appear in the time, or a little after the Operation.

By the fault of the Chirurgeon; when in the beginning he suffers the Lips of the Ulcer to be to soon joyned together, before he be certain that the Bottom of it is detersed and agglutinated, or be­cause no accidents appearing he hath di­lated the Bottom of it to much, and that he hath not had care after the first eight or ten days at most were over, moderat­ly to Compress the bandage, and to make use of small and very narrow Compresses laid upon the two sides of the Incision.

On the part of the Patient, when his Urine being too sharp corrodes the Ʋrethra, and hinders the reunion, or that he lies not still as he ought, not ob­serving [Page 163]Directions, and not suffering himself to be treated according to the rules of Art; to which must be added his being emaciated, the abundance of Urine, and if he moderate not his pas­sions, or exceed in his food, the super­fluities whereof causes a too long sup­puration.

The most remarkable accidents that contribute to the Fistula, are a Putri­faction, which causes great loss of substance in the Ʋrethra, and adjoyn­ing parts; an Ulcer in the Bladder, or Kidneys, the suppuration whereof re­quires that the parts be kept dilated.

The differences of these Fistula's are drawn from hence, that some of them are even and straight from the Skin to the Ʋrethra, without any other profound or superficial sinuosity, and are apparent on the side of the seam; others have their Orifice in the Rectum; some are accom­panied with great loss of substance, others have one or more sinuosities in the Ʋrethra, and in the neighbouring parts, or otherwise they happen in a bad subject; and these differences are [Page 164]discovered, if it be observed in time of dressing the Patient, that thirty or for­ty days after the Operation, the Ulcer cicatrises, except one or more little passages, or a small Lump or Tubercle, which is named, the Pullets rump on the side of the seam, through which the Urine escapes; or if the Patient being much extenuated, the superveening ac­cidents have caused a great loss of sub­stance in the Ʋrethra, or that new Flesh cannot breed; the issuing of the Urine by the Anus makes it apparent that the Orifice of the Fistula is in the Rectum.

All Fistula's in the Perineum are not alike hard to be cured; for the first kind may be taken into cure, provided there be no great loss of substance, and that the subject be good, the rest being com­monly incurable; some of those who are troubled with Fistula's have this comfort that they do not always run. If the subject be good, not too lean, and the Ulcer filled with well conditioned Flesh, the cure of the Fistula may without interruption be undertaken: but if the Patient be extenuated, or if there be [Page 165]great loss of substance in the Ʋrethra with Callous Flesh, the cure is not to be attempted, until the strength be re­stored, that it may be tryed if new Flesh can be procured. In that case he must be comforted, giving him hopes that at another time he may be cured. Those that have their Orifice in the Rectum are sometimes less troublesome and they are not to be tampered with.

For curing of the Fistula, we shall not speak in this place of the universal regiment, we suppose that to have been observed, either whil'st the Patient was under cure for the Stone, or since, but we shall only treat of the particu­lar management of that cure. Authors speak of Potions and many Topical Me­dicines for the cure of Fistula's: but since my design is only to describe what I have observed to have been successful, I can affirm that many have been cured by the following means; which consists in introducing into the Bottom of the Fistula, a Catheretick Trochisque de­scribed in the last Chapter; next the falling off of the Escar is to be procu­red [Page 166]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 Ʋrethra, 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 Ʋrethra, 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 [Page 168]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 [Page 169]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 Ʋrethra above and near to the place where the Incision hath been made. When the Bandage is applied, the little Eminence presses the Ʋrethra 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, [Page 170]where there might be a Bolster for the Rupture, and the little eminence for com­pressing the Ʋrethra, 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 [Page 171]he cut the Rectum, especially in the les­ser Operation, if he take not good heed; most frequently the violent Motions of the Patient contribute to it, but much more Putrifaction, Abscesses, or other Accidents that follow the Operation.

Their Kinds, Signs, and Prognosticks, are taken from the more or less Eject­ion of the Excrements by the remaining Fistula, which is far more uneasie than the spilling of the Water, or the Fistula alone. The Cure of this stercoral Ex­cretion is impossible, when it is caused by Incision of the upper part of the Sphincter of the Rectum, or when there is great loss of Substance; if any pre­tend to take such Patients into Cure, they are to observe the Method of curing Fi­stula's in the Anus.

We need not enlarge to prove, that these kinds of Distempers may have se­veral Causes concurring at the same time; when many of these Indispositions hap­pen together, we must have our recourse to the Method of curing complicated Di­stempers, as well for the Prognostick Part, as for the order of the Complications.

CHAP. XXIII. Of Medicines to prevent the Stone, for a­voiding of the Stone, and of Medica­ments for dressing those that are cut.

THough we promised to enquire in­to the Medicines that may pre­vent the Stone; we must, however, con­fess, that it is very difficult, and perhaps impossible to determine precisely where­in they do consist; because the most learned in natural Discoveries, speak on­ly in general of the Figures of Bodies, and Microscopes have not been able to make known the particular Nature of e­very one, nor yet of all their Pores. Possibly we might succeed without ob­serving all these Particularities; for though Enquiries into Nature were pur­sued to that very point, yet still there would be causes that did not depend on us, and which might form the Stone; the Bigness, Figure, Number, and Motion of the Particles of Bodies of which we are composed, and of those which serve us for Food, are no ways in our power; though these things be sufficient to pro­duce [Page 173]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, [Page 174]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 [Page 176]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 Marsh­mallows, 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 [Page 177]of Salt: Keep it for the Use aforesaid.

The Garden-flags, or blew Flower­de-luce that grows upon Walls, infused cold into what quantity one pleases of White-wine, and an Ounce of the In­fusion, taken for the first time by Chil­dren of ten or twelve Years of Age, brings away the Stone: The Dose is to be increased or diminished, according to the Age of the Patient and its Opera­tion, giving always too little, rather than too much, for fear of drawing the Stones in too great abundance towards the Sphincter of the Bladder, which would cause a suppression of Urine. One may renew it two or three days after, and Purge by the Advice of a Physician. The use of White-wine, Raddish-water, and Wine made of the Fruit of Eglan­tine, or Sweet Briar, taken now and then, is good.

Paracelsus, in the end of the Preface to his second Treatise of his great Chi­rurgery, prescribes for remedying the suppression of Urine, the use of the stones that are found in the Heads of Crabs, beat into a subtil Powder, drank in the [Page 178]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, 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 [Page 179]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 [Page 180]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. ℞ Nucleorum mespil. Unc. 1. Pul. elect. [Page 181]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, Ʋnc. 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. ℞ 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. [Page 182]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 [Page 183]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. ℞ Gummi Elemni & te­rebinthinae abietinae ana Ʋnc. 1. Sem. saevi castrati antiqui & liquefacti, Ʋnc. 2. Pin­guedinis Porcinae Ʋnc. 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 of Water un­till the Juice of them be Extracted: Then the Decoction is to be strained through a Cloath, and the Colature cla­rified with the white of an Egg, adding thereto a little of the Juice of Limon, white Sugar, and Cinnamon; the Co­lature is to be set over the fire again, and when it begins to boyl, a white scum will rise, then a little White-wine is to be put into it to settle the scum, and a little af­ter, when the scum rises again, some more White-wine is to be put into it; the Humidity is to be let evaporate, until one perceive that the Liquor becomes Glewy, then it is to be taken off, and quickly strained through a clean Linnen Cloath, and put into Vessels, to be kept for Oc­casion: A spoonful or two of it is now and then to be given to the Patient, to stop his Looseness.