I. Of the Nature, Causes, Difference, and Symptoms of the Gravel and Stone.

THE Disease of the Stone, either in the Kidneys or the Bladder, and that of the Gout, which are nearly related, are two of the most cruel and inexorable Tyrants that persecute the Race of Mankind: So great is their Vio­lence, and so unextinguished their Fury, that they afflict the unhappy Patients with such frequent and insufferable Tortures, as make Life an undesirable Possession, and rather a Burthen too hard to bear, than a State of Satisfaction and Enjoyment. And had not the All-wise Divine Author, planted in our Nature, so strong an Aversion to Death and Dissolution, it is highly probable that many, grown utterly impatient of undergoing such [Page 2]a Weight of Misery, would lay Hands upon themselves, and soon put an End to their Calamities and their Lives together, the Grievance or the first to much over-balancing the Pleasure of the last. Some, it is true, of these forlorn Creatures, have endeavoured to ease themselves by adventuring on these tra­gical Expedients, and, no doubt, Multi [...]udes more wou [...]d follow their Example, did not a Principle of Religion among Christians, and a powerful Instinct of Self-Preservation among all Men, controul their Impatience, and prevent Self-execution: Nor is it a Won­d [...]r they shou [...]d prefer the Shades and Tran­quility or the Grave, to the Heats and In­quietudes of such acute Diseases.

But it must be allowed, that of this Pair so near y allied, the Stone and the Gout, the first is the most terrible, and distinguished for its Fierceness and Cruelty. This Lictor and Minister of Death, inflicts, above all others, the sharpest and most insufferable Tortures: What a melancholy Scene! What a moving Spectacle of mortal Nature is it, to see the unhappy Patient extended on the Rack, groaning and crying out in Agonies of Distress and unspeakable Torment: E'er Night is half spent, he wishes for Day; when Day appears, he longs for Night; Distracted [Page 3]with his Sufferings, he lies wakeful, count­ing the Hours, any one of which, when protracted and multiplied by raging Misery, seems a numerous Train, so sluggish and unprogressive does Time grow under griev­ous Sufferings. He changes his Pillow, but not his Pain; new-makes his Bed, but keeps his old Inquietudes, and though he often turns from Side to Side, he never leaves his Agonies behind: They, hapless State! know no Cessation or Interruption: If they some­times remit and abate their Violence, they soon recover their Strength, rekindle their Rage, and insult the Patient with as great Fury as before. It must therefore be a com­mendable Action, and becoming an Aescu­lapian worthy to endeavour, with all his Might, to repel or disable this Plague that so much infests Mankind; and therefore ac­cordingly I have undertaken to assist those who have already attacked this Pest with Skill and Vigour: For this is not the Work of a single Aggressor, but as in hunting down a Forest Beast, or that enormous Bird the Ostrich, many Champions unite their Power, armed with various Instruments of Death, Cutlasses, Lances, Hooks, and Javelins, that with different Weapons and mutual Assist­ance they may subdue the Enemy, or at least [Page 4]oblige him to retreat; so, as a ready Auxiliary, I bring my Forces, such as they are, to join those of abler Combatants, in order to quell this formidable Enemy, at least to diminish his Strength and restrain his Fury.

As to the Nature of the Disease, there are scarce any Part of the Body privileged from breeding Stones in their larger Cavities, or more minute Interstices, which are, in some measure diversified, according to the Nature of the Bowels or Organs where they are pro­duced. They are found sometimes in the external Muscles of the Body, as well as in the Lungs, the Stomach, the Liver, the Gall- Bladder, the Bowels or Contents of the Abdomen, as well as in the Tongue, the Brain, and even the Blood it self: For seve­ral credible Authors have affirm'd, that upon opening a Vein, small Stones, together with the spouting Blood have rush'd into the Re­ceiver. In all which Nest, the petrifying Prin­ciples, meeting and embracing each other, produce a single Stone, or a Quarry of them But this Discourse is confin'd to the Stone in the Kidneys, and that in the Bladder, which in this Dissertation I shall consider as the same, and not as the Disease of a distinct Species When it is formed and settled in either Kid­ney, it is accompanied with various Symptoms [Page 5]according as it is large or small, smooth or rugged, fixed or loose, closely or slightly co­herent, i. e. hard and solid, or friable and porous.

Of the minute Stone, that is, the Grit and Gravel, formed of sandy Rudiments in the Kidneys or Bladder, which however are per­fect Stones, there are three Sorts distinguished by their Colour, that is, White, Yellow, and Red. White is the native Complexion of these little Bodies, Atoms indeed, in respect of those of the largest Dimension, as are the Sands on the Shore, when compared with the Rock at whose Feet they lie: These pri­mitive Stones are, however, so close and un­porous, that the Cohesion of their Parts, are not to be unclasped and dissolved, but with great Difficulty, insomuch that they imitate the Hardness of the Diamond, and will po­lish Glass, like the Dust of that Jewel, as celebrated Authors assert; and it facilitates our Belief of the indissoluble Structure of this Grit, when we reflect on the like Qua­lity in that called Hour-Glass Sand, which is found, by Experience, to be less porous, or more solid than Flint; and therefore the Operators in Glass have laid aside the first, and now employ the last, as Materials for their finest Works. But these minute white [Page 6]Stones, cannot, as I conceive, give nephri­tick Pains, or a Fit of the Stone, unless a Collection or Congeries of them, are involv­ed or united by some adventitious, mucous, slimy, or other anomalous Matter, so as to form a Moles or Bulk, large enough to ob­struct the Mouths or Channels of the Uri­nary Passages, and that, it is true, may some­times happen; but, generally speaking, since the minute pale Stones are so smooth and small, that they may enter with Ease the Ori­fices of the Urinary Aquaeducts, and passing through those Conveyances, may, without creating Pain or Trouble, be excluded with the common Stream; and though there should be a great Quantity of that small in­coherent Sand, it may, however, without Difficulty, flow through the Ureters into the Bladder with the serous Current, and toge­ther with it be discharged.

As to the Yellow Gravel, it is evident that the minute Particles that compose it, are stained with that Colour, by the alkalizate or lixivial Salts of the Urine, which abounds with such Contents: And this Mixture in the small Yellow Stones, is the Reason why they are less solid, and more dissoluble than the White of a purer Composition; which is likewise observ'd, and from the same Reason, [Page 7]in the Stones generated in the Receptacle of the Gall, whose Parts have not that strict Connexion and close Structure as the White.

The Red Gravel receives that Complexion, from being infected with a little Drop of Blood issuing from some lacerated Vein where the Gravel lay.

All these, if they are ragged and uneven, may, by pricking, vellicating, or wounding the tender Membranes that include them, cause either duller and heavier, or more a­cute Pains, according as they are arm'd with more or less pointed Angles whilst they lie in the Pelvis or Basin of the Kidneys, and there roused and disturbed by the Motion of the Body on Foot or Horseback, rub up­on and fret the neighbouring Membranes; and so nephritick Sufferings may arise from Gravel, which consists in real and perfect Stones, as before observed, though called Sand, or a friable, gritty Matter, by Reason of their small Dimension. This is the first nephritick Symptom before a larger Stone is formed, which, however, is vexatious, and often attended not only with Pain, but much Inquietude, Sickness of the Stomach, and a general Disorder of the whole Oeco­nomy, while the sandy Atoms, that lie heap­ed up in the Kidneys, are worked and agi­tated [Page 8]by the Motion of the Back or Loins, irritate and gaul their Membranes of exqui­site Sense during their Confinement in those Lodgings.

It ought to be observed, that there are often sound in the Urine of Persons in good Health, or at least not much distempered, a Red Gravel or Sand, that sticks to the Sides of the Urinal or Chamber-pot that receives it; but this is not the genuine Gravel, that causes nephritick Sufferings, but the Produc­tion of the Blood in Persons of a scorbutick Disposition, or a warm Temperament, and is distinguished from the true Gravel in this, that the last falls down, immediately after the Urine is rendered, to the Bottom of the Receiver, whereas the spurious Kind does not break off from its Mixture and Union with the Urine, till after some Hours standing in that Vessel, when it is at length loosed from its Embraces, precipitated and thrust down by the Cold of the Air, and afterwards, if the Urine be gradually heated again, it will recover its former Connexion with it, which is not the Case of the genuine nephri­tick Gravel: Besides, there is often observed in Persons of such a Constitution, a thin Sub­stance floating on the Surface of their Urine, imitating melted Fat or Grease, but when it [Page 9]is skimmed off, and dried upon a Paper placed in the Sun, it discovers it self to con­sist of gritty saline Concretions, united to­gether by some viscous or slimy Bonds.

If the Stones are of a larger Size than those called Sand or Gravel, they affect Humane Bodies with yet more painful and afflictive Symptoms, and supposing that their Figure is unequal, and varied with many Angles; then their Points, especially upon bodily Motion, vex and vellicate the Repositories where they are nested, and as so many sharp Thorns in the Sides of the Pelvis, continually grieve, prick, or wound their Membranes; whence arises the frequent Discharge of bloody Urine, a common Symptom of this cruel Disease, which, if fresh, and newly let out of the Veins, gives the Urine a red Co­lour, and the Blood is discernable to the Sight; but if it has lain, for some Time, ex­travasate in the Bladder, or if but a few Drops stay in that manner in the Kidneys, by turning to grumous and coagulated Clots, they impart a dark and blackish Tincture to the Urine, not unlike to that of Coffee; this is a Symptom likewise that often accompa­nies this Distemper: It is true also, that pale limpid Water sometimes attends the Pa­roxysms of the Stone, like that observed in [Page 10]Convulsive, Hypocondriacal, and Hysterick Passions, and from the same Cause, that is, the Spasmodick Disorder or Contraction of the System of the Nerves during the Fit.

Another Symptom, that accompanies the Stones last described, is great Sickness of the S [...]omach, Nausea, and frequent Vomitings, or Strainings to Vomit; for while the Fibres in the Kidneys are grieved, and lacerated by the rough Stone or Stones bred and confined there, the Suffering is propagated to the Sto­mach by a Consent of Parts, or Communi­cation of Nerves, from one of those Bowels to the other; and this is so distinguishing a Symptom of this Disease in the Kidneys, that other Symptoms without this, are not suffi­cient to induce the Physician to pronounce the Distemper the Stone.

If the Stone in the Kidneys be some Degree larger, and likewise jagged, it creates un­sufferable Pains, while it remains in the Pelvi [...] or Basin of the Kidneys, grating and lacera­ting the enclosing Membrane, or while if strives through the Ureters, and wounds the Fibres as they make their Way.

When the Stone formed in the Kidneys is grown yet larger, and so disproportioned to the Mouth of the Ureter, that it cannot enter, even though its Superficies is smooth and [Page 11]equal, it will obstruct the Orifice of that Tube, while it attempts to pass into it, or will stick in the Channel of it; and while it continues fixed there, as it stops the Current of the Wa­ter through the Pipe, so it creates exqusite and enormous Misery, by distending the sensible Membranes; and if it be unequal and ragged, it will produce the most afflictive Tortures, till it is protrude [...] by Art or Nature through the Ureter, and excluded into the Bladder. This happens as often as the Stone grows to a greater Size than is suitable to the Inlet and Passage of that Tube: And the Effect is the same if the Stone, though not of a dispropor­tinate Bulk to pass the Ureter, should how­ever lye a-cross the Orifice, for then it will obstruct the Descent of the Urine, and create great Disorder, till it find a proper Position, and its Figure is adapted to the Inlet, and then it enters and is at last discharged.

After the Stone has made its Passage through the Ureters for some Years, by stretching and enlarging the Road so often, it becomes ca­pacious enough to receive much larger Stones than the first, and to let them through into the Bladder; so that the Cavity of the Ureter, through which they have passed so long, is by Degrees sometimes extended to a Finger's Breadth, as unquestionable Authors assure us. [Page 12]The Stone of the Kidneys is likewise consi­dered as loose or fixed; if as loose and float­ing, or not adherent to any part of that Bowel, but is always attempting to pass the Ureters to the Bladder, it produces the pain­ful Symptoms before described; but if it is fixed, it then Nests itself and settles in the Sub­stance of the Kidneys, where it grows by Ac­cretion of Parts, and spreads [...]ike branching Coral through the Body of the Kidney; and while it lodges there in this quiet and inactive State, the Patient may sometimes feel Heavi­ness, or a Weight in the Back, which however is but an inconsiderable Suffering; and some in this Condition have felt no Symptom at all, and dyed of other Distempers; and when they were, after Death, dissected by the S [...]r­geon, a considerable Stone has been discovered, propagated through the Kidney, of which however the Patient never complained.

And this was the Case, as I have been in­formed of the late Lord Mohun's Father, who being open'd after he dyed of a Wound re­ceived in a Duel, a large Stone was discovered spreading through the Kidney, of which not­withstanding in his Life Time he was entirely unconscious. I likewise knew an eminent Divine, of a very Lean and Unmuscular Con­stitution, who told me in Conversation, that [Page 13]suspecting he had a Stone in the Kidneys, tryed one Night in Bed, if he could not feel it, and by pressing his Loins, much emaciated with his long Fingers, he assured me he felt the Stone, and then, said h [...], I reflected it must be a large one propagated through that Bow­el, and therefore that no Medicinal Methods should be attempted to break it, lest the Frag­ments falling into the Pelvis, should stop the Passage of the Ureters, and create great Fits of the Stone; upon this, said he, I f [...]ll asleep, and during many Years, thought of it no more, till of late some Incident, which he named, and I have forgotten, brought again to his Mind this Observation, and when he (some Years afterwards) Died and was Dissected, a large Stone was found in his Kidney, which though he felt, as said before, yet lying un­disturbed and quiet in its Nest, it gave him little Uneasiness.

The Stone we are discoursing of is either lighter or heavier, or which is the same thing, more porus and friable, or more close and so­lid. The Particles that compose the first, hang together by a slight Connexion, which is easily broken and dissolved, like Flocks of frozen Snow, the Sides of a Spunge, or the unsolid and porus Substance of the Pumice-Stone, and these by any internal or external Violence, [Page 14]or milder Motion, are often separated and crumbled into Parts, that drop into the Ureters and pass into the Bladder, to be discharged, and these Fragments, like the small sandy and gritty Stones spoken of before, produce the same troublesome Effects.

I have accounted for the Stones, that owe their Production to the Kidneys, and shall now pursue their Progress and follow their Course to the Bladder. When the Stone generated in the Urinary Strainer is discharged by the Ure­ter into the common Receiver, it too often happens, that it acquires so large a Dimension, that the Outlet of the Bladder is not wide e­nough to let it through, and therefore of Ne­cessity it must remain imprisoned there, where by the Accession of new petrifying Particles, and gritty Matter continually descending from the Kidneys, and adhering to it, its Size is gra­dually augmented, till it is yet more incapable of being excluded, where if it is loose and float­ing, it produces many grievous Symptoms; for though it be only smooth and equal, and so does not lacerate the Bladder, yet it will often, as it plays against the Neck of it, and attempts to pass through, stop the Mouth of the Aquaeduct, that conveys away the Urine, and by so doing, produces very great Torment, while the Bladder is excessively distended, and [Page 15]unable to discharge the enclosed Deluge; and if the Stone be uneven and rugged, it will by goading and wounding the encompassing Membranes, create exquisite Pain and bloody Urine, and by long repeated Cruelties of this Kind, it frequently forms an Ulcer in the lace­rated Part, which is discovered by the Secre­tion of putrid Matter mingled with the Urine; for when it has stood some Hours, a pale slimy Sediment is precipitated to the Bottom of the Receiver, like the Excrement of the Nose, or the Whites of Eggs, and is distinguished, from the like Matter that descends to the Bladder, from an Ulcer in the Kidneys, by the Odour, which is strong and faetid, if the purulent Mat­ [...]er comes from an Ulcer in the Bladder, but that derived from one in the Kidneys has no such offensive Smell, as said above. And the Case is the same when an Ulcer arises in the Kidneys or the Neck of the Bladder, not from the Stone but from other Causes, such as pro­duce Ulcers in the Lungs, in the Intestines, or other internal Parts, that is, the Impurities and incongruous Particles, which by Reason of their disproportionate Size and Figure, can­not slide through the strait Passages of the Glands, but stick in them, till more of the like Nature entangled there, encrease the Obstruc­tion and swell the Parts, whence by Degrees [Page 16]they are inflamed, putrify, and by their Dis­ruption, form an Ulcer; and when this Disease is produced in the Kidneys or the Bladder, the putrid Contents issuing from them, and toge­ther with the Urine excluded into the Re­ceiver, shew themselves, as I have said, by their viscous and ropy Quality, and are di­versified by their faetid or inoffensive Smell: And it should be observed, that their mucous and slimy Nature, distinguishes these Contents from others, that proceed from a scorbutick or unhealthful Habit of Body, when much white, mealy, and light Matter appears in the Sediment, and which being without Con­nexion, upon shaking the Glass will rise and float incoherent in the Urine, but unslimy, as well as without Faetor: This therefore, as I have said, does not proceed from any internal Ulcer, but is a Defect arising from some irre­gular and depraved State of the Blood, that communicates with its Serum such Matter to the Kidneys.

The Suppression of Urine, occasioned by a Stone too large to pass the Urethra, is not at­tended with Sickness and Vomiting, as when a Stone sticks in its Passage through the Ure­ters, there being no Communication of Nerves between the Bladder and the Stomach, to con­vey the Sensations from one to the other. But [Page 17]exquisite and grievous Pains however attend it from the Distention of the Bladder, as I have said, and sometimes a smaller Stone, that has entered the Mouth of the Urethra, yet being too great to slide through, stops near the En­trance, or in the Middle, and creates a total Suppression of Urine, as well as great Torment.

I have now accounted for the Nature, Pro­perties, and Symptoms of this Disease, and have likewise in carrying on my Discourse, inter­mixed an Ennumeration of its various Kinds, discriminated by the Receptacles, where the Stone is contained, or by its different Colour or various Shape and Figure; and now I shall proceed to search into the Causes of it.

The remote, antecedent Cause of the Stone, is a defect in the digestive Faculty of the Stomach, or that of the Blood, or nervous Juices, whence such Impurities and feculent Portions remain, as produce the Coagulations and Concrescencies, that become the Founda­tion of the Stone, whose Rudiments and pri­mitive Materials, consist in a close Combina­tion of a volatile in a superior, and acid Salt in an inferiour Proportion. That these two are the petrifying Principles, is known by Experience, that shews us that this is the Effect of Acids and Alkalies meeting together; as for Example, Juice of Lemon, and Salt of Tartar; [Page 18]Let it be supposed then, that from the inordi­nate and depraved Concoctions before-named, such hard Coalitions, slimy Coagulations, or cretaceous Confederacies should be left be­hind, and it is easy to conceive how, when yet more hardened and prepared in the Blood, they may by the Power of the urinous Salts in the Kidneys, be soon converted into gritty, sandy Atoms, which, clustring together, and cohering, form at length a Stone of the lowest Size; that by the daily Accession of new simi­lar Particles, acquires a far greater Dimension in the Kidneys, and yet a greater after its Descent from that Bowel to the Bladder; for while it is detained, from being too large to be excluded, it has more Room to receive Aug­mentation, whilst constantly fed by the sandy Rivulets, that empty themselves through the Outlets of the Ureters into that Cistern, where it grows by such Accretion, till sometimes it becomes exceeding large: Thus petrified Fos­sils and Flints in the Earth, as well as rotten, Sticks and Pieces of Wood turned to Stone, owe their Growth, as well as Production, to lapidescent or stony Particles, that continually accede to, and st [...]ctly embrace the former col­lected Materials; But as to the intrinsick Na­ture of [...]he Stone bred in living Creatures, and those last named, that is, Minerals and Vege­tables, [Page 19]there is a vast Difference; for the greatest Part of the first are formed of volatile Salts, or Animal Alkalies, but the other are not com­posed of any such Ingredients. It is truly re­marked, that those who are obnoxious to the Stone, are generally of a hot Constitution, as it is likewise observed of gouty Patients, by which means their Blood is more inclined to breed cretaceous, hard, and gritty Combina­tions, which by a certain Degree of Heat, are soon advanced into proper Materials for the Gout and Stone, Diseases so nearly related, that they are easily convertible into each other. But of these Subjects I have discoursed at large in my Treatise of the Gout, to which I refer the Reader.

When the Seeds or Principles of the Stone, that is, the viscous, tough or sandy Concre­tions, not to be dissolved and separated from the Blood, bearing however a Figure and Di­mension proper to enter the papillary Glands, the Strainers in the Kidneys, they are there yet more indurated, and acquire a gritty and sabu­lous Constitution; though even in the Blood itself, before the Serum is separated from it by the secretory Glands, small Stones are often formed, as they are in all the Parts of the Body, as before observed.

It is remarkable that those Countries, that lye upon the River Rhine and the Northern Parts of France, who drink a thin, sharp, pale Wine, which is more replenished with Tarcar than other Fruits of the Vine, con­cocted by a hotter Sun, are most obnoxious to the Stone in the Kidneys: For such Wines convey to the Blood in great Plenty, a Sort of petrifying Fluid, whose redundant acid Parti­cles, before their Nature is changed to an Al­kali by the active Princ [...]ples of the Blood, meeting and combining with the volatile Salts there, the Result is a hard and tartarous Pro­duction, easily formed into a Stone.

The voluptuous Life of those that eat and drink deliciously every Day, cannot but ad­minister to the Blood, the Seeds and Principles of the Stone, in Constitutions disposed and prepared for that Distemper: For these costly and luxurious Meats and Drinks, excessively and constantly ingested, being unequal to the digest ve Power of the Stomach, fill it with a Load of Crudities and unconcocted Foods; which transmitted by the Ministry of the lacteal Passages to the Veins, communicate to the Blood, not only great Plenty of noxious Impurities, but likewise a rich Chyle, abun­dant in volatile Salts, with such a Proportion of Acids, as are apt to create this Distemper.

A sedentary and inactive Life, especially when the Persons are of a vigorous and hot Complexion, much promotes the Production of the Stone; for while the Blood runs lazy and unagitated in its Channels, for want of due Labour and Exercise of the Limbs to push on its Streams with due Celerity, it is easy to conceive how the crude and impure Parts run into various Concrescencies and Coagulations. On the contrary, when due Activity, either by the Labour of the Hands, or by riding, or o­ther Exercises of the Body, the Motion of the Blood is accelerated, it is obvious to appre­hend, that by the Rencounters and mutual Col­lisions of the Parts dashing and rubbing upon each other, they are broken, divided and atte­nuated, till they become so minute and so well mixed, that the tough, slimy, and yet harder Combinations are unlocked and dissolved, by which means the Seeds and Rudiments of the Stone are prevented, and the Cause removed: And therefore in this Case, as in the Gout, the sedentary Lawyer; the over-thoughtful Person; the hard Student; and the inactive, indolent, and voluptuous Gentleman, are ob­noxious to this grievous Distemper, as are likewise Men of covetous Tempers; while the laborious Husbandman, and Mechanick, the daily Traveller, and indefatigable Sportsman, [Page 22]are seldom attacked and tortured by it: For these keep the Body in a Healthful State, while their repeated Exercise helps their di­gestive Faculties to do their Duty, and refine the Blood, by a constant Expulsion of inordi­nate and incongruous Humours.

II. The Method of Curing the Gravel and Stone.

FIRST, of the lowest Degree of this Dis­ease, that is, the small Sand-like Gri [...]t, either White, Red, or Yellow, which though very minute, yet are true Stones, and distinct from the scorbutick Red Matter, that does not separate and fall down from the Urine, till after some Hours standing, and then is pre­cipitated by the Impression of the Cold from the Ambient Air, as above described. The Cure of this Distemper, consists in the carrying off the sabulous and sandy Atoms, and pre­venting the Generation of more, and so cut­ting off the Supplies, that use to fill the Room of the forther, that are discharged with the [Page 23]Urine: And it is highly necessary to attempt this, lest otherwise the small Stones, continu­ing undisturbed, should unite and adhere to each other, and receiving gradual Augmenta­tion, from new Particles daily arriving, should grow to a Stone of great Bulk, and become incapable of passing the Ureters, or at least without great Difficulty and Pain; and when they slide through and drop into the Bladder, should contract there a large Size as before de­scribed. For it is highly probable, that the Stone is very seldom originally generated in that Receptacle, and that all, or at least the far greatest Part found there, descend thither from the Kidneys, and receive their Encrease from the sandy and gritty Supplies, transmitted to it through the Ureters. It has therefore been an unhappy Neglect, committed by some Patients, that though they have long perceived a considerable Quatity of Gravel discharged with their Urine, and have felt the Trouble and Uneasiness of it in their Kidneys, have however, taken little Care to clear them of these gritty Materials, and prevent the breed­ing of more; from which Omission, at length, Stones of a bigger Bulk, always painful and often fatal, have been produced.

It is therefore evidently the Interest of all Persons, when they observe that a Quantity of [Page 24]such Sand and Gravel, the Rudiments and Mo­ther of bigger Stones, is excluded with the Urine from the Bladder, to endeavour, by pro­per Means, to free the Kidneys from these noxi­ous Inhabitants, and prevent the Generation of new Supplies; and in the first Place, it is requisite to convey away the Gravel, that is already bred, for which Purpose the following Method is most efficacious.

First Purgatives.

Take over Night, going to Bed, of Elixir Salutis, three Spoonfuls; and the next Morning, drink a Quart or three Pints of purging Mineral Waters, such as those of Epsom, Dulledge, Acton, Northal, &c. And at Night going to Bed,

Take of Milk-Water, two Ounces; com­pound Water of Horse-radish, half an Ounce; twelve Drops of liquid Lauda­num, and three Drachms of Diacodium; make it a Draught: repeat both Medi­cines every other Day and Night, for three Times.

After an Interval of three Weeks do the same, and sooner, if the Symptoms of the Gravel call for it.

Or, Drink alone, two Quarts of such purg­ing Waters several Days, and then rest.

The Reason why these Waters are very be­neficial for the Purpose intended, is, that a considerable Part of them pass by Urine, and in their Passage through the Kidneys, wash away in their Current the Sand and Gravel, and suffer them not to lodge there, till they grow to a Stone of a large Size: And 'tis the same in respect of the Bladder; for the same Flood that rushes down through the Ureters, carries off the Gritt from the Receiver, and expels it with the Urine.

Diureticks, to be employed in the Intervals of purging, for the same Purpose, are such as follow.

Take of Roots of Chervil, Stone Parsley, Eringo, Fennel, Sorrel, each half an Ounce; of Seeds of Burdock, Anise, and sweet Fennel, each a Drachm; of Juni­per Berries, three Drachms; boil these Ingredients, in three Pints of Spring-Water, to a Quart; add to it, a Drachm of purified Nitre; strain it, and add a Pint of Rhenish Wine: Drink a Quar­ter of a Pint Morning and Evening.

Or, Take Millepedes alive and washed, fifty, bruise them in a Mortar, with a [Page 26]Quarter of a Pint of Rhenish Wine, and four Ounces of compound Horse-radish Water; make a strong Expression for a Draught, to be taken twice a Day.

But the most effectual Diuretick for carry­ing off Gravel, and clearing the Parts afflicted with it, are mineral unpurging Waters, such as those of the Bath, Tunbridge, the Spaw, and other Chalybeate Springs: For these, rushing with a plentiful Tide through the uri­nary Organs where the Gravel is lodged as well as generated, disturbs its several Nests, and rolls along in its Stream, the Sand-beds it meets in its Way, till at length they are dis­charged in the Urine. But this is not the only Advantage, that attends the drinking co­piously Chalybeate Waters; for besides this, it very much contributes the laying the Axe to the Root of the Disease, and preventing the Generation of such petrifying Seeds, as shall be shewn afterwards. There are other diure­tick Remedies useful in this Distemper; as a Mixture of Water, French Brandy, and Juice of Lemon, called Punch, if made small, and not intoxicating, though taken in a conside­rable Quantity. Juice or Syrup of Lemons; Syrup of Marsh-mallows; and fresh Oil of Sweet Almonds; of each an equal Portion, [Page 27]mixed and beat together, with as much Sugar as is sufficient to give them a Consistency, taken to a Spoonful or two often in a Day, is very beneficial; so is a Spoonful or two of compound Juniper-Water of Cologne, or Holland, drank now and then in a Glass of White-wine; add to these Remedies, the ex­ercise of the Body, by riding sometimes on a hard trotting Horse, sometimes by hurrying in a Coach over paved Stones, or other rugged and uneven Ground, (if the Patient can bear it) which by the repeated working and Con­cussion of the Back, move and dislodge the Gravel in the Kidneys, and force it thence into the Bladder, whence it is excluded with the Water.

Now to prevent the Production of little Stones or Gravel, all those Remedies are re­quired as most effectual, that have an opera­tive Vertue, to loose and disengage all viscous and tough Coagulations, and dissolve the Co­hesion and Structure of cretaceous and gritty Coalitions, whence small Stones and Gravel are created, some in the Blood, and others in the urinary Strainers. This is indeed a Matter of the greatest Importance in this Case; for if this is effected, the formidable and pernicious Disease will be crushed in Embrio, and not suf­fered to arrive at a mature State. I shall there­fore [Page 28]set down the Medicines, endowed with the greatest Force, for procuring this End.

It is easy to see that those Remedies, that restore the Blood when depraved, to its native Temperament, and keep it in that just and sa­lutary Constitution, which specifially belongs to this Animal Fluid, are in general to be cho­sen; and in this Case in particular, those are to be insisted on, that are most capable of dis­joyning and separating the associated, viscous, and sandy Particles, that conspire to the For­mation of a Stone, and so to attenuate and refine them, that they may easily incorporate with the Blood, and produce an uniform and equal Mixture.

And for this Purpose, Chalybe [...]te Medicines, prepared by Art or Nature, are the most pre­ferable: And since Patients afflicted with this Disease, are commonly of a hotter Constitu­tion than others, those Preparations that have the least Sulphur left in their Composition, are most beneficial to them; such as the Salt of Steel, or the Tincture of it in Wine: But a­bove all, mineral Waters, impregnated with Steel in Embrio, are in this Case most cele­brated, which not only dilute and attemper the Blood, and carry off in their Current the sandy and petrifying Materials, as before ex­plained, but likewise by their active Vertue, [Page 29]animate, ferment, and exalt the Blood, break the Cohesion of the knotty and cretaceous Seeds of the Stone, and by wresting the Parti­cles from each others Embraces, prevent the engendering of this Disease, by the Confede­racy of such Impurities. So that these salu­tary Springs, are not only highly useful in free­ing the Veins from immiscible and hurtful Matter, cleansing the Urinary Channels, and rolling away in their Flood, the Gravel lodged in the Cavities, through which their Waters make their Way, but they likewise very much contribute to the Recovery of a just Crasis, or Constitution of Blood, by destroying the Prin­ciples and Rudiments of this Disease, 'ere yet they combine in a Stone of large Size, and reach a mature State, which they effect in the Manner described.

But if hard and gravelly Materials, associate and unite in the Kidneys, by a slight Structure, and are rather entangled one with another, and hang together like a piece of Spunge, Hoar-Frost, or a Flake of Snow, than strictly co­here, whence they become very porus and friable; or if when more closely complicated and connected, they grow to a greater Bulk, and create great Pain either in the Kidneys or the Ureters, by grating the Membranes with their unequal and ragged Figure in their Pas­sage, [Page 30]or by their too large and disproportionate Size, stop at the Entrance, or in their Way through these Tubes, in such Cases, the proper Remedies do remove them from the Kidneys, and oblige them to pass the Uteters into the Bladder, are such as these.

III. How to remove a Fit of the GRAVEL, or STONE.

Take three or four Spoonfuls of Elixir Sa­lutis, or of the Tincture or Infusion of Sena and Rhubarb and Anniseeds, over Night, and a Quart of purging Mineral-Water the next Morning, and the Night following take this Draught,

Of Milk-Water, two Ounces; of compound Horse-radish-Water, three Drachms; of crude Opium colated, a Grain and half; Syrup of Marsh-mallows, half an Ounce; make it a Draught: And if the Stone or Gravel, be not removed, but the Fit con­tinues, take the next Morning, two Quarts of the same purging Waters, either Epsom, Dulledge, Acton, &c. and the Night following, the same composing [Page 31]Draught, and so the next Morning and Night, for three Times, during the Fit; and if notwithstanding, the Paroxysm is still prolonged, then let the Patient take the following Draught, going to Bed, every Night, if the Pains are vio­lent, or otherwise every other Night.

Take of Oil of Sweet-Almonds, and Ounce; of the pectoral Decoction, a Quarter of a Pint; of Syrup of Meconium, ten Drachms; make a Draught.

Take also such oily and diuretick Medicines as follow.

Take of Oil of Sweet-Almonds, and Lin­seed, drawn without Fire, each an Ounce; of Syrup of Lemons and Marsh-mallows, each ten Drachms; of Saffron, a Scruple; of fine Sugar, as much as is sufficient; let it all be well mixed in a marble Mortar, and made a Linctus. Let the Patient take a Spoonful or two often in a Day and Night.

Small Punch likewise, especially if made with Spaw-Water, is useful to push on the Stone, or Gravel, when either of them sticks in the Ureters, and to clear the Kidneys of the Beds of Sand collected there.

Juniper-Water, especially that of Cologne, or Holland, and the diuretick Apozem, above set down, are beneficial.

To be more particular, let the Patient in the Paroxysm, that eludes the Force of the forementioned Remedies, take the following.

Take of Flowers of Camomile, two Hand­fuls; Roots of Marsh-mallows, six Drachms; of wild Carrot-Seed, half an Ounce; of Venice Turpentine, dissolved with the White of an Egg, three Drachms; of the Electuary of Hiera cum Agarick, six Drachms; make it a Clyster.

Or, Take of the common emollient Decocti­on, twelve Ounces; adding to the Ingre­dients Juniper-Berries, six Drachms; Seeds of the wild Carrot, three Drachms; dissolve in it of Lenitive Electuary, ten Drachms; use it for a Clyster.

Let one of these Clysters be given every Day, for three or four Times.

For easing the Paroxysm, it will likewise be very Advantagious, for the Patient to sit up to the Waste, in a Bath of Lukewarm Water, and repeat it two or three Times, or in a medicated Bath, which may be made thus.

Take of the Leaves of Mallows, Marsh-mallows, Pellitory of the Wall, each three Handfuls; Flowers of Camomile, Melilot, and Elder, each two Handfuls; Tops of Camomile, two Handfuls; Juni­per-Berries, six Ounces; of Linseed, and Fenugreek-Seed, each two Ounces; boil all in a sufficient Quantity of Spring-Water, and let the Patient sit in it Lukewarm, up to the Waste, in a Ba­thing Tub.

In this Case also, there are vast Varieties of Remedies, prescribed by celebrated Authors, as Fomentations, Liniments, Plaisters, &c. to be externally applied, which notwithstand­ing, are little availing for removing a Fit of the Stone, or Gravel: The most effectual, are certainly the Use of purging Mineral Waters, three or four Times, and tak [...]ng at Night, af­ter their Operation, a Grain and half of Opium, as before-mentioned, or an equivalent Quan­tity of liquid Laudanum, that is, about thirty Drops.

But in Case that Method should not suc­ceed, the next most valuable Medicines are Pills made of Venice-Turpentine, or rather Chios, taken to the Quantity of a Scruple, alone, or mixed with an equal Part of Rhubarb.

Or, Thus,—Take of Venice, or Chios-Tur­pentine, four Scruples; of Rhubarb, a Drachm; of Salt of Tartar, half a Drachm; Cinnamon, half a Scruple; of Balsamick Syrap, as much as will make a Mass, to be formed into Pills of ordi­nary Size; take four every other Day, at Bed Time.

For the same End, Emulsions are condu­cive, such as these,

Of Sweet-Almonds blanched, number fif­teen; of Seeds of Melons, Pumpions, Violets, each two Drachms; bruise them together in a marble Mortar, pouring on them, gradually, a Quart of Barley-Water; strain it for use; drink often of it, a Quarter of a Pint, or six Ounces, Day or Night.

Or, Take of Seeds of Violets, three Drachms; of Seeds of Pumpions, Me­lons, white Poppies, each two Drachms; eight blanched Sweet-Almonds; bruise them together in a Mortar, and pour upon them, Milk-Water, and Corn Poppy-Water, each a Pint, strain it, and make it an Emulsion to be drank as the others

Oily Medicines, are likewise very useful, as they envelop and soften the acid and acrimo­nious Juices, and promote the Expulsion of the Stone, as thus,

Take two Spoonfuls of Linseed-Oil, newly drawn, without Fire, twice a Day.

Or, Take new Oil of Sweet-Almonds, and Linseed-Oil, drawn without Fire, each an Ounce; of Syrup of Marsh-mallows, and Violets, of each six Drachms; of Syrup of Lemons, half an Ounce; of Saffron, rubbd fine, half a Scruple; mix them well to make a Linctus: Take a Spoonful often, shaking it well.

Or, Take an Ounce of fresh Oil of Sweet-Almonds, in a Quarter of a Pint of the Decoction for the Syrup of Marsh-mal­lows, and repeat it frequently.

Riding in a Coach, or on Horseback, in rough unequal Ground, or our paved Streets, conduces much to the Discharge of the Stone, or Gravel, when either one or t'other sticks in the Ureter, or Pelvis, if the Patient can endure it.

And while these Remedies are made Use of, opiate Medicines must be given, mingled with them, or alone, to abate the spasmodick Con­traction [Page 36]of the tender Membran [...]s, and give Ease to the disordered and afflicted Spirits, that they being lulled to Rest and Quiet, may cease their convulsive Grasps, and the mean Time the Stone, or Gravel, sollicited by city smooth Remedies, slippery and gentle Diureticks, may slide through the Ureters, and drop, [...]r pass, into the Bladder without Resistance.

Take of crude Opium, dissolved and s [...]rained, a Grain and half, or two Graine; of the pectoral Decoction, a Qua [...]ter of a Pint; Syrup of Lemons, three Drachms; make it a Draught, to be taken at Night, or at any Time when the Pain is violent, and repeat it as the Symptoms shall re­quire.

Or, Take of Cinnabar of Antimony, half a Scruple; Crabbs-Eyes and Coral, of each six Grains; Laudanum Opiatum, a Grain and half; make it a Powder, to be taken at the Draught now prescribed.

If the Patient is disposed to Vomiting, or straining to Vomit, let him take two Spoon­fuls of the following Mixture, and repeat it four or five times, once in four Hours.

Take of Mint-Water, or Barley Cinnamon-Water, two Ounces; of Juice of Lemons, [Page 37]two Ounces; of Salt of Wormwood, a Drachm and half; of Laudanum, a Grain and half; make a Mixture.

For easing the Pain, and facilitating the Passage of the Stone, or Gravel, various diu­retick Remedies are recommended, by emi­nent Physicians, the following Decoction of Forrestus, is for this Purpose, much cried up.

Take of Seeds of Mallows, Marsh-mal­lows, each two Drachms and half; of fat lenten Figgs, cut and sliced, num­ber nine; Sebestens in number seven; boil these Ingredients in three Quarts of Water, to three Pints: This soft and slippery Decoction, like that for making Syrup of Marsh-mallows, or the pectoral Decoction, in the London Dispensatory, may be improved by o­ther diurclick Ingredients, (viz.) Seeds of Burdock, Roots of Fennel, Violets, Eringo, wild Carrots, Juniper-Berries, &c.

In a Fit of the Stone likewise, the De­coction of the Flowers of Camomile, is much applauded by some worthy Phy­sicians; and that of the Water-Lilly; and if some Drops of sweet Spirit of Salt, or Vitriol, were added to each Draught of such diuretick Apozems, their Force would be still improved.

IV. To preserve from, or prevent the return of Fits of the Stone, or Gravel, when the Pa­roxysms cease.

GENTLE Purgatives of Sena, Rhubarb, Elixir Salutis, &c. taken once in a Month or six Weeks, are beneficial, as they cleanse the Stomach, and their appending Roads from their Impurities, and the crude and unconcocted Remains of the Foods ingest­ed; but the best Way is frequently to use purg­ing [Page 39]Mineral Waters; and in the Intervals, diu­retick and alterative Remedies, should be taken, such as these that follow.

Take of the Pulp of candied Citron-Peel, and of the Root of Marsh-mallows, each an Ounce; of Species Dialthaeae, and Di­atragacanth frigid, each a Drachm and half; of Crabbs-Eyes, two Drachms; of the Seeds of Purslain, and white Pop­pies, each a Drachm; of the Fruit of Alkakengi, two Scruples; of Gumm Ara­bick, two Drachms; Syrup of Marsh­mallows, as much as will make an Elec­tuary; take the Quantity of a large Nutmeg, or small Chesnut, twice a Day, Drinking after it, a Quarter of a Pint of the Decoction for the Syrup of Marsh­mallows.

But for cleansing the Kidneys, and carry­ing off the Sand and gritty Concrescences, lest by daily Augmentation, they should at last form a larger Stone, slippery and oily Re­medies, and Turpentine, such as mentioned above, Whey, and above all, unpurging Mi­neral Waters of all Kinds, but chiefly the Cha­ybeate, such as Tunbridge, must be relied upon; or the Islington Waters, call'd New-Tunbridge. [Page 40]Millepedes, are also a good Diu­retick in this Case: But I have above treated on this Subject, where I have discoursed on the Gravel, and small sandy Concretions, which are the minutest real Stones, and the Seeds and Rudiments, that by their Consluence and Coherence, produce those of a greater Dimen­sion, and to that Discourse I refer the Reader; for the true Method of preserving the Patient from the Return of his Paroxysms, is to pre­vent the Generation of such fabulous Mate­rials, out of which the Stone is made, or to carry them off before they have formed such large Bodies.

It is very useful in a Paroxysm of the Stone, to go into a Bath of Spring-Water moderately warm, which by stopping Sweat and Perspi­ration, and soothing the Spirits, relaxing and dilating the Fibres, promotes Urine, and therefore the Protrusion and Expulsion of the Stones, that hang or stick in the Ureters which after they have acquired a considerable Magnitude, will notwithstanding strive and make their Way for a while through th [...] Tubes, which are much stretched and enlarged by being the beaten Road for Stones to pa [...] from the Kidneys to the Bladder; yet at lengt [...] they encrease to such a Size, that when they have entered the Orifice of the Ureter, a [...] [Page 41]are incapable of proceeding farther, they plug up the Passage, and stop the Current of the Urine; and if afterwards another Stone of such a disproportionate Size, should fall from the Kidney into the Mouth of the other Tube, a total Suppression of Urine and Death in a short Time, that is, in ten or eleven Days, are the Consequence; for a total and destructive Stoppage of the Urine, cannot arise from the Obstruction of one Ureter; for Nature that has framed so many double Organs for other Func­tions, two Eyes, two Ears, two Jugular Veins, two Lobes of the Lungs, &c. that if one of these Instruments should be lost or become defective, the other, at least in a great Measure, might perform the Office of both; so it has evidently for the more certain and effectual Secretion of the Urine, provided a pair of Con­veyances, one in each Kidney, that if one be entirely disabled and stopped up, the other may do double Duty, and discharge the Por­tion of Serum, that used to run through the other Aquaeduct. It is therefore evident to a Demonstration, that no total Suppression of the Urine can happen, where both the Ureters are not entirely stopped; and it is hard to con­ceive how at any Time two Stones should at once fall down, one from each Kidney, and stop in the same Instant, each of those Organs [Page 42]of Separation: If therefore a full Stoppage of Water happens, and neither of the Ureters was before that Time obstructed, it is most agree­able to Reason, that we should assign another Cause of that Event, that is, a paralytick Im­potence of the secretory small Tubes and pa­pillary Glands, which strain the Serum from the Blood, through the Kidneys and Ureters, into the Bladder; for if these secretory Tubes by a Paralysis affecting the Spirits residing in them, quite lose their Tension and falling flat together close up their Foramina, or Passages, no Serum can be longer separated from the Blood, or conveyed into the Receptacle of the Urine; and this will prove as effectual and adaequate a Cause of a total Obstruction of Urine, as if both the Ureters were compleatly stopped by the falling of two Stones of dis­proportionate Size into their Mouths. And this was the Case of an illustrious Person, one of the first Rank of the English Nobility, who having for several Years been afflicted with the Gout, one Day felt a severe Pain in one of his Shoulders, which after some Time ceased to afflict him; but he had not been long at Ease, when the Flow of his Urine was entirely interrupted, and continued so to the eleventh Day, when the noble Patient expired, not­withstanding all the Means and Methods that [Page 43]his Physicians, of whom I had the Honour to be one, could direct for his Recovery. Upon opening the dead Body there appeared, when the K [...]dneys were divided, some small Stones in the Pelvis, and others entangled in the Fibres or Strings of the Kidneys, but no Stone in the Mouth or Channel of either Ureter; so nothing can be more certain, nor more ob­vious to the meanest Capacity than this, that the Stone could not be the Cause of hindring the Water from descending into the Bladder, no Stone being found in the Ureters, nor in the Kidneys, of a Size capable of stopping the Tubes before-named; and had there been bred in the Kidneys, any Stones of a sufficient Big­ness, to have compleatly stopped the Ureters, yet it must be supposed, as before suggested, that two Stones of such a Magnitude fell at the same Instant, one into the Orifice of each Ureter, else a total Suppression of Urine could not have followed; and this must be supposed scarce ever to have happened, and is but bare­ly possible. But de facio, there were no such Stoppage found in either Ureter. Yet not­withstanding one of the Physicians declared his Opinion, and obstinately persevered in it, that the Suppression of Urine, of which the Patient dyed, proceeded from the Stone in The Kidneys.

These are the best preservatory Means against the Return of this formidable Disease, since the true and effectual Way, as mentioned above, is either to enable the active Princi­ples of the Blood to keep the Mass in such an equal, regular, and just Mixture, and to refine and exalt it to such an healthful State, as may prevent the Generation of hard and gritty Con­crescences, that as they are the Foundation of the Stone, so they administer Materials for the Superstructure; and for procuring this End, the Remedies already enumerated are most availing, in as much as they animate and enliven the Spirits, refine and elevate the Mass of Blood, and dissolve and sever creta­ceous or sandy Coalitions, by maintaining its Circulation with a due Celerity. To these may be added such Medicines as subdue the acid and acrimonious Quality of the Juices, by blunting and smoothing their sharp Points and Angles, such as Coral, Crabbs-Eyes, Crabbs-Claws, Oyster-shells, and other testaceous, ab­sorbing and correcting Powders, given with Asses-Milk, or mixed with other Ingredients in Pius or Electuaries; and likewise those, that are proper to assist the digestive Faculty of the Stomach, to concoct the Foods and Liquors it receives, into a wholesome well-laboured and duly mixed Mass of Chyle, that the un­concocted [Page 45]and faeculent Parts, the first Seeds and Principles which by their Union and Coacervation produce the Stone, may be prevented.

The Forms of such Medicines that pro­mote Digestion in the Stomach, are such as these.

Take of Conserve of Roman Wormwood, of candied Citron Peel, or the outward yellow Rind of the Orange, each an Ounce; of Coral, Crabbs-Eyes, and Pearl, each a Drachm; of candied Nutmegs, a Drachm and half; of Salt of Wormwood and Tartar, each two Scruples; of com­pound Powder of Wake-Robin, and the Leaves of Chamaepitys, each a Drachm and half; of the Syrup from candied Nut­meg, as much as will make an Electuary. Take the quantity of a large Nutmeg, every Morning and Evening, drink­ing after it, a Glass of Wormwood-wine, or the Infusion of the Root of Gentian, or Twenty Drops of the Tincture of Gen­tian in a Glass of White-wine.

Or, Take of the Tops of Roman Worm­wood, and the lesser Centaury, each half a Pugil; of the Root of Gentian, and Vir­ginian [Page 46]Snake-root, each a Drachm; of Cardamom Seeds, two Scruples; of Cori­ander Seeds, two Drachms and half; of Salt of Tartar a Drachm; infuse all in a sufficient Quantity of Spring-Water to a Quart; strain it, and add to it, of com­pound Wormwood, and compound Gen­tian Water, each an Ounce and half; take a Quarter of a Pint each Morning fast­ing, and also in the Afternoon, about three Hours after Dinner.

Sometimes Take of Elixir Propriet at is tar­tarised, five and twenty, or thirty Drops in a Glass of Mountain White-wine, twice a Day, viz. at about Eleven and Four.

Besides these Remedies, moderate Exercise, pure and well ventilated Air, Regularity and Temperance, in Eating and Drinking, must be carefully observed, without which the best Methods of Physick may be unavailing.

As to those Medicines called by the Greek Physicians Lithontriptica, that is, such as break and dissolve the Stone, either in the Kidneys or Bladder, and to which many Em­piricks have pretended, assuring us that they gradually wear and crumble it away, and re­duce [Page 47]it to such minute Fragments, that they easily pass the Ureters into the Bladder, and with the same ease slide through, and are ex­cluded thence together with the Urine: I ac­knowledge I am incapable of conceiving how a Medicine ingested by the Mouth can produce this Effect. It is true, that the celebrated Car­thaginian General Hannibal, as Historians re­port, found means by Vinegar, or some in­vented sharp and acid Liquor, to dissolve the Alpine Rocks, and so to eat his Way through those Mountains into Italy. But if any Pa­tient, afflicted with the Stone, should swallow a proper Quantity of this powerful Fluid, were it to be had, or any other of like Vertue, since it must first undergo a great Alteration by the Ferment and digestive Faculty of the Stomach, and then a farther by mixing with the bilious Humours descending from the Gall-Bladder, and afterwards with the acid Juices issuing from the Pancreas, and then another by pas­sing the lacteal Strainers, and mingling its Stores with the Lympha brought by numerous Water-Pipes into the common Receptacles; then another by its Admission into the Veins, where during repeated Circulations with great Celerity, the Parts by innumerable Attritions, Reverberations, and Glances from their violent [...]shing and beating one upon another, receive [Page 48]Comminution, and are attenuated, ex­alted, and smoothed, till they acquire a re­fined volatile State; and at last of all, since they must receive another Alteration by entering and passing the urinary Strainers in the Kid­neys: Let, I say, all these Changes be contem­plated, and will not, do you think, the Medi­cine ingested be unedged and disarmed of its sharp Points and Angles, and lose all its dis­solving or Stone-cutting Quality? For no a cid Juices, not Vinegar itself, continue acid after they have mingled and circulated with the Blood, and have felt for some Time, the di­gestive Power of its active Principles.

Those bold Persons therefore that pretend to be Masters of Remedies, which given by the Mouth, will break or dissolve the Stone in the Kidneys, or the Bladder, impose upon Man­kind, not only because the Medicine loses its peculiar Qualities, by undergoing such a Va­riety of Changes and Alterations, as have been enumerated, but likewise by mingling and being diluted with above Twenty Pound of Blood, (for few Men have less) and frequent­ly running its Circuit with it, by which means it becomes quite another Thing, before it reaches the Stone it was designed to dissolve or crumble to pieces.

It must be observed, that as above-menti­oned, there are some porus, light, and friable Stones, whose Constructure is so slight, that they will by a little Shock or Collision, crum­ble, and be divided into small Fragments, while the Parts of others so strictly cohere, that they are scarcely capable of Separation; and it is of these harder and more solid Stones that I speak, when I say they cannot be broken, or cut in pieces, by Remedies given at the Mouth, but they defy the Edge of the keenest Lithon­triptick Weapon in all the Arsenals of Greece.

When therefore Stones or Gravel are at any Time removed from the Kidneys, and exclu­ded with the Urine, it is not by Vertue of any Stone-breaking Medicine, acting upon them, but by the Operation of its diuretick Quality, exciting a great Separation of Serum, which rushing in a swift Current through the Kid­neys, washes away in its Streams the Gravel and Stones lodged there, that by their propor­tionate Magnitude are capable of passing the Ureters, as a sudden Storm or sharp Shower of Rain, rolls down the Streets in its Torrent, the Sand and loose Stones, as well as other promiscuous Impurities to be carried off by the common Drain: Though it is very pro­bable that sometimes this Flood of Serum, [Page 50]transmitted from the Veins by its immoderate Quantity, as well as the Strength of its Tide, in its Passage through the Kidneys, may like­wise disunite, and shatter to Pieces some smaller friable Stones, whose Parts hang toge­ther by a very slight Connexion.

But if Nature or Art can afford any Medi­cines, that are capable of breaking a hard large Stone in the Bladder, the most probable Way of making them effectual, would be to inject them directly into the Bladder; for then, having undergone none of those various Al­terations above enumerated, which those Re­medies must do that are taken by the Mouth, they would exert their Stone-dissolving Ver­tue, if they have any, entire and undiminish­ed, and would have the great Advantage of acting upon it by immediate Contact, by which means the Stone in the Bladder, if it could be effected by Medicines, would be wasted and moulder away. But Experience shews that this is not found practicable; for were such a Medicine discovered, it would prevent the Tortures and Misery of many un­happy Patients, and make the useful Art of Cutting for the Stone unnecessary, of which I shall speak afterwards.

When large Stones are bred in the Kidneys, or such as cannot pass, but with great Pain and Difficulty, all forcing diuretick Medicines must, be forborn, and only such as are smooth, oily, and slippery should be employed; lest such as powerfully provoke Urine, should dis­turb and push forward the bigger, that lay quiet in the Kidneys, into the Ureters, where they will either stop at the Entrance, or stick in the Passage, and by that Means either shut up the Mouth, or create a violent Fit of Pain, together with bloody Urine, if their Surface be rough and ragged; and therefore in such Cases, slimy, soft, and mucilaginous Remedies, are chiefly to be depended on, to promote the slipping of the Stone into the Bladder: And if active Diureticks, have been employed in vain to push on the Stone, which often hap­pens in a violent Paroxysm, opiate Medicines of good Force should be given, that the Fibres of the enclosing Membranes, whilst stimu­lated by the Torture of the Stone, and urged by the Medicine designed to expel it, being eased and lulled by their narcotick Vertue, may cease to contract themselves and clasp the Stone so closely, and by dilating and re­laxing themselves while at Ease, may make Way for it to slide through into the Bladder. [Page 52]But if the Stone in the Kidneys is large, solid, and branches through their Substance, no Means at all should be used for its Cure; for if [...]here are any Remedies that have Power to break and dislodge its Fragments, which I be­lieve, as I have said, there are not, what would that be, but to send them down to stop the Ureters, or to give unsufferable Torments, by sticking in their Channels!

As to the Stone in the Bladder, which, as said above, is no more than a Stone first bred in the Kidney, and thence conveyed through the Ureters; where it receives its ob­long Figure, into the Bladder, and gains there such a Magnitude, that it becomes incapable of being expelled with the Urine, being fed and augmented continually with new Gritt and sandy Materials washed from the Kidneys and falling down into the Bladder; when it first descends into that Receptacle, and its Size does not exceed a due Proportion, while it floats in the Urine, it often plays, aims, and offers at the Orifice of the Urethra, but its Fi­gure or Position not being accommodated to it, cannot pass through that urinary Channel; and then it not only creates great Uneasiness, by lying cross its Mouth, but likewise often by interrupting the Streams of Urine, and some­times [Page 53]by totally obstructing the Passage. When the Gravel, or Stone, or Stones, are yet small enough to enter and pass the Urethr [...], to faci­litate their Discharge, the Veins should be filled with such diuretick Liquors, as I have before set down, that they may communicate a constant Flow of Urine to the Bladder, which being commonly kept full, will be the more apt to eject the Stone, together with the Flood that distends it. But if it grows so great, that it becomes unable to make its Way, by Reason of its disproportionate Size, it will be daily augmented by the Accretion or Ad­dition of new Gritt or Gravel, carried from the Kidneys, through the Ureters, by the Streams of Urine, as Sand and small Stones, are rolled along from a rising Ground, by Rills of Water, that flow down its Sides. Now these Sands or minute Concretions, as I have ex­plained above, are the Seeds, or Mother of the Stone, that is, the Principles or first Materials, that combine for the Formation of it in the Kidneys, and afterwards to its Augmentation in the Bladder; and to hinder its encreasing there to a great Magnitude, those Remedies are to be used which were enumerated before, for cutting off the Generation of Gravel, and such sandy and fabulous Combinations; to which I refer the Reader.

But if through Neglect, or the Inability of Methods and Medicines to prevent the breed­ing of Sand and Gravel in the Kidneys, which washed away by the Urine into the Bladder, constantly feed and amplify the Stones con­fined there, which grow not like Animals and Vegetables, by Nourishment admitted by the Mouth or the Root, and conveyed and distri­buted to the outward Parts from the inward, but by the daily Access, Accumulation, and Adhesion, of hard, sandy Particles to the Sur­face of the Stone; if, I say, the Stone, by the Arrival and Complication of new petrifying Principles, becomes large and ponderous, and being attended with a terrible Train of Symp­toms, that render the Patient a great Object of Compassion, while Death is more eligible than Life, and no effectual Means can be sug­gested, how it may be cut, dissolved, or crum­bled to pieces, as I have before demonstrated, all that can be done by Medicine, is to quiet or reduce the enormous Pains and Torments, inflicted by this cruel Disease; and for the ef­fecting of this, only crude Opium, or its Pre­parations, the Gift of Divine Benignity to mi­tigate the Tortures, and alleviate the extream Miseries of Mankind, can be depended on. This is the Patient's Refuge, and the only Con­solation [Page 55]to allay his Agonies, and restrain the Rage of his Sufferings. And therefore in this Case, let him take the following Pills.

Take of Saffron, beat small, three Grains; of Extract of Gentian, six Grains; of crude Opium dissolved and strained, a Grain and half; Balsamick Syrup, enough to make it into Pills, for one Dose, to be taken in violent Pains, and repeated when the Force of the first is worn off, if the Torments continue.

But if the Quantity of Opium prescribed, is not sufficient to remove the Pain, it may gra­dually be encreased, by adding a Quarter of a Grain; and if that likewise should be ineffec­tual, add half a Grain, and so on, till the Pa­tient has found what is the just Quantity that will relieve him, and when he has taken his Measure, and settled the Proportion, he will be obliged to take it as often as his Agonies shall make it absolutely necessary. All smooth, soft, and slippery Meats and Drinks, as well as Medicines must be chosen; for those of an opposite Nature will irritate and enrage the Paroxysm, especially if an Ulcer [Page 56]attends the Stone, which is an incurable Dis­ease: And as Ulcers produced either in the Kidneys, or the Neck of the Bladder, from other Causes besides the Stone, elude the Force of all Remedies, which is likewise the Case of all other internal Ulcers in the Lungs, Liver, &c. so those, that arise from the Fret­ting and Laceration of the Membranes in the Kidneys or the Bladder, by Stones of a rough and ragged Superficies, can never be healed, at least while the Stone continuing there, is always wearing and wounding the Part where it lodges: And therefore all that can be done, is to drink plentifully of smooth, and soft Li­quors, besides taking slippery and oily Reme­dies, that may constantly dilute and wash a­way the ulcerous Matter, lest gathering to­gether in too great a Quantity, it should stop the Passage of the Urine; which Obstruction is sometimes so great, that the Surgeon's Hand is necessarily required to pass his Catheter in­to the Bladder, for the Relief of the Patient, through which the imprisoned Urine may flow freely out; and the Patient is obliged to fly to this Refuge for Ease, as often as Clysters and other Medicines ingested by the Mouth are ineffectual. The soft and smooth Liquors that may assist the Patient, by diluting the [Page 57]corrupt Matter, and making it fit to flow, are Mead, or other Liquors made of Honey; also Decoctions of Barley, Liquorish, Marsh-mal­lows, dryed Figgs, and Raisins of the Sun, stoned; or rather, the following Apozem.

Take of Flowers of Mallows, an handful; of Root of Marsh-mallows, half an Ounce; of sweet Fennel-Root, an Ounce; of Leaves of Violet, Parietaria, each a Pugil; of Anise and Carraway Seeds, each a Drachm and half; boil all in three Pints of Spring-Water, to a Quart, strain it, and add of Syrup of Marsh-mallows, three Ounces; and six Drachms of the Tincture of Saffron, made with Treacle-Water; drink half a Pint, or six Ounces of it, three Times a Day.

The smoothest and softest Spring-Water, should be chosen for common Drink, such as that of Bristol, or any other, that rises from Chalk-Hills: A good Draught likewise of White-wine, and new Ale, [mind this] now and then repeated, is useful to dislodge and carry off the noxious and impure Matter, issu­ing from an Ulcer in the Kidneys or Bladder; and the Sediment of each of them is distin­guished [Page 58]by their slimy, glutinous and ropy Quality, from the white, mealy and light Con­tents, found often in the Urine, from scor­butick Causes, as above suggested, that by shaking the Glass, will presently rise and float in the Bosom of it, which however has no weight, nor viscous, nor gritty Quality, but swims in pale, discontinued, and incoherent Matter, communicated to the Urine from the Blood, abounding with such Impurities. And they are discriminated from one another, by a faetid and offensive Smell, proper to the Mat­ter discharged from an Ulcer in the Bladder, and contracted from long mixing with the Urine, which is not found in those slimy Con­tents that flow down from the Kidneys, and are excluded with the serous Streams, as I have above explained.

After all, when notwithstanding the due Care and Observance of the best Rules to pre­vent it, the Stone in the Bladder grows very large, and the Pains are greater than Humane Patience can bear, the last Refuge from this dreadful Tormentor, is manual Operation, when Incision is made into the Bladder, and the Stone extracted through the Wound. So strong is the Principle of Self-Preservation, and so terrible the Idea and Apprehension of [Page 59]Death, that to continue a little longer in Be­ing, Men submit, not only to a great Variety of lingering Sufferings and Calamities, but likewise to the acutest Fains, or which their yeilding to this Method of curing the Stone, is a most convincing Evidence.

Though the Cutting for the Stone is a pain­ful Operation, and attended with the Hazard of Life, yet many Patients have been relieved by it, and continued well after it for many Years, especially those, that were Cut in their Youth. Yet it must be acknowledged, that many also have miscarried, either from the Nature of the Stone, their ill Habit of Body, the Unskilfulness of the Operator, or his want or sufficient knowledge in Surgery to heal the Wound. And this Misfortune often happens likewise from the Patient's deferring the Ope­ration too long, out of an Abhorrence of the Violence of the Cure, or from flattering Hopes that the Disease will not arise to that Extre­mity, and torment them with such insuffer­able Symptoms. It is therefore the Interest of Persons afflicted with it, to undergo the Operation, by which the Stone is extracted, when as yet it is of a moderate Size, and there­fore more Easily to be drawn through the Wound, and before their Strength is ex­hausted [Page 60]by long Sufferings, and repeated Pa­roxysms of Torture, and before the Ulcer that is often formed by it, becomes deep and inveterate; and then, while their Vigour is unwasted, and their Constitution otherwise hail, and the Stone not of an extraordinary Magnitude, the Operation is likely to be suc­cessful: And if these Rules were observed, the Lives of many of these unhappy Patients might be saved, that are lost for want of a timely Submission to this Method of Cure.

When the Stone, lapsed from the Kidneys into the Bladder, are not augmented there to that Proportion, as makes them incapable of entering into the Mouth of the Urethra, yet sometimes after it has entered, it is however too large to make its Way through that Aquae­duct, and therefore stops in the Road, where it not only creates great Pain, but likewise obstructs the Current of the Water, till at length there is no Remedy left but the Sur­geon's Art, who in this Case easily relieves the Sufferer, by cutting upon the Stone where he feels it lodged, and thrusting it forth through the Orifice of the Wound: And this is the most practicable and least dangerous Instance of Cutting for the Stone.

As for Cutting into the Bladder, and ex­tracting the Stone thence, various Methods have been invented, of which a distinct and accurate History is not the Business of this Dissertation: It is enough for me in this Place to mention the most Practicable and safest Way, and this, as I am informed, is that of cutting into the Bladder, in the Region above the Os Pubis, lately brought into Use. Whe­ther there occur any dark and obscure Hints of this Practice in ancient or modern Authors, or whether the first Invention does Honour to the ingenious Surgeon Mr. Douglass, it is certain, that either as Reviver or Inventor of this new Method, he has deseryed well of Mankind, and merited the Thanks and Es­teem of all the Faculty, since all Ways of per­forming this Operation known before, were accompanied with more difficulty, more suf­fering, and greater Hazard of Life.

Before the Patient consents to undergo this Method of Cure, great Care and Caution should be used, that the Operator may be sure himself, and so able to satisfy the Patient, that there is a Stone in the Bladder, the Cause of all his painful Symptoms, and fit to be ex­tracted. For there have been other Diseases of the Bladder, that have so perfectly imitated [Page 62]the Stone in all its Symptoms, and have im­posed upon Surgeons, eminent in their Art, who after strict Search have pronounced the Case to be the Stone, yet when they have cut the Patient to relieve him, no Stone has been found, and upon opening the dead Body, ei­ther a Fungus, or some Excrescency, grown to a great Bigness in the Neck of the Bladder, or some other Disease, or Errour of Nature in the Bladder, appeared to be the only Cause of all the Nephretick-like Symptoms, that afflicted the Patient: And therefore, I say, the Undertaker, before he attempts the Operation, ought with the greatest Delibera­tion, and most careful Scrutiny, to get the fullest Conviction in himself, of the real Existence of the Stone in the Place he expects to find it.