as for the order of the Complications CHAP. XXIII Of Medicines to prevent the Stone for avoiding of the Stone and of Medicaments for dressing those that are cut THough we promised to enquire into the Medicines that may prevent the Stone we must however confess that it is very difficult and perhaps impossible to determine precisely wherein they do consist because the most learned in natural Discoveries speak only in general of the Figures of Bodies and Microscopes have not been able to make known the particular Nature of every one nor yet of all their Pores Possibly we might succeed without observing all these Particularities for though Enquiries into Nature were pursued to that very point yet still there would be causes that did not depend on us and which might form the Stone the Bigness Figure Number and Motion of the Particles of Bodies of which we are composed and of those which serve us for Food are no ways in our power though these things be sufficient to produce in us the Maladies that we fear if the Secretions and Excretions be not performed according to the Course of Nature That we may reap Benefit from the Miseries of others it is to be considered that they who are most subject to the Gravel or Stone live after such a manner as may be avoided or at least corrected by other means and seeing we have spoken of fenny and marshy Places gross and thick Air calculous Food muddy Waters and of the Excesses that may much debilitate the Parts of the Body they are carefully to be avoided using moderately those things that are for our Nourishment following Exercises suitably to our strength without affecting too much Niceness and Delicacy It were better to use a little too much than not enough because Life consists in Action and men love themselves too well not to repose and take their Rest if we be not guilty of Excesses the Parts of our Body continue in good Health ready to resist all attacks Though few things contribute more to the forming of the Stone in the Bladder than continuing long without making of Water yet we must not at first give Diureticks but only gentle Purgatives to empty the Intestines and adjoyning Parts of that kind are Manna Cassia Catholicum duplex Lenitive Electuary Diaprunum simplex a day or two after Turpentine prepared in this fashion may be given in drink Take an Ounce or Six Drachms of the best Turpentine unwashed dissolve it in a Mortar with a little of the yelk of an Egg then add to it two or three ounces of the Water of Winter-Cherries Smallage Pelletory of the Wall or of some other Liquor according to the Nature of the Disease and the state of the Patient Stir all together that it may be exactly mixed and become of so white a Colour that it looks like Cream or coagulated Milk Bever C. XI of the Stone of the Kidneys and Bladder The Bath gives ease to those that are troubled with the Stone and contributes much to the bringing away of little stones that stop in the Kidneys and Bladder The use of the following Ptisanne or Barley-water is very good against the same Distempers It is made with an Ounce of Linseed and the Roots of Mallows and Marshmallows of each two Ounces put into five quarts of water boyled away to four into three Ounces of this Ptisanne may be dropped four or five Drops of the Spirit of Sulphur and it may be made stronger by augmenting the Dose of the Ingredients in the same quantity of water It is approved of for making one void Water mitigating Pain and bringing away Stones The two following Receipts were given me by Monsieur Jonnot the first of which he told me hath often to his Experience been successful in easing Nephritick Pains and those who are subject to void small Stones and that the second never failed him provided the Stone be of a Bigness fit to come out of the Pelvis or Bason of the Kidneys The first Medicine is to be taken in the Spring and Fall every Morning for three days together Take six Ounces of the Water of Pelletory of the Wall an Ounce of the Oyl of sweet Almonds and an Ounce and a Half of the Syrup of Limons in case of necessity it is taken at any time For the second Remedy the Patient must be once or twice blooded and twice purged with two or three Drachms of Sena infused overnight in the Decoction of Dogs-grass Roots of Marsh-mallows and a little bundle of Flax to the Colature of which must be added an Ounce of cleaned Cassia for every Dose The day after he is to make use of the following Limonade and is to continue it three days successively in the waning of the Moon fasting three or four Hours after Take of Argentine or Wild Tansey Water Lentils and Cresses of each one Handful let them boil half a quarter of an hour in a quart of water when it is taken off the Fire add to it the Juice and Rind of three or four Limons let all infuse together for the Space of four Hours then strain it and add thereunto three Ounces of the Powder of Sugar-Candy and twenty Grains of the Spirit of Salt Keep it for the Use aforesaid The Garden-flags or blew Flower-de-luce that grows upon Walls infused cold into what quantity one pleases of White-wine and an Ounce of the Infusion taken for the first time by Children of ten or twelve Years of Age brings away the Stone The Dose is to be increased or diminished according to the Age of the Patient and its Operation giving always too little rather than too much for fear of drawing the Stones in too great abundance towards the Sphincter of the Bladder which would cause a suppression of Urine One may renew it two or three days after and Purge by the Advice of a Physician The use of White-wine Raddish-water and Wine made of the Fruit of Eglantine or Sweet Briar taken now and then is good Paracelsus in the end of the Preface to his second Treatise of his great Chirurgery prescribes for remedying the suppression of Urine the use of the stones that are found in the Heads of Crabs beat into a subtil Powder drank in the Juice or Water of Raddishes and if the Patients do not thereby make water to make a little bag of Saffron and lay it upon the Kidneys or the Belly towards the passage of the Ureters and upon the Perinaeum Or to make a Powder of dried Acorns and give it to be drank in the Water or Juice of Raddishes in what quantity the Physician shall judge fit The two following Medicines are approved of for bringing away of Sand and small Stones In the wain of the Moon the Patient being Purged let him take in the Morning the bigness of a Nut of fresh Butter and swallow it down like a Pill then let him take a four Limon and squeeze out the Juice of it into four Ounces of White-wine
which was not left in the Bladder it is said that Patient hath a Quarry of Stones The figure and bigness of the Stone being considered after the Operation one may judge whither or no the consequences will be dangerous for if it be monstrous the parts have been much dilated and coutused and if it be craggy and pointed there hath been dilaceration or adherence and some times complication the Stones that have many asperities are never so big as those that are even and smooth in their surface and that for two reasons the first is because the minute Bodies that compose those rough Stones are not so closely comparted and some of them may break off and be voided with the Urine the second because those asperities cause a more sudden and pungent pain than other Figures and force the Patient to betake himself more speedily to the Chirurgeon for ease who performs the operation before that it hath had time to encrease to a greater bigness CHAP. VIII What is to be observed by the Chirurgeon before the Operation HYpocrates having taken an Oath never to undertake the cutting of the Stone hath instructed us how necessary it is to observe all circumspection in performing it Wherefore when a Chirurgeon pretends to the cutting of the Stone he ought to frame to himself a Notion or Idea of opening to himself a passage to the Bladder through a convenient place for extracting of the Stone by his Rules and Precepts he will know if he can Operate and then he is to resolve upon it He that is troubled with the Stone is his Subject matter and it is the duty of a skilful Chirurgeon to foresee the consequences to the end he may guard himself with necessary remedies against the accidents of the matter and of the Operation A Chirurgeon that is called to search or cut a Patient ought to make himself be distinguished from Quacks this will be easie for him to doe if he observe what is taught in the Principles of Chirurgie where they treat of the Qualities of the Chirurgeon and of the Servants It is one of his chiefest qualities to have great skill in Anatomy that he may know the formation and fcituation of the Parts that so he may Operate with necessary circumspection being bold but yet not rash he ought to make his prudence appear by making his prognostick and distinguishing between those things that are ineffectual and perilous and those things wherein according to the Rules of his Art he may succeed without exaggerating the least circumstances and events that depend not upon him by an unnecessary stood of words He is to consider the State Strength and Age of the Petient for knowing that a Man is upon the brink of death before that he search or probe him he is to acquaint those that are by that it is no disgrace to him if he cannot search him or if though the Catheter be even introduced into his Bladder if he make but little or no Water by reason of his weakness because a Patient falls sometimes into an apparent suppression when he hath no Urine to render this happened to me about 3 Years ago I was sent for to search Mr. Sartorin an advocate he was very Ancient Hydropical and at the very point of Death and had not made Water for three days I did not search him and he died within an hour after I saw him when he was open'd there was not one drop of Water found in his Bladder his Ureters were so closed up that the Urine would not pass The Chirurgeon ought to be Informed from the Patients own mouth and by those that wait on him of the secret matters and distempers to which he is subject of the excesses that may have contributed to his Indisposition nothing is to be concealed from him because of the Remedies and Instruments which he is to choose Hypocrates in the sixth Aphorism of his sixth Book affirms that old Men are hardly cured of the Diseases of the Kidneys and Bladder and elsewhere he assures us that he never saw any past fifty years of Age Cured because according to Caelius Aurelianus their Bladder is Nervous and they have but little natural heat besides it is seated too high so that Medicines cannot be conveighed to it They are weak and many Excrements fall continually that way Nevertheless several have been cut and cured of the Stone at a greater Age. It is a good presage for the Cure after the operation is performed if the Patient sleep if his respiration is equal his tongue moist and if he be not dry nor do vomit the lower region of the belly little or not at all swelled with moderate pain and a slight Feaver because in that disposition according to Celsus the inflammation ceases most commonly about the fifth or seventh day He ought to know that the Patient oftner dies by the accidents that accompanie or follow the Operation than by the Stones whilst they are in the Bladder If the Patient be too weak he ought to have time to gather strength otherways the Operation would reduce him to evident danger and the Chirurgion ought to give notice of it that he may avoid the blame before the Operation some time is to be allowed for the digestion of the food that the Patient hath taken that so his Body may be in better plight to endure it Celsus observes that most of learned men have a weak stomack and that they are not strong by reason of Watchings and over Studying The Medicines of Pharmarie cannot cure the Stone they only bring relief when the Stones are very small in the Kidneys or Bladder and when they are as yet but a kind of matter easy to be resolved into Powder and to be evacuated with the Urine The Chirurgeon ought to make his prognostick examining if he can the bigness of the Stone with his finger thrust into the Fundament informing himself how long the Patient has complained of it observing the season place and other circumstances directed by the Principles of Chirurgerie Those that have the Jaundice or Dropsie are not strong enough to endure the Operation When one hath discovered the signs of the Stone or Gravel if the Urine after it hath been bloody or becomes full of purulent matter it is a sign that there is an Ulcer in the Kidneys or Bladder caused hy the roughness and asperities of the Stone and that there is no hopes of curing an Ulcer in the Kidneys because hot and penetrating Medcines are required for expulsion of the Stones and the contrary for Ulcers nature sometimes stirred up or assisted by diverting Medicines discharges it self of that load and gives opportunity of easing the Patients of their tormenting pains The Chirurgion ought not to expect a Cure if after the Patient has been cut the Nephritick Colick continue long with pains that are sometimes heavy and dull and sometimes acute and sharp because that is a Sign that there is a big Stone or
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 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 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 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 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 Vrethra underneath and then putting his Thumb below the Wound he drew them out with a smal Scoop without any trouble page 81 page 81 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 page 82 page 83 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