The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 2. Of the Stone in the Bladder.

ALthough we should speak of these Diseases of the Reins in order, yet because the Stone in the Kidneys and Bladder a••e of the same Nature, and what hath been said of the one, may agree with the other, we shal speak next of the Stone in the Bladder.

The Material and Efficient Cause is the same of both: only this Difference there is; That Chil∣dren are most subject to the Stone in the Bladder, and Men to that in the Kidneys. The Reason of which, is given by Galen, 6. Epid. Sect. 3. because thickness of Urine, which Children often have by Reason of their gluttony, is dissolved by their gentle heat; neither doth it stay in the Reins by the help of the Expulsive Faculty of the Reins, which is stronger in that age; but being fallen into the Bladder, there it staies longer, because children given to play and sleep, piss more seldom. More∣over, their Urine is not so sharp, neither doth it provoke the expulsive faculty of the Bladder, while the quantity is burdensom, and so the dregs remain because the Passage is very narrow; besides, the bladder being stretched by the plenty of Urine cannot so exactly contract it self to empty out all the Urine, but some remains in the bottom, which is thick, and fit to breed the Stone. On the contrary, old men do often piss forth that Matter which is in the bladder, and their passage is larger; but the thick humor remains in the Reins, because it is clammy, and cannot be dissolved by their weak heat, or strain through by reason of its dryness. Hence Hippocrates in Coacis, saith that the Stone in the bladder is not bred after fourteen yeers of age, to three score, except it was there before.

Fernelius mentioned a new Opinion of the Stone, breeding in the Bladder, saying, That every stone in the bladder, had its beginning from the Kidneys, and grows afterwards in the bladder: For when in a fit of the stone, it fals from the Reins, if it be great, it staies in the Bladder, and by getting new Matter it encreaseth by degrees. For he affirmeth that in grinding of some stones taken out of the Bladder, he found as it were a Kernel which fel from the Reins of another color and substance, and that he never knew any that had a stone in the bladder, who was not formerly vexed with pains in the Reins. But this Opinion is cast off by divers very good Authors, who by their Experience have found the contrary, and have taken many stones from the bladders of children, which have been wholly of the same color and substance within. And common Experience teacheth us, that Chil∣dren have the Stone in the Bladder, who never had pain in the Reins, which would be otherwise if the stone came first from the Reins. It is true, that in men many times stones fall from the Kidneys into the Bladder, and encrease by the addition of new Matter; but we deny that it is alwaies so, and we constantly affirm, that many stones have taken their beginning in the bladder.

The knowledg of the stone in the bladder is difficult, especially in the beginning, when it is little; but when it is great it is evident. But we shall discover it as much as we can by Art.

The First Sign is, pain in the neck of the bladder, which is worse towards the end of pissing, and reacheth to the end of the Yard, like that which is in difficulty of Urine from Inflamation, called Dysuria, and it is scarcely at first distinguished from it, but when other signs appear.

The Second Sign is, Itching in the Yard, which makes the Patient scratch it often.

The Third Sign is, Weight in the Peritonaeum, or inward covering of the Guts, and all about the Pecten where the Hair groweth, with a heavy pain, when the stone is great.

The Fourth Sign is, When there is a great stone there is great stoppage of Urine, with pain like women in travel, and dropping of water, and often endeavoring to pils.

The Fifth Sign is, Stoppage suddenly in time of pissing, by reason of the stone falling to the Orifice of the Bladder.

The Sixth Sign is, Easier making Water lying upon the back, because it puts the stone from the Orifice to the bottom of the bladder.

The Seventh Sign is, Often standing of the Yard, which comes from stoppage of Urine, and of the Inflamation of the bladder by the stone rubbing against it.

The Eighth is, An often desire to go to stool, which follows the desire of pissing, by reason of the consent of the Sphincter Muscles of the Anus and Bladder; for when one is provoked, the other is provoked, because they have branches from the same Nerve.

The Ninth is, The Patient cannot rest in a place, but shakes his Leggs, and if the stone be great he can scarce stand upright, ride, or walk in rough places; for then the mouth of the bladder is much afflicted with the stone.

The Tenth is, That the Patient is helped by no Remedy, but worse commonly; for all Medicines that go through the passages of the Urine, either do bring new matter, and encrease the evil, or car∣ry away the flegm, which being about the stone made it less offensive, but being bare, doth grate the inward Tunicle of the bladder.

The Eleventh Sign is, When the Patient is in pain of the Reins, and after a fit useth to void stones which caused it, but now voideth none as formerly, it is a sign that the stone causing the pain is sent to the bladder, and there remains, where by degrees it encreaseth, and causeth the aforesaid Symptomes. Therefore if any after such pain, voids no stone, and after a time begins to be stopped from making urine, it is very probable that there is a stone in the bladder.

The Twelfth Sign is from Hippocrates, Aph. 79. Sect. 4. They who make a sandy Ʋrine have a stone in the Bladder. Which Aphorism hath troubled many Wits. Galen in his Commentary thereupon, saith, that it is manifestly lame, and defective, because Hippocrates left out half of it; for whether the stone be in the Kidneys or Bladder alwaies the Urin is sandy. And Hippocrates himself contradicts this Aphorism, Lib. de internis Affectionibus, where he reproveth the old Physitians that supposed sand in the Urine to be the sign of the Stone in the Bladder. Cardanus in his Comment up∣on the same Aphorism, saith, That he voided for thirty yeers, first red, then white sand, every day in abundance without any suspicion of the stone either of the Kidneys or Bladder; and he further saith, that there are scarce one in ten who doth not void Gravel, yet few there are that are troubled with the stone in the Kidneys, and fewer with that in the bladder. The Spaniards void much Gravel, and yet are not subject to the stone.

We distinguished of sand in the former Chapter, which may signifie the stone: But we said it was an equivocal sign. For that sand is somtimes sent forth by the strength of the expulsive faculty, and is not kept in the Kidneys and Bladder any while. And if this sand did shew the stone more surely, yet it would never declare that of the Bladder only. And therefore that Aphorism, as the words are is false.

Beverovitius and Salmasius, have greatly contended about this Aphorism (both Learned men) and good to open dark Sentences) and they have written both whol Volums of the same. It is not our intention to stay long upon it, determining this one thing for an end of all Controversies; That the Opinions of Authors, which at first seem contrary to Truth and dayly Experience, are alwaies to be taken in that sence which is most conformable to Truth, although the words will not bear it, which in such a case are to be thought to be added by simple fellows in the Translation, or the whol Sentence to be put in by them; as Galen saith often of some of Hippocrates his Sayings, That they are thrust in by others, when they carry not the weight and Majesty of Hippocrates. And the O∣pinion of Beverovitius concerning sand in the Urine, seems not to be according to the mind of Hip∣pocrates, nor to be of great use in Practice. First, it seems not to agree with Hippocrates, who in his foregoing Aphorisms, takes signs from things contained in the Urine; and following his matter in hand, saith, That Sand in the Urine, signifieth the stone of the Bladder. But Beverovitius inverts the Sence, and saith that Hippocrates is to be understood of Sand, which formerly used to be voided, that if they subsist, that is, be retained in the Bladder, and be no more sent forth, it is a sign that the Sand so retained is turned to a stone in the bladder. This Interpretation, as I said, doth agree with Hippocrates his Intention, and it nothing avails for Practice: for they who use to void gravel, have some time of intermission, in which there is not a stone bred in the Bladder. Nor hath it much weight that Beverovitius observeth, That Hippocrates in his other Aphorisms, where he laies down the signs to be taken from the things contained in the Urine, doth not use the word Subsidentia, or set∣••ing▪

or falling down; but the Word Excretion, or voiding. As for example, they who piss matter or blood, with thick and branny Urine, &c. But here he useth the word that signifieth setling, to shew that he meaneth somthing else. But we bringing all things to Practice, say that Hippocrates in this Aphorism, could not use a word which signifieth only sending forth, or Excretion because he ought to distinguishe that sand which signifieth the Stone, from that which doth not. This Sand as we said in the former Chapter, settles in the bottom of the Urinal; but other Sand doth only stick to the sides; and therefore Hippocrates, that he might distinguish them, said well. They whose san∣dy matter settleth; for others which do not settle, are not a sign of the stone in the bladder.

But that we may bring this Aphorism to Truth, and Practical use, we suppose that the Opinion of Johannes Zechius, is the best; who makes it a proper sign of the stone of the bladder, and there is great use of the Aphorism in Physical Practice, when by al other Interpreters, it is made unprofitable. And that Zechius may be honored by them who have not his Works, we think it work our labor to repeat his words, which are in his Book of Consultation, 58. Consult. Hippocrates (saith he) Aph. 79. Sect. 4. said thus, which was never understood yet, either by Galen, or any other. They whose Ʋrine hath a sandy settling or sediment, have the stone in the bladder. Which Sentence, if we should take it according to Galen, woudl be false, because we observe that many men do piss sand all their lives (whereof I am one) without any suspicion of the stone in the bladder. From whence I cannot but wonder at Galen, and all the rest after him, that they should either not understand so useful an Aphorism (which I can scarce beleeve) or by reason of its ambiguity pass it by. The whol difficulty is in the signification of the word [Sabulosa] in Greek called Psammodea: Hip∣pocrates would have nothing understood thereby but thick gravel mixed as it were with fat Earth like Clay or snot in the bottom of the Ʋrinal; a certain sign of a great stone in the bladder. But because there is nothing constant in man, it is not to be admired that some that have this Disease have not this sign; as when the stone is smal, as we observed m Cardinal Paleotus. Now the cause of this muddy Excrement hath shewed in another place. So far Zechius; but where he shew∣ed the cause of it we could never find. But we plainly shewed it in former Chapter, when we said that this snot-like matter is the proper Excrement of the bladder distempered, when it cannot concoct the great quantity of blood, and superfluous humors which are sent thither, and turn them into its self, but turns them into that consistence like snot; and this evil disposition of the bladder comes from the stone therein. Let that be perused, for it maketh much for the understanding of what hath been said.

But there still remaineth one difficulty, for some have dayly flegmatick, slimy matter in their Urine, and yet are free from the stone in the bladder. And Cardanus reports of an Augustine Monk called Leo, that shewed him often so much congealed flegm in the bottom of the Chamber pot as was bigger than a Goose Egg, and yet he had not the Stone. To this doubt we answer, That the slimy matter that comes from the bladder, is to be distinguished from that which comes from other parts, because that which comes from the bladder, is more clammy and glutinous, so that it sticks fast to the bottom of the Pot or Urinal, and cannot be shaken off when the Urine is powred forth; but that which is from other parts doth so cleave, but comes presently forth with the Urine; Experience hath taught me this, which hiterto no Author ever yet observed. This clamminess comes from the Nature of the Bladder, which is a Membrane, and apt to produce this glewiness, as you may see Glew is made of Membranous Skins of Beasts.

This tough glutinous Matter, I say, comes from the evil disposition of the bladder, which is caused by the stone there, and we can thus prove it besides what hath been said; Because we have known a Child twelve yeers old, that had a stone in the Bladder, and pissed continually a glutinous matter that cleaved to the bottom of the Glass. And after the stone was cut forth, he voided the same for a month, but afterwards none at all. Which cleerly shews that that Matter comes from the evil dis∣position of the Bladder, which could not presently be cured after the Bladder was cured, that matter appeared no more, which shews that it came from no other part but the blad∣der.

For a Conclusion of this, let us take notice, That whensoever this slimy matter appears with all the aforesaid conditions, there is a stone in the Bladder; but when it doth not appear, it doth not follow that there is no stone, for it often happeneth that the stone is smooth, or little, and so doth not hurt the bladder, and then the Urine is alwaies cleer. This is a true sign, that there is a stone when it appears; but when it is absent, it is not a sign of no stone.

Nor would this Objection, or rather Cavil, become a wise man, because from our Observation be∣fore mentioned, we proved that such matter might be voided by Urine, and yet no stone in the bladder, for it was cut forth. It is sufficient that either a Stone was lately there, which was the cause of this Disease; and so this kind of Matter signifieth, either a Stone there now, or lately hath been there.

The last sign is by tryal with the Catheter, and putting the finger into the Anus, which operation

must be used to take away all doubt; for the most part it doth: for somtimes the Stone is covered with slimy matter, so that the Cutters themselves are deceived thereby. But the Catheter is more uncertain than the finger, by which you may not be certain of the Stones being there, but of the form and bigness of it.

As for the Prognostick of this Disease: It is alwaies painful and dangerous; painful, because on∣ly very smal stones can pass through the Neck of the Bladder.

The great ones, if like flint, cannot be dissolved; if soft like Chalk, or brittle, they may be dissol∣ved with long use of powerful Medicines, which for the most part the Patients wil not stick to, and therefore they are seldom cured; therefore there is often cutting, which how terrible it is, dayly Expe∣rience wil declare, because many die under the Operation. Hence Hippocrates in his Oath, commands his Disciples that they use it not, but leave it to men of that Profession only. But in Women, the Operation is less dangerous, because their Passage for Urine is wider, and it may be done without cutting, only by enlarging the part.

The way of Cure is the same with that of the Kidneys, first Evacuation of the antecedent matter, Re∣vulsion, and hindering of the breeding of it: and let the Matter conjunct, or the Stone it self, be dimi∣nished, worn away, or dissolved; for which there are good Medicines in the Chapter aforegoing.

Of which, the distilled Water of Onions is most excellent, by which continued twenty daies we saw a stone bigger than a Bean thrown out of the Bladder.

But the best Authors and Experience teach, That things taken at the mouth cannot dissolve the Stone in the Bladder. Hence it is that we commonly refer them to the Cutter. But because there are many stories of men cured by such Medicines, we wil speak of the chief, that every one may try them, if he please, before he go to the terrible Chyrurgion. Somtimes the Stone is so soft and newly congealed that it is not impossible to dissolve it; but hard flinty stones cannot.

Horatius Augenius, Tom. 2. Epist. Med. Lib. 9. Epist. 8. I (saith he) have twice seen the stone broken in the Bladder. Once by chance I had the same of one Janetus a Printer at Rome in cure, whom I purged that he might be cut with more safety. For he had tried all the Venetian and Flo∣rentine Physitians. But when nothing did him good, be sent for the Priest to consult about his soul, and resolved to be cut. The Priest being a Jesuite, and hearing his Confession, and the con∣dition of his Disease, told him a Medicine, of which he had made tryal in himself and others. He tryed, and was cured in the space of nine daies. The Medicine was this:

Take of the Pouder of Hog-lice or Sows, one dram, or four scruples at the most: Aqua vitae half an ounce: red Pease Broth, nine or ten ounces. Let him take it five hours before dinner.

I cured one of eighteen yeers of age, of a hot and dry complexion, by taking away some part of the Aqua vitae, and gave it him but every other day, and at other daies of Bean and Strawberry Wa∣ter, of each five ounces, with six drops of Oyl of Vitriol, and one ounce of the Julep of Violets to cool him, thus:

Take of the pouder of Sows prepared, one scruple: Aqua vitae two scruples: red Pease Broth eight ounces. Mix them, and give it six hours before meat. Thus Augenius.

Sennertus in his Chapter of the Stone in the Bladder, tels a famous story of William Lauremberg, Professor of Rostoch, who being old, and troubled with the stone, was unwilling to be cut, and ther∣fore sought for other Remedies. First he tried the famous Water against the Stone, which is so much prized by Princes, which is thus made:

Take of Salt of white Tartar one ounce: Parsley Water one pint: Mix them, and strain them with a brown Paper; and with Orange peels make it yellow. He used also the Indian Jewel, called in Spanish, Igiada, which is most famous for breaking the Stone; but both to no purpose. Therfore be desired to make tryal of the Medicine of Sows, which Horatius Augenius saith, cured two yong men.

In imitation of whom, after general Physick, and good Diet, he took of Sows one scruple; the Spirit of Juniper two scruples; red Pease Broth ten ounces: which he took in the morning; but the first and second time he found a straightness in his Breast, and a fainting, so that he was con∣strained to take one dram of Treacle with the Potion; and so used it fifteen daies: but all this while he voided no gravel. And then he added other things, and made it thus:

Take of prepared Sows two ounces: a Hares and Goats Blood prepared, wild Rose Flowers, and purple Violet seeds, of each one ounce: Species Lithontribi, two scruples: mix them for an Antidote, of which take two scruples: the Diuretick Decoction ten ounces: the Spirit of Juniper two scruples.

Which Medicine after he had taken it the second time at five a clock in the morning, four hours after he felt a great pain under the Os Publis, about the Neck of the Bladder: A little after he made a little Water, and therewith some thin red things like scales of fishes; which though they seemed to be slimy, yet when they were touched turned to sand. So that it plainly appeared that they were the outside of the Stone.

By the continuance of this Medicine, every fourth or fifth day he voided the like scales, and som∣times bigger pieces, especially when he used a sweet bath. But when the neck of the bladder was wounded by the fragments and the stone, he used Medicines to asswage pain; and by the use of these Medicines, was in seventeen months cured. The Decoction was.

Take of Liquoris four scruples: Roots of Marsh-mallows, Couch-grass, Rest-harrow, of each half an ounce: Winter Cherries twenty: red Pease six ounces: Raisons one ounce: the four great cold Seeds, of each one scruple: Barley two handfuls. Boyl them in Winter Cherry Water, Rest-harrow, Strawberry, and Bean Flower Water, of each one pint and an half: to the straining add of the Syrup of Marsh-mallows four ounces.

The Sows are thus prepared:

Take of live Sows two pound; wash them in Rest-harrow Water: then drown them in Spa∣nish Wine; then powr the Wine out, and put them in Glasses, the more Glasses the better, because then they will dry better: Put these Glasses well stopt into the Oven when the Bread is drawn, that they may dry gently till they will pouder: then put some Spanish Wine upon this Pouder, as much as it will take in, and dry it again; do so thrice: and fourthly wash it with this Liquor:

Take of Straw-berry Water three ounces: Spirit of Vitriol half a dram: mix them Then dry it, and make it fine, and keep it in a Glass for your use.

Besides the aforesaid, the use of the distilled Water of Goats blood, or of the Urin of a Goat new∣ly slain, which was formerly mentioned in the Stone of the Kidneys.

If the Stone cannot be broken with Medicines, necessity requireth the manual operation, though it be dangerous, lest the Patient die with lingering pain. This requires a skilful and wel exercised Ar∣tist, and that it may have good success, as we have observed.

It is the Duty of the Physitian, before the operation to prepare the body by bleeding, purging, and diet, as the state of the business requireth. And observe, that the taking away of a stone from a Woman hath no danger, because it is done only by enlarging the Passage of the Urine, which in them is very short.

If the Patient fear cutting, or want a good Chyrurgion, he may use asswaging Medicines least the Stone should cut and ulcerate the neck of the bladder, such as are prescribed for heat of Urine.

But if a stone fastened in the neck of the bladder stop the Urine, it must be shaken back with lying upon the back with the leg up, and the body shaked; and then by a good somentation or bath, and with a Catheter, let the stone be sent back into the bladder.