An Account of a Gentleman's Being Cut for the Stone in the Kidney, with a Brief Enquiry into the Antiquity and Practice of Nephrotomy

II. An Account of a Gentleman's being Cut for the Stone in the Kidney, with a brief Enquiry into the Antiquity and Practice of Nephrotomy. Nephrotomy restraining its Signification to Cutting in the Kidney for the Stone, is an Operation which hath been hitherto so little practised, and always thought to be attended with so much difficulty and danger, that very few of those Authors who have treated of the Diseases of the Kidneys, and particularly of the Stone there, have thought it worth their while to mention it; and they who have, have done it generally to condemn it. Some indeed have imagined, that Hippocrates in his Book De Intern. Affect. hath commanded the Operation; where, enumerating the Diseases of the Kidneys and their Cure, he hath these words, Quam autem intumuerit & elevatus fuerit, sub id tempus juxta renem secato & extracto pure, arenam per urinam cientia, sanato. Si enim sectus fuerit, fuga spes est, sin minus, morbus homini commoritur: and Sinibaldus in particular, Antiph. Hippocr. 4. l. 5. upon these words of Hippocrates, who he tells us (as Macrobius had done long before) tam fallere quam falli nescit, is so solicitous to have this unknown Practice, as he calls it, Revived, that he passionately exhorts the French and Roman Surgeons to make the Experiment upon Brutes, that they might with greater dexterity and readiness perform it upon Men; but with Submission, he seems to infer more from Hippocrates's words, then upon a due Examination they will be found to bear, not considering, as he ought, the Conditions which Hippocrates requires, for to say nothing of ταμνευ κατὰ τοῦ νεφρίου, justa renem secare, as himself, Mercurialis, Foesius, and others have rendered it, or ad Regionem renis, as J. Martinus; who, if I mistake not, is the single Person that hath expressly Commented upon this Book of Hippocrates, but deduces no such Practice from these words) but admitting it in as large a sense as he will, and that Hippocrates did intend (as I suppose he did) that we should cut in renem as Fr. Rossetus Translates it; yet I say, if he had considered the Conditions which Hippocrates's requires to precede the Operation, there would be no such occasion to Practice upon other Animals, to render a Man dextrous when acting (according to Hippocrates Directions) upon Humane Bodies: for 'tis not sufficient that we take our Indications only from the common Symptoms of the Stone, be they never so grievous and never so evident; but there must be an Apostem too, ἐξελῶν τὸ πέτρα, says he, and that is to manifest itself externally by a Tumor ὑπότροπος ἢ ἀποδυνάμωσις ἢ ἐξελῶν. And then indeed, the necessity and reason of the Operation are so obvious, and the Difficulty so little, that no Man ought to decline it. I quarrel not with Sinibaldus, or the rest, for proposing this or any other Operation, whereby the Art of Healing may be advanced, or the Miseries of Mankind relieved; but for perverting this passage of Hippocrates, and abusing his Authority to Countenance a Practice which I am confident Hippocrates knew not, and in this place, nor, for any thing that appears in any other, neither advised nor intended. Of Apostems in the Kidneys, occasioned by an Inflammation (for from an Inflammation to an Abscess, the transition is easy) and from other Causes exclusive of the Stone, and of Matter discharged thence by opening, examples are so frequent, that there is nothing wonderful in that Case; and any Man who hath missed, or is surprized at an Instance of that in his own practice; may be supplied with variety enough, from many of those Authors who have made it their business to Publish Observations. And most of those who have written of Nephritic Diseases in general, have taken care to deliver the manner of treating them, tho' it be not the design of their Writing to furnish us with particular Cases. Nor do we want Instances of Apostems in the Kidneys, occasioned originally from the Stone there, and manifesting themselves by a Tumour, upon opening of which Stones have been discharged with the Pus, or have been soon after removed, and this is the very Case which Hippocrates supposes, and upon which he justly advises the Practice. Some Observations we have of Stones which have gradually wrought themselves out of the Kidney, without any preceding abscess, an instance of which (to mention no more) we have in Tulpius, l. 4. Obs. 28. (whose Authority when he writes from Autoply, I take to be as unquestionable as any Mans) of a Person who having long labour'd with the Stone in the Kidneys (which was hereditary to him) had at length one discharged through his Loins, which occasioned a Fistula, through which his Urine continued to flow with the Pus for a long time; for the healing of which, after many fruitless Attempts, all that they could effect, was only to close the external Orifice, which locking in the matter, forced it into the Abdomen, which throwing him into a Fever killed him. And this, among other mischiefs, Tulpius makes use of, as no mean Argument against the Practice of Nephrotomy. But whatever some Men have inferred from Hippocrates, 'tis my Opinion, that we have no manner of Evidence, that Nephrotomy was practised in his time, or in many Ages after. For Celsius (who, by Heurnius his leave, is valuable for something thing besides the Purity of his Style) is silent in the matter, altho' he be so particular and accurate in his Discourse of cutting for the Stone in the Bladder. And Galen himself, whose way is to say all he can upon his Subject, and is copious enough upon Diseases of the Kidneys, especially the Stone, mentions it not; which, had it been in use in his Days, or perhaps before him, would hardly have escaped him. Cardan indeed, De libr. propr. p. 149. ed. Lugd. mistaking Hippocrates with the rest, reckons it inter desperata, and is pleased (with his usual rudeness) among other Operations, to attribute the loss of this to Galen, and for no other reason, but because he omitted to mention it. But this from a Person whose Candor and Judgment are not always without exception, without better Arguments, is of little import; especially if we remember how pleased he seems, with every advantage which he fancies he hath over him; how frequent he is in exposing him, and with what contempt he often uses him, not considering how very open himself lies in almost all his own voluminous Writings: And yet this surmise of Cardans (or whoever else dreamed before him) was Authority sufficient to an Author as fantastical as he, Dr. Meric. Casaubon in his Censure of the Royal Society, to reproach the memory of Galen, and with just as much reason and equity. But if his Silence be all the reason they have (and there is no other imaginable) then are Celsus and Ruffus, who preceded him, and Aretaeus, who was at least his Contemporary, equally to be blamed. But indeed there are no footsteps that I can discover among any of the Greek or Latin Physicians, some of which being very full upon all Nephritic Cases, cannot be supposed universally to have omitted so important a Practice, had it been in use among them; Tho' an Abscess Absciss in the Kidneys, and the Method of Cure, be, what several of them do mention, as well as the Moderns. The first light which I can pretend to discover of the Operation, as practised in our Case, is among the Arabians, tho' even by them with an intention to discourage and deter all Men from the Attempt; for Serapion, who is placed by Wolfgangus Justus, betwixt the Tenth and Eleventh Century, tho' by Ren. Moreau three hundred years earlier, gives his Opinion of it thus; Tract. 4. c. 22. Quidam antiquorum praecipereunt lapidem renum extrabili cum ferro incidente retro super latus duorum iliorum in loco renum. Ego autem video quod hæc audacia est difficilis vehementer & administratio istius curationis est maxime periculoa & suspecta de morte. Who these Ancients were that advised, I confess to be beyond my Conjecture; it being, as I have said, to be found in none of their Writings, which have remained to our times; unless we may be allowed to say, that he also had misunderstood Hippocrates, as some have manifestly done since. Betwixt 12 and 1300 Avicen had much the same Opinion, both of the Practice and the Practitioners; Sunt qui laborant extra-here ipsum per incisionem ilii & per dorsum. Sed est magnus timor in eo & operatio ejus qui rationem non habet. Pag. 361. ed. Ven. 1562. The difference of their Sentiments being only, that one thought it the Undertaking of a Mad-man, the other of a Confident Fellow; but from Avicen's Words, there is some colour to believe that it was practised in his Days, tho' undoubtedly, if it were, from his talking so lightly of it, it was only by Persons of a mean Character, such perhaps as our Mountebanks, who having no regard or concern for the lives of Men, and little Reputation of their own to loose, venture boldly, and sometimes successfully, upon those things which wary and more judicious Men avoid. But, notwithstanding Avicen's words, that it was very rarely, if at all, practised among the Arabians themselves, I think a Man may very reasonably infer, from the general Silence of all the rest of their Writers. Among the Moderns, as well as I can inform myself, Fr. Rossetus libr. de partu Cæsareo seems to have been the first; who, to make that Operation, for the sake of which he wrote his Book, obtain, by relating others which were Analogous, began seriously to advise the Practice; tho, after all his endeavours, he is not able to produce one Instance, either of his own or other Mens Experience, where they were not first invited and directed by a visible preceding Tumour. He seems either not to have met with, or not to have believed that extraordinary Case in Cælius Rhodiginus var. lett. l. 3. c. 12. of a Woman, who having for a good while been afflicted with a load and pain in the Region of her Kidneys; scratched with that rage and impatience so long with her Nails, till she made a Wound so large and deep, as to discharge eighteen Stones magnitudine quantâ in tesseris visitur. And very justly does he reject that Account in Parey, l. 24. c. 19. as a Story whose authority was remote and suspicious, and the manner of the Relation altogether uninstructive. For tho' Mezeray in his History takes upon him to tell us that the Kidney was opened, yet all that can be learned from Parey, who Transcribed it from the same Author, from whom without doubt, Mezeray took it, (viz. Enguerand de Monstrelet dans ses chroniques depuis l'an 1400. jusques en l'an 1467. Printed at Paris 1572.) amounts to no more than this, that there being a Criminal, who had been long subject to Calculous Pains, condemned to Dye, the Physicians, upon pretence that it would be for the Benefit of Mankind, obtained leave of the King that they might open him alive, and inspect the parts affected; which having done, and placing them all right again, they stitched him up, and the Man survived, but no Account where they opened him, what parts were Diseased, or what they observed. But from Parey's Relation, most certain it is, if there be any certainty in the Story at all, that they did not cut into the Body of the Kidney. But when Parey inserted into the Margin, *Superat hæc narratio non modo omnem admirationem sed & fidem*, he might as well have added, *& lectione vix digna*. But notwithstanding Rosset's Zeal to bring this Operation into use; and tho' he urges Hippocrates's Authority to justify the cutting into the Kidney, he is yet so ingenuous as to acknowledge *Præsente tumore, nec aliter, Hippocratem imperasse sectio- nem*. And as plausible as his Reasoning may seem, it does not appear, that he hath been able to gain many Proselytes to his Opinion; the sense of those Authors who have mentioned it (who are not many neither) being generally against it, and concluding in effect with Riolan. Ench. Anat. l. 2. c. 28. *Nisi naturâ monstrante viam atque praeeunte, nefas est tentare nephrotomiam*; tho' in his younger and more daring years, he seems of a quite different Opinion, when in another place without those Restrictions he pronounces, *Renes vulnerari & incidi posse, indictum est nephrotomiam secure administra- ri posse*. Altho' it appears to be the concurrent Opinion of those Authors who have treated of Wounds in the Kidneys, that if they penetrate the *Pelvis* they terminate in Death, yet if they had lived to have beheld the Experiment which I am about to relate, performed by so great a Man with so good success, they would, no doubt, have made their Prognostic with more caution and reserve, and not so Magisterially have exploded the Operation. But to detain you no longer with a Digression, be pleased to receive the History as I had it from Mr. Hobson himself, who was the Person upon whom the Experiment was made, and for any thing that falls within my Knowledge. The First; This Gentleman, who was Consul for the English at Venice, having been long afflicted with the Stone in the Kidney, was at length attacked with a Fit of that Duration and Violence, that it reduced him almost to Desperation; and finding no Relief from any means that had been used, he determined to apply himself to Dominicus de Marchettis, who, as Ch. Patin in his Lyceum Patavinum tells us, was Primarius practicæ Extraordinariae Professor at Padua, a Fam'd and Experienc'd Practitioner there, the Son of Peter, both well known to the Learned part of their Profession. To this Person Mr. Hobson, under the greatest Extremity of Pain imaginable, addressed himself, imploring of him, that having made use of all conceivable means, and the best advice that was to be had in Venice, without Success, he would be pleased to cut the Stone out of his Kidney, being fixt in his belief that no other Method remained capable of Relieving him; adding that he was not insensible of the Danger; but that Death itself was infinitely more eligible, than a Life in that Misery, under which he had long and did then Groan. Marchetti seemed very desirous to have declined it, representing not only the extreme hazard, but as he feared the impracticableness of the Operation, that 'twas what he had never attempted, and that to proceed to it, was in effect to destroy him: But Mr. Hobson persisting that if he refused it, he would never desist till he found out one who would do it. Marchetti was at length, by his Resolution and Importunity prevailed upon upon to undertake it; and having prepared him as he thought convenient, he began with his Knife, cutting gradually upon the Region of the Kidney affected, so long, till the Blood disturbed and blinded his Work, so that he could not finish it at that attempt: wherefore dressing up the Wound till the next Day, he then repeated and accomplished it, by cutting into the Body of the Kidney, and taking thence two or three small Stones, he dressed it up again. From this Instant he was freed from the Severity of his Pain, and in a reasonable time was able to walk about his Chamber, having been in no danger, either from Flux of Blood or Fever. Marchetti continued to dress the Wound for a considerable time, but was not able to close it up, it soon becoming Fistulous from the continual flowing of the Urine through the Sinus; but being in all other respects restored to his former Health and vigor, and the Matter discharged being little, he took leave of the Professor, and returned to Venice, under the Care and Management of his Wife; who, one Morning as she was dressing the Sore, fancied she felt something hard and rugged as she wiped it; upon which, Examining a little more carefully with her Bodkin, which served her instead of a Probe, she found it to be a Stone, of the Figure and Magnitude of a Date Stone; which being removed, he never after complained of the least uneasiness in the part. About Ten Years after this he returned to London, where the Learned Dr. Tyson, and my self, were, by Dr. Downes, who had known him formerly in Venice, invited to see him, which we did at the Castle-Tavern in Pater-Noster-Row; where, after we had received this Account from himself, he gave us the Satisfaction of viewing the Sore, which continued open, and permitted me without any Com- plaint (the Callosity being great) to pass my Probe so far into the Sinus, that we concluded it reached into the Kidney: the Matter it then discharged was but little in quantity, but always diluted with and smelt strong of Urine. The Orifice would sometimes close for three or four Days together, and then the Matter made its way through the common Passages with the Urine, yet without any difficulty or Pain. There is no question, but that there was a Coalition of the Kidney, and the Muscle Psoas. When we saw it he applied nothing to the Orifice but a clean Linnen Rag, which had a strong Urinous Scent. He was then as able in appearance, to perform all the Functions of life, and to undergo any Fatigue, as any Man of his Years; being then, I conceive, upwards of Fifty, and was the next day to ride Post forty or fifty Miles. I have heard that he is since dead, but could not be informed of what Disease.