The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

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

SEeing wee cannot otherwise help such men as have stones in their bladders,* 1.1 wee must com to the extreme remedie, to wit, cutting. But the patient must first bee purged, and if the case require, draw som blood; yet must you not immediately after this, or the day following hasten to the work: for the patient cannot but bee weakned by purgeing and bleeding. Also it is expedient for som daies before to foment the privities with such things as relax and soften, that by their yeelding, the stone may the more easily bee extracted. Now the cure is thus to bee performed.* 1.2 The patient shall bee placed upon a firm table or bench with a cloth many times doubled under his buttocks, & a pillow under his loins and back, so that hee may lie half upright with his thighs lifted up, and his legs and heels drawn back to his buttocks. Then shall his feet bee bound with a ligature of three fingers bredth cast about his anckles, and with the heads thereof beeing drawn upwards to his neck, and cast about it, and so brought downwards, both his hands shall bee bound to his knees, as the following figure sheweth.

[illustration]

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

The patient thus bound, it is fit you have four strog men at hand; that is, two to hold his arms, and other two who may so firmly & straightly hold the knee wish one hand and the foot with the other, that hee may nei∣ther moov his limbs, nor stir his but∣tocks, but bee forced to keep in the same posture with his whole bodie. Then the Surgeon shall thrust into the urinarie passage even to the blad∣der, a silver or iron and hollow probe,* 1.3 anointed with oil, and opened or slit on the outside, that the point of the knife may enter there into, and that it may guide the hand of the work∣man, and keep the knife from pierce∣ing anie further into the bodies lying there under. The figure of this probe is here exprest.

[illustration]

Probes with slits in their ends.

Hee shall gently wrest the probe, beeing so thrust in, towards the left side,* 1.4 and also hee who standeth on the patient's 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 libertie to make the incision upon the probe, which is thrust in and turned that way. But in making this incision, the Surgeon must bee careful that hee hurt not the seam of the perinaeum and fundament. For if that seam bee cut, it will not bee easily consolidated, for that it is callous and bloodless, therefore the urine would continually drop forth this way. But if the wound bee made too near the fundament, there is danger, least by forcible pluc∣king forth of the stone hee may break som of the hemorroid veins, whence a bleeding may ensue, which is scarce to bee stopped by anie means, or that hee may rend the sphincter-muscle,

or bodie of the bladder, so that it never can bee repaired. Therefore it must bee made the space of two fingers from the fundament,* 1.5 according to the straightness of the fi∣bres, that so it may bee the more easily restored afterwards. Neither must the incision thus made, exceed the bigness of ones thumb, for that it is afterwards enlarged by putting in the Crow's beak 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 torn. Then presently put into the wound som one of these silver instruments delineated here below, and called by the name of Guiders, for that thay serv as guides to the other instruments which are to bee put into the bladder; these are made with a round and prominent head, whereby it may bee put into the described cavitie 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 bee put un∣der the former, beeing 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 bee drawn forth, and the guiders to bee thrust and turned up and down in the bladder, and at length to bee staied there by putting in the pin; yet such guid∣ers as want a pin are fitter for the hand, and are by som called spatbae. Then must they bee held betwixt the Surgeon's fingers. It will bee also necessarie for the Surgeon to put an∣other instrument called the D cks-bill between the two guiders into the capacitie of the bladder; hee must thrust it in somwhat violently, and dilate it so thrust in with both his hands, turning it everie way to enlarge the wound as much as shall bee sufficient for the ad∣mitting the other instruments which are to bee put into the bladder; yet it is far better for the pati••nt, if that the wound may with this one instrument bee sufficiently dilated, and the stone pulled forth with the same without the help of anie other.

[illustration]

The effigies of an instrument called a Ducks-bill.

Which if you have not in a readiness, and the largness of the stone require more dilata∣tion, then must you put in this dilater; for beeing 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 help of this instrument beeing dilated as much as is sufficient, then putt in the straight Ducks-bill before described, or the crooked here exprest.

[illustration]

Crooked Forcipes's like a Ducks-bill.

The stone may bee sought and taken hould of with these instuments, and beeing taken hold on, the branches of the instrument shall bee tied together, least they should suffer that to slide away which they have once taken hold of. Neither shall the stone bee suddenly plucked out, but easily shaken to and again, and at length gently drawn forth. Yet you must beware that you do not press it too straightly in the forceps, least you should break it in pieces: Som, least it should slip away, when they have once taken hold thereof, put their two fingers into the fundament, and put them about the stone that it may not fall out, nor slip back again, which I think conduceth 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 instruments, so that the stone can slip forth on no side.

[illustration]

Winged instruments to hold the stone with the Duck's-beak.

[illustration]

The figure of another.

[illustration]

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

* 1.6After the stone is by these means drawn forth, observ diligently whether it beee worn on anie side, and as it were levigated; for that happeneth by the wearing or rubbing of one or more stones upon it; yet there is no surer way to know this, than by searching with a Ca∣theter. The one end of the following instrument may supplie the want of a Catheter or pro∣be, and the other may serv for a scoop or clenser.

[illustration]

A cleanser or scoop whereby you may search whether there bee anie more stones behinde, as also clense or purge the bladder from gravel, clots of blood, and other such bodies as use to remain behinde after the drawing forth of the stone.

For if other stones remain behinde, thay shall bee drawn forth as the former, which bee∣ing don, the end oft the instrument, which is crooked and hollowed like a scoop or spone,* 1.7 shall bee thrust by the wound into the bladder, and therewith you shall gather together and take out what gravel soever, clotted blood, and the like refuse as shall bee there, for that they may yeeld matter for another stone.* 1.8 But if you finde that the stone which is in the blad¦der bee too great, so that it may not bee plucked forth without great and fearful rending of the bladder, it will bee better to take hold thereof with this Crows bill and so break it to peeces.

[illustration]

The effigies of a toothed Crow's-bill made neatly to break greater stones, with a screw to force it together.

This Crows-bill hath onely-three teeth, and those sharp ons on the inside, of which two are placed above, and one below, which is the middle-most, so that it falleth between the two upper. When the stone is broken, all the peeces therof must bee taken forth, and wee must have a special care, lest any peece thereof lie hid; for that in time, increased by the access of a tough and viscuous matter, or conjoined with other fragments by the inter∣sition of the like matter as glew, may rise to a stone of a large bigness.

Notes

• * 1.1

  What to bee don before dissection.
• * 1.2

  How to lay the patient.
• * 1.3

  Why the probe must bee slit on the out∣side.
• * 1.4

  Why the seam of the perinae∣um must not bee cut.
• * 1.5

  Where to make the wound to take forth the stone.

  That which is torn sooner healeth then that which is cut.
• * 1.6

  A note of more stones than one.
• * 1.7

  How to clens the bladder.
• * 1.8

  How to break a stone that cannot bee ta∣ken out whole and at once.