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

CHAP. XLII. How to cut men, for the taking out of the stone in the bladder.

SEing wee cannot otherwise helpe such men as have stones in their bladders, we must come to the extreme remedy, to wit, cutting. But the patient must * 1.1 first be purged, and if the case require, draw somebloud; yet must you not immediately after this, or the day following hasten to the work, for the patient can∣not but be weakened by purging & bleeding. Also it is expedient for some daies be∣fore to foment the privities with such things as relaxe and soften, that by their yeel∣ding, the stone may the more easily be extracted. Now the cure is thus to be perfor∣med; The patient shall be placed upon a firm table or bench with a cloth many times * 1.2 doubled under his buttocks, and a pillow under his loynes & back, so that he may lie halfe upright with his thighs lifted up, and his legs and heels drawn back to his but∣tocks. Then shall his feet be bound with a ligature of three fingers breadth cast about his ankles, and with the heads thereof being drawn upwards to his neck, and cast a∣bout

it, and so brought downewards, both his hands shall bee bound to his knees, as the following figure sheweth.

[illustration]

The figure of a man lying ready to be cut for the stone.

The patient thus bound, it is fit you have foure strong men at hand; that is, two to hold his armes, and other two who may so firmely and straightly hold the knee with one hand, and the foot with the other, that he may neither move his limmes, nor stirre his buttocks, but be forced to keep in the same posture with his whole body. Then the Surgeon shall thrust into the urenary passage even to the bladder, a silver or * 1.3 iron and hollow probe, annoynted with oyle, and opened or slit on the out side, that the point of the knife may enter thereinto, and that it may guide the hand of the workman, and keep the knife from piercing any farther into the bodies lying there-under. The figure of this probe is here exprest.

[illustration]

Probes with slits in their ends.

He shall gently wrest the probe, being so thrust in, towards the left side, and also * 1.4 he who standeth on the patients right hand, shall with his left hand gently lift up his Cods, that so in the free and open space of the left side of the perinaeum, the Surgeon may have the more liberty to make the incision upon the probe which is thrust in and turned that way. But in making this incision, the Surgeon must be carefull that he hurt not the seame of the perinaeum and fundament. For if that seame bee cut, it will not be easily consolidated, for that it is callous and bloudlesse, therefore the u∣rine would continually drop forth this way. But if the wound be made too neare the fundament, there is danger, lest by forcible plucking forth of the stone he may break some of the haemorrhoide veins, whence a bleeding may ensue, which is scarce to be

stopped by any meanes, or that hee may rend the sphincter muscle, or body of the bladder, so that it can never be repaired. Therefore it must be made the space of two fingers from the fundament, according to the straightnesse of the fibres, that so it * 1.5 may be the more easily restored afterwards. Neither must the incision thus made, exceed the bignesse of ones thumbe, for that it is afterwards enlarged by putting in the Crowes beake and the dilater, but more by the stone as it is plucked forth. But that which is cut, is neither so speedily nor easily healed up, as that which is torne. Then presently put into the wound some one of these silver instruments delineated * 1.6 here below, and called by the name of Guiders, for that they serve as guides to the o∣ther instruments which are to be put into the bladder; these are made with a round & prominent head, whereby it may bee put into the described cavity of the probe, and they are noted by these letters A. A. then there are others marked with the letters B. B. and called by the like name, and are to be put under the former, being made forked at the end, that so it may, as it were, embrace the end of the former.

[illustration]

The figures of Guiders of two sorts.

Now the probe is to be drawne forth, and the Guiders to be thrust and turned up and downe in the bladder, and at length to be stayed there by putting in the pin; yet such Guiders as want a pin are fitter for the hand, and are by some called spathoe. Then must they be held betwixt the Surgeons fingers. It will be also necessary for the Surgeon to put another instrument called the Ducks bill between the two Gui∣ders into the capacity of the bladder, hee must thrust it in some what violently, and dilate it so thrust in with both his hands, turning it every way to enlarge the wound as much as shall be sufficient for the admitting the other instruments which are to be put into the bladder; yet it is farre better for the patient, if that the wound may with this one instrument be sufficiently dilated, and the stone pulled forth with the same without the help of any other.

[illustration]

The effigies of an instrument called a Ducks bill.

Which if you have not in a readinesse, and the largeness of the stone require more dilatation, then must you put in this Dilater, for being put into the bladder, and the handle pressed together, it will dilate the incision as much as you desire.

[illustration]

The figure of a Dilater shut and opened.

The wound by the helpe of this instrument being dilated as much as is sufficient' then put in the streight Ducks-bill before described, or the crooked here express.

[illustration]

Crooked Forcipes like a Ducks-bill.

The stone may be sought & taken hold of with these instruments, and being taken hold on, the branches of the instrument shall bee tyed together, lest they should suf∣fer that to slide away which they have once taken hold of. Neither shall the stone be suddenly plucked out, but easily shaken too & again, and at the length gently drawn forth. Yet you must beware that you doe not presse it too straightly in the forcep••, lest you should breake it in pieces: Some, lest it should slip away, when they have once taken hold thereof, put their two fingers into the fundament, and put them a∣bove the stone that it may not fall out, nor slip backe againe, which I thinke condu∣ceth much to the easie extraction of the stone. There are others who strengthen this comprehension by putting in on each side above and below these winged instru∣ment, so that the stone can slip forth on no side.

[illustration]

Winged instruments to hold the stone with the Ducks-beake.

[illustration]

The figure of another.

[illustration]

The figure of another winged instrument, the end of whose handle is fastned by a screw, as also a bended iron plate which is marked with this letter A. for the firmer holding thereof.

After the stone is by these meanes drawne forth, observe diligently whether it be worne on any side, and as it were laevigated; for that happeneth by the wearing or * 1.7 rubbing of one or more stones upon it, yet there is no surer way to know this, than by searching with a Cathaeter. The one end of the following instrument may supply the want of a Cathaeter or probe, and the other may serve for a scoop or Cleanser.

[illustration]

A cleanser or scoop whereby you may search whether there be any more stones behind, as also cleanse or purge the bladder from gravell, clots of bloud, and other such bodies, as use to remaine behind after the drawing forth of the stone.

For if other stones remaine behinde, they shall bee drawne forth as the former, * 1.8 which being done, the end of the instrument, which is crooked and hollowed like a scoop or spoone, shall bee thrust by the wound into the bladder, and therewith you shall gather together and take out what gravell soever, clotted bloud, and the like refuse as shall be there, for that they may yeeld matter for another stone. But if you find that the stone which is in the bladder be too great, so that it may not be plucked * 1.9 forth without great and fearfull rending of the bladder, it will be better to take hold thereof with this Crowes bill and so break it to peeces.

[illustration]

The effigies of a toothed Crowes-bill made neatly to breake greater stones, with a screw to force it together.

This Crowes bill hath onely three teeth, and those sharpe ones on the inside, of which two are placed above, and one below, which is the middle-most, so that it fal∣leth between the two upper. When the stone is broken, all the peeces thereof must be taken forth, and we must have a speciall care, lest any piece thereof lye hid; for that in time, increased by the accesse of a tough and viscous matter, or conjoyned with other fragments by the interposition of the like matter as glew, may rise to a stone of a large bignesse.

Notes

• * 1.1

  What to bee done before dissection.
• * 1.2

  How to lay the patient.
• * 1.3

  Why the probe must be ••it on the out-side.
• * 1.4

  Why the s••ame of the perinaeum must not be cut.
• * 1.5

  Where to make the wound to take forth the stone.
• * 1.6

  That which is torne is sooner healed than that which is cut.
• * 1.7

  A note of more stones than one.
• * 1.8

  How to cleanse the bladder.
• * 1.9

  How to break a stone that can∣not be taken out whole and at once.