The art of curing diseases by expectation with remarks on a supposed great case of apoplectick fits : also most useful observations on coughs, consumptions, stone, dropsies, fevers, and small pox : with a confutation of dispensatories, and other various discourses in physick / by Gideon Harvey ...

CHAP. VIII.

Of the Abuses in the Stone, and particularly of the abuse of the Catheter; also the Strangury and difficulty of Vrine.

1. THE rash and too frequent sounding by Catheter and Itinerary, to clear the doubt, whether a Stone be residing in the Bladder or not, proceeds more from the In∣treague of the gain-thirsty Surgeon, tho' to the greatest prejudice and pain of the Patient, than any abso∣lute necessity; for unless his Reso∣lution is entirely to submit himself to the hands of the Lithotomist, in case such a quarry be discovered, the certification of the conception and growth of the Stone must inevitably intail upon him a con∣tinual fear and anguish, whereof he is not like to be freed, before despair has thrown him upon so dubious a Remedy as the Knife and Forceps. But if his Mind

wants firmness of Courage to en∣dure the cruelty of such an Ope∣ration, let him by no perswasion yield to the search of any crafty Stone-cutter, whose business is more, to dive into his Pocket than his Bladder, witness that silly ignorant Fellow of the Town, whose Ma∣sters Reputation was his sole Court∣card, whereby to gain so extraor∣dinary a point.

2. Since length of time, with the assistance of assured Remedies, pointed at by those demonstrable Indications above written, will cure a Patient of the Stone, and that any other Disease, that may be mistaken for it, be curable by the same means, to what end shall a search by Catheter be made; espe∣cially when that sort of explora∣tion by the stop of the Instrument at the narrowness of the Sphincter, so render'd by swelling, a callosi∣ty, or a small carnosity, hath pro∣ved so oft fallacious to that de∣gree, that men have been per∣swaded

to be cut, where no Stone was, or ever had been; and ha∣ving passed the dread and tor∣ture of the Operation, were for∣ced to run the risque of a trou∣blesome Cure of the Wound, that seldom is performed without a remainder▪ of a perpetual leaking, and difficulty of miction, and very oft with the loss of Life. Moreover, where probing hath detected no Disease in the Blad∣der, it frequently hath caused one, viz. Inflammation of the Sphincter, bloody Urine, Excoriations, Ul∣cers, continual gleets by injuring the prostates, and involuntary micti∣on, strangury, dysury, total sup∣pression of Urine, and almost all Diseases incident to the Bladder and Yard, not omitting those that Death hath ensued. On the other hand, the uncertainty of the Catheter and Itinerary is no less evi∣dent in those that really having a Stone fixt in a part, where that Tool not reaching, or having pene∣trated

thro' a Stone, whose softness made no resistance, hath imposed on the Surgeon a fallacy of Opini∣on, that the Patients were free.

3. There is no case wherein the use of the Catheter can rationally be justified, except in a total sup∣pression of Urine, occasioned ei∣ther by Mucus, crumbs of blood, or Stone being loosned and fallen to the neck of the Bladder, and the like occasions, to let out that liquid Excrement by removing▪ the obstacle.

4. The Stone grown moveable by being forced from its fastness by probings (as too oft has hap∣ned) violent motions, vomiting, purging, potent diureticks, and by its own weight or bigness, is the only argument, that ought to pre∣vail with the Patient, to surren∣der himself to the doubtful suc∣cess of Stone-cutting; for the pe∣santure of a Stone of compass, will ever incline it to return to the same place of declination,

where it occasioned the former suppression, unless by lying still in bed so long, as by peradventure is required to be reattached to the side of the Bladder, from which it was torn off, it be prevented; so that the pretences of Gravel-Surgeons, in removing the Stone from the mouth of the Bladder by Catheter, to give passage to the Urine that stops by fits, where there is a long interval of time between, is a most ignorant and impudent cheat, the Stone in those cases being always firmly fixt to the side of the Bladder, and a suppression of that kind is ever occasioned by Mucus, Gravel, and the like causes. True, the Ope∣rator may notwithstanding some∣times perceive a Stone, which the posture or manner of decumbiture in the Patient, or swelling of that side of the Bladder, may bring nea∣rer to the entrance of the Sphincter, the touching of which with his Tool, (the Catheter and the Itine∣rary

within it) gives him that false apprehension, that he moved the Stone, (which in that case is the greatest nonsense and stupidi∣ty imaginable) for in all persons the Stone is ever fixt in the begin∣ning, and its growth, and never becomes loose or moveable, but where the ••its of suppression return almost every moment; and the attachment of the Stone to the side of the Bladder is so univer∣sal, that by reason thereof, many have been discovered to have lodged a Stone many years, and probably all their Life-time, upon the dissection of their bodies after death, who whilst living were ne∣ver sensible, or suspicious of such a preternatural growth. Though Ignorance and Knavery are so he∣reditary to most, that are appur∣tenances and giblets of the Art of Physick; yet these Operators for the Stone (who commonly by reason of their desperate misfor∣tunes are forced to be Renegades

and Mountebancks) contain those qualities in the highest abstract.

5. A strangury; and difficulty of Urine, proceding in a lesser stream than usual, have frequently driven several into erroneous apprehen∣sions of the Stone, being occasion∣ed by a glutinous Mucus, through stagnation and adhesion, contract∣ing a smart stimulating acrimony, that has drawn humors towards the Sphincter, whereby from an intumescence both a narrowness of the passage, or weakness of the discharging faculty, and an irri∣tation to Urine, have ensued; the latter specifying a strangury, and the two former symptoms a dif∣ficulty. In neither of these purg∣ing, or diureticks have been found advantageous, but detrimental, so that these Pispot-Doctors to this hour have continued disarmed of proper Remedies to oppose them.