Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XXX. URINE STOPPED.

I. URine is stopped either by the Stone, or by some Tartarous Matter sticking in the Passages of the Ʋrine, which hin∣ders its coming forth; which lat∣ter is commonly called the Ischu∣ria, and of which we have dis∣coursed in the Third Edition of Our Synopsis Medicinae, L. 5. C. 49.

II. If the Obstruction be made in the Reins or Ʋreters, where no Instrument can come, nor any Manual Operation be done, you must then have recourse only to Medicaments.

III. This Cause, whether of the Stone or Strangury, is from a Tartarous Matter heaped up in the Reins, and falling into the Pas∣sages of the Ʋrine; the way of making of which we have dis∣coursed of in Chap. 27. Sect. 2. aforegoing.

IV. The Signs. If it be in the Reins, there is a heavy Pain, and Soreness in the Reins; if in the Ʋreters, (which are the Passages from the Reins to the Bladder) there is pain in the Flanks be∣low the Navel, to the Groin, and bottom of the Belly.

V. There is also Stoppage of Ʋrine, Sickness of Stomach, and many times Vomiting withal, a Heat and Pain in making of Wa∣ter, and in Men a Pain at the End of the Yard.

VI. If the Obstructing Matter be in the Bladder, it is known by the last enumerated Signs; but the Pain is more particularly and eminently at the end of the

Yard: And if the Sick stands upon his Head, he has present Ease and Relief, by reason the Stone falls from the place stopt.

VII. If it be in the Urethra, or Passage from the Bladder, it may be known by feeling, or searching, and sometimes a Swelling of the Part.

VIII. To distinguish whether it be a Stone, or Tartarous Matter that stops the Ʋrine: If Speci∣ficks remove the Obstruction, or bring away Slime and Pus, there possibly may be no Stone; but if no Relief comes, a Stone is to be feared.

IX. In the Bladder, or Urethra, it is known by searching, either with a Wax-Candle, or a Ca∣theter, or the Gripe, which is the surer way.

X. The Prognosticks, If it be a Stone in the Reins, it is uncura∣ble, unless small; so also in the Ʋreters: If in the Bladder, and large, only by Cutting: So also if it be lodged in the Ʋrethra, without which, nothing but Death can be expected.

XI. If it is Tartarous Matter, Sand or Gravel, it is more easily cured; and more easily in the Bladder, than in the Reins.

XII. If it be inveterate, the Cure is more difficult than if it be recent; so also in such as are weak, old, or decrepit: If the Stoppage is removed, and it often returns, it is so much the worse.

XIII. The Cure. 1. Medicinal. Among Vegetables, these things are most prevalent. Water distilled from Arsmart, drunk ad ℥vi, at a time. Parsley-water, also Water distilled from Onions in like pro∣portion: Bean-shell-water with Syrup of Violets, which is of good use: So also Grass-water.

XIV. Of Juices. The Juice of Pellitory of the Wall, or Syrup of the same Juice given ab ℥ij. ad ℥iv. Juice of Camomil given ad ℥iv. is famous, I know it by Experience: So also Juice of Onions given ℥j. ad ℥ij. in White Wine, and repeated. And in∣ferior to none, is the Juice of Winter-Cherries, given ad ℥j. or more, in White Wine, as afore∣said.

XV. Seeds. Those of Violets are said to be of excellent use, because, together with expelling the Stone, they are said to Purge, if used by way of Emulsion. Daucus Seeds given either in Pouder ad ʒss. or more; or in Decoction, are much commend∣ed: So also the Seeds of Grom∣well, Fennel, Parsley, Bishops∣weed, &c.

XVI. Berries. Juniper-berries provoke Urine powerfully; so also Bay-berries, whether in their Substance, as Pouder, Extract; or in their distilled Waters, Spirits, Oil, Potestates, &c.

XVII. Foecula's, Ashes. Tartar made into a Salt, or Oil per De∣liquium, and given ad ℈j. or ʒss. in Arsmart or Parsley-water, is an approved thing. Pot-ashes, Broom Ashes and Bean-stalk Ashes, drunk in White Wine, are of excellent use.

XVIII. Woods. The chief a∣mong Woods, is Lignum Nephri∣ticum; which being rasped, may be either given in Substance, in Pouder, or else in Infusion

in Water or Wine, which being used for some time, has done Wonders.

XIX. Gums. The chief a∣mong Gums are, Turpentines of all Kinds, Balsams de Chili, Co∣payba, of Gilead, Peru, and Tolu, Opium; the various ways of u∣sing th••m you may search out in Our Seplasium, lately emitted into the World.

XX. Among Minerals, these are f•• most use. 1. Nitre given in Pouder a ℈ss. ad ʒss. 2. Sal Prunellae, given in White Wine, sweetned with double refined Sugar. 3. Spar, given in fine Pouder ad ʒj. 4. Lapis Nephri∣ticus, given à ʒss. ad ʒj. in some proper Vehicle.

XXI. Mineral Spirits. The chief of these are Spirits of Salt, of Sulphur, of Vitri∣ol, of Nitre, Bezoardick Spirit of Nitre, Spirit of Alum. Tin∣cture of Lapis Nephriticus, made with rectified Spirit of Salt, the Stone being first poudered, and then both digested, till it makes a green Tincture.

XXII. Among Animals, these are esteemed. Egg-shells calcined, and given à ʒss. ad ʒj. which Medicine is said to be valuable before all other things: Hog-lice are in great estimation, being given in Pouder à ℈j. ad ʒss. or their Salt, à ℈ss. ad ℈j. So also the Pouder or Salt of Bees. Cochi∣nele in Pouder, ad ℈j. or ʒss. or its Tincture ad ʒj. given in Rhenish Wine, is said to be a gentle and pleasant Medicine, and of great Virtue. To these things add, the Pouder, Salt and Oil of Scorpions.

XXIII. Spirits from Animals. Spirit of Ʋrine, of Sal Armoni∣ack, and of Hartshorn, mixt with some proper Diuretick-Water or Tincture, and so taken. Spirit of Sal Armoniack given in Rhenish Wine, is said to be a Specifick: To which things add, Our Spiritus Ʋniversalis.

XXIV. But Crabs Eyes are thought to be inseriour to nothing that has yet been enumerated; they may be poudred, levigated, and given à ss. ad j. in Ar∣smart Parsley, Pellitory, or O∣nion Water, or in Rhenish Wine.

XXV. Among singular Com∣pounds, you may use these follow∣ing: ℞ Juice of Liquorice jss. which dissolve in Juice of Winter Cherries, q.s. Camphir ʒj. dis∣solved in S.V. q.s. Saffron ℈ij. Laudanum nost. ʒij. White-wine lbviij. mix, let it settle, and de∣cant the clear. Dose ℥iv. at Bed time.

XXVI. Liquor Nephriticus: ℞ of the Lynx-stone, Jews-stone, Hog-lice dried, Crabs eyes, Egg∣shells, a. q.v. dissolve in Spirit of Salt, filter the Solution, and di∣stil to driness; the Caput Mort. put into a Cellar, to dissolve per deliquium. Dose à gut. xij. ad xx. or xxx. in any proper Ve∣hicle.

XXVII. Sal Lithontripticus: ℞ Sal Prunellae, of Tartar, of Wormwood, a. ʒj. Volatil Salt of Amber ʒjss. mix them. Dose a gr. viij. ad ℈j. or ʒss. in White-wine or Saxifrage-wa∣ter.

XXVIII. Pulvis Nephriticus: ℞ Crabs eyes, Goats blood pre∣pared,

Calx of Egg-shells, a. ʒij. Lapis Judaicus, Nephriticus, Bone of a Pikes Head, Pouder of Winter Cherries, a. ʒjss. Grom∣well seed, Daucus seeds, Crystals of Tartar, Sal Prunellae, a. ʒj. mix, and make a Pouder. Dose ad ʒj.

XXIX. Julepum Nephriti∣cum: ℞ Julep of Roses lbj. Cinnamon Water ℥vj. Tartar Vi∣triolate ℈iv. mix them. Dose ad ℥ij. Or this: ℞ Tincture of Lignum Nephriticum lbj. Horse-radish Water lbss. Syrup of Corn Poppies ℥iij. Tartar Vitriolate ʒij. Pouder of Crabs eyes ʒiij. mix them.

XXX. Spiritus Antinephriti∣cus: ℞ Roots of Rest Harrow, white Saxifrage, a. ℥j. Liquo∣rice ℥ss. Goats blood dried, Crabs eyes bruised, Hog-lice, Nutmegs, Cinnamon, a ℥j. Saffron ℥ss. Cloves ʒij. Strasburgh Turpen∣tine ℥xvj. Spirit of Wine lbv. cut and bruise what are to be cut and bruised, mix, and digest together for 14 or 20 days; then distil in B.M. Dose, from one Spoon∣ful to two, in a Morning fast∣ing in Parsly or Arsmart Water, sweetned with a little refined Sugar; as much in the same man∣ner at Noon; and in like man∣ner at Night going to Bed.

XXXI. While these things are taking, you ought also to exhibit Emollient and Nephritick Clysters, Examples enough of which you have in Our Pharmacopoeia's Lon∣don, and Batean, and in some other of our Books. Or you may give this: ℞ Strasburgh Turpentine ℥j. Tolks of two Eggs, grind them together till they are well mixt; to which add Chicken Broth, White-wine, a. lbss. hot enough to be given for a Clyster; mix, and exhibit.

XXXII. But if after all, you find that none of these, or other pro∣per things will do; if it be in the Reins, you must commend the Patient to Heaven, to place his Hope there, since so little is left him to trust to upon Earth. But if by the Symptoms you find the Matter stopping be in the Blad∣der, or its Mouth, or in the Ʋ∣rethra, you must then apply your self to the following Manu∣al Operations.

XXXIII. If it be a Stone which is lodged in the Urethra, and will neither go backwards nor forwards, but sticks fast there, whereby the Passage of the Ʋrine is totally stopt; you must first try all fit means to educe it without In∣cision, as Emollient Oils, Oint∣ments, Fomentations and Baths, Injections of Oil, &c.

XXXIV. If those things will not do, you must come to Exten∣tion: The Ʋrethra is to be ex∣tended by Wind blown in, tying that part of the Yard beyond the Stone next the Pubes; whereby the Ʋrethra being di∣lated, the Stone may possibly with the Fingers be forced out.

XXXV. If this will not do, the next way is, by strongly Suck∣ing the Part; so that by draw∣ing the Breath very strongly, the Stone is drawn forth with it.

XXXVI. If this yet does not, you must endeavour to break the Stone by the help of a pair of For∣ceps and Probe, which many

times succeeds well enough, if the Stone is of a brittle substance; otherwise not.

XXXVII. But if none of these ways do, you must come lastly to Incision; tho' the place where it should be made, Authors contend much about: Some are for the Lateral Parts, lest if the lower Part should be cut, there be a new Passage for the Urine: O∣thers are for the Lower Part, lest the Nervous Part should be hurt.

XXXVIII. But both ways have been tried with Success, and found easie enough; yet sometimes the Lateral Apertion hurts Erecti∣on, as I observed once in one Patient; for which Cause I should rather chuse the Lower Part of the Ʋrethra.

XXXIX. Incision being made, the Stone is either to be pulled forth with a little smooth Hook, or pressed forth with your Fingers; after which, the Wound (whe∣ther of the Ʋrethra or Bladder) must be cured after the usual Method of Curing Wounds in those Parts.

XL. But if the Matter sticks not so fast in the Neck of the Bladder, but may be removed, or put back by Instrument, whereby the Urine may be drawn forth, we commend to you the use of the Catheter.

XLI. Now, because the Silver Catheter, by being put in by un∣skilful Hands, may sometimes hurt the Prostatae, or break the Semi∣nal Bladders, whereby an incura∣ble Gonorrhea is produced; we have for that cause, in this Cure, rejected it, and make choice of that of Helmont; which as it is infinitely more safe, so it fully answers all the ends which we require from it.

XLII. The Description of Hel∣mont's Catheter, as you find it in his Treatise of the Stone, Chap. 7. Because (says he) the little Silver Catheter, to bring forth Urine, is Cruel and Bloody, and much torments the Patient, it very much displeases me: And among many which I have tried, this which I have made of Lea∣ther, being as fit as harmless, I have chosen.

XLIII. I cause (says he) the Leather to be painted within, of a white Colour, made of Ceruse and Linseed Oil; which, when it is as it were dry, let it be made into a Pipe, by sowing it very smoothly upon a fit Brass Wire, so as the seam may not stick out: The one end of the Pipe is to be lesser than the other; the bigger end is so large, that the Pipe of a Syringe may be put into it, as often as one pleases, that by this means, any fit Li∣quor might be injected into the Bladder.

XLIV. This done, the whole Leather Pipe is besmeared with dissolved Glew, to strengthen it; which being dried, is over that painted with Ceruse, mixed with Linseed Oil; and this also, as well for the firmness of the Pipe, as to prevent it from being wet through, whereby it would grow weak and flaggy.

XLV. Now draw forth the Brass Wire, and fit another for the Pipe, made of Whale-bone; so will you have a Leather Catheter,

easie, thin, and flexible, which will not any ways hurt or pain the Patient in putting it in, al∣though it may be Fourty times put up into the Bladder in one day.

XLVI. This Catheter being put up into the Bladder, removes and thrusts in what lay in the Neck of the Bladder, or in the Mouth there∣of; which done, the Whale-bone is drawn out of the Pipe, and then the Ʋrine freely passes forth thro' it, without any stop or pain; and you may every time draw it out as you please. I know one, who by the means of this Instrument, caused a Lithontriptick Patient to make Water with ease, for Eight or Nine Months toge∣ther.

LXVII. The Ʋrine being emp∣tied, you may (if you so please) cast into the Bladder, by a Sy∣ringe, any proper Liquor, which you may think fit, to dissolve the Tartarous Coagulum, which makes the Obstruction; but it ought not to be of too sharp a Nature, nor what may any ways cause pain.

XLVIII. Lastly, you must note, that the Syringe must be fitted (before-hand) to the outmost end of the Catheter, that the whole Operation may be done neatly, and easily.