The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XLI. What manner of section is to be made when a stone is in a boyes bladder.

HItherto we have shewed, by what means it is convenient to draw small stones out of the ureter, bladder and passage of the urine; now will we briefly shew the manner of taking of greater stones out of the blad∣der, which is performed by incision and iron instruments, and I will deliver the practice thereof first in children, then in men, and lastly in * 1.1 women. First therefore let the Surgeon take the boy (upon whom it is determi∣ned the worke shall be performed) under the arme holes, and so give him five or sixe shakes, that so the stone may descend the more downewards to the neck of the blad∣der. The must you cause a strong man sitting upon a high seat to lay the child upon his backe with his face from himward, having his hips lying upon his knees. The * 1.2 child must lye somewhat high that he may breathe the freelier, & let not the nervous parts be too much stretched, but let all parts be loose and free for the drawing forth of the stone. Furthermore, it is fit that this strong man, the childs legges being ben∣ded backe, wish the child, that putting his legs to his hams, that he draw them up as much as he can, & let the other be sure he keep them so; for this site of the child much

conduceth to well performing of the worke. Then let the Surgeon thrust two of the fingers of his left hand as farre into the childs fundament as hee is able; but let him with his other hand presse the lower belly, first wrapping a cloth about his hand, that so the compression may be the lesse troublesome, and lest inflammation should happen rather by this meanes than by the incision. Now the compression hath this use, to cause the stone descend out of the bottome of the bladder into the neck there∣of under the os pubis, whither after it is arrived, it must be there kept, & as it were go∣verned by the command of your hand, lest it should slide from that place whereto you have brought it. These things thus done, nothing now remaineth, but that the Surgeon, with a wound some two fingers breadth distant from the fundament, cut through all the flesh even to the stone on the left side of the perinaeum. But in the in∣terim, * 1.3 let him beware that he hurt not the intestinum rectum; for it may, and usually doth happen, that whilest the stone is brought out of the bottome of the bladder to the neck thereof, this gut is doubled in: now if it bee cut with your incision knife, it commeth to passe that the excrements may sometimes come out at the wound, and the urine by the fundament, which thing hath in many hindred the agglutination and consolidation of the wound; yet in some others it hath done little harme, be∣cause * 1.4 in this tender age many things happen, which may seeme to exceed nature: the incision being made, the stone must bee plucked forth with the instrument here expressed.

[illustration]

Hookes to pull stones forth of childrens bladders.

The stone being drawne out, a small pipe shall be put into the wound, and there kept for some space after, for reasons hereafter to bee delivered; then his knees shall bee bound together, for thus the wound will the sooner close and bee agglutinated. * 1.5 The residue of the cure shall be performed by reducing the generall cure of wounds, to the particular temper of the childs age, and the peculiar nature of the child in cure.

Notes

• * 1.1

  Why the boy must be shaken before cutting.
• * 1.2

  How to place the child be∣fore dissection.
• * 1.3

  Where to divide the perinaeum.
• * 1.4

  Nature very powerfull in children.
• * 1.5

  Generall rules must be redu∣ced to particu∣lar bodies.