Some Additional Remarks on the Extracting the Stone of the Bladder out of Those of the Female Sex. By Thomas Molyneux, M. D. S. R. S

I take these Cores to be scorch'd Skin, mortified, (beat into the Flesh by that Hail-shot) and appearing like burnt Leather: Which must be worked out before the Wound could be healed; as is usual, when other Heterogeneous Matter is forced into the Flesh. That some of the People not far off, might be thrown down, and not otherwise considerably hurt, is not strange; who might be within the Blast, though not within the reach of the Fire; as we see in the Explosion of Gun-powder, (to which I take this to be very like) when Windows (and other things at a Distance) are shaken and shatter'd by the Blast, or great Concussion of the Air, though the Flame do not reach them. III. Some Additional Remarks on the Extracting the Stone of the Bladder out of those of the Female Sex. By Thomas Molyneux, M.D. S. R. S. About Six Years since, a Paper of mine was read before our Philosophical Society here in Dublin, and after publish'd in the Philosophical Transactions, Numb. 202. Wherein I gave an Account of a Stone of an extraordinary bigness, spontaneously voided through the Vthera, by a Woman here in Dublin: And as a Corollary or Deduction from this History, I there proposed the Extraction of the Stone, by the gradual Dilatation of the Vrethra, or Neck of the Bladder, without any manner of Section, as the most safe and easy Way, and of most general use, for the freeing those of the Female Sex from the Stone in the Bladder. I then alledged two Instances of Fact, to prove not only the Reasonableness, but the real Success of this Practice; and I have been since still more confirmed in that Opinion by several other successful Operations I have seen of the like kind: but more particularly, by one lately performed in this Town on a Girl, between Eleven and Twelve Years Old, one Sarah Jones, that for Six Years past, has been severely afflicted with all the painful and unusual Symptoms of the Stone, but on the 16th of October, was happily relieved, by only dilating gently, the Neck of the Bladder, and then extracting a Stone of a very considerable bulk, without making any Incision at all. The whole Operation was performed in Six or Seven Minutes, and was the more remarkable on the Account of the extraordinary large Size of the Stone, whose Shape and Bigness is exactly represented in the annexed Figure, Vid. Tab. Fig. 1. I did omit taking the Weight of it, nor was it truly any great neglect, since I think it no very material Circumstance for our Information in such Cases, to know exactly what a Stone Weighs; for the greater or less Gravity of these Bodies, depend not on their outward Dimensions, so much as on their internal Parts accidentally cohering more or less compactly together, as they are formed in the Bladder, and as if no importance in the Operation of extracting them: the Difficulty or Easiness of which, as well as the Danger and Success, more immediately depend, on the Magnitude and Shape of the Stone, rather than on its Gravity; so that if we have a right Idea of those, 'tis altogether sufficient to our Purpose. By the Size of this we have here figured, it appears to have been so big, that it may seem almost incredible a Solid of that Bulk, should be forced through the Urethra of so small and so Young a Child, without any manner manner of Section: and that the Child should recover so as to be perfectly well, without the least ill Accident succeeding the Operation. But we may gather hence, of what vast Extention this Urinary Passage, though Naturally strait, is capable; and how much still wider it may be dilated, where 'tis proportionably larger, I mean of those of this Sex of Riper Years, or grown up to Womens Estate; who may yet more easily and safely be relieved after this same manner, even of Stones of a much larger Size than this we here speak of. The French, a Nation certainly very subject to the Stone in the Bladder, and whose Chirurgeons therefore, must of necessity be very conversant with this Disease, and expert in the Operations requisite for the Cure of it, have, I see, lately established this sort of Practice; tho' I must needs own I did not know so much, till I had perused a very useful Book of Chirurgery, Published but this last Year, 1696. at Paris, in 8vo. by Monsieur de la Vanguion; Entituled, Traité Complet des Operations de Chirurgie: where I find in his Thirteenth Chapter, that treats of the Stone in the Bladder, and describes the way of Extracting it out of Women; he has these Words: On dilate l'Uretre avec le Dilatateur sans rien couper, & 'lon tire la pierre avec un crochet ou bien avec de Tenettes. And a little after; L'Uretre de Femmes se dilate extraordinairement, ainsi il arrive rarement qu'on soit oblige de leur faire une Incision. These Quotations may shew, how that right Reasoning, together with due Experience, have not only suggested, but likewise approved and settled this way of Extracting the Stone out of the Bladder of Women without Section. When I was a Stranger to this Practice, I did only then propose it to be well considered of by the Judicious; but now that it proves so successful, I cannot but recommend it to the skilful Chirurgeon, as an Operation fit for general use in these Cases, being both safe and easily Practicable, and also of great Benefit and Relief to no less than the Moiety of Mankind, when ever they are afflicted with this painful Disease. And to say truly, if Women in this case would but timely seek for help, they might with far less Danger and Pain be relieved of this torturing and lasting Evil, than they are delivered of a common Natural Birth. I say timely seek for Help; that is, before the Stone is grown to so large a Magnitude, as not to admit this sort of Operation; of which there may be some Instances, though I believe, as the attempting the Cure of such will be very dangerous, so likewise they will be very rarely met with; for Experience Justifies what I have elsewhere observed, (Numb. 202. of the Philosophical Transactions) that Women are not capable by Nature of breeding Stones in their Bladders of so big a Size as Men frequently do; which is most apparent from those many Histories of stupendious large Stones (I mean them of the greatest Magnitude) Registered by both George and John Schenkius, Hildanus, Greonevelt, the Philosophical Transactions, and other Authors; all which that have hitherto occur'd to me, have been only found in Men: Whereas the largest I have heard of bred in a Womans Bladder, was not one fifth Part of what has been produced of this kind in a Man's. In the Philosophical Transactions, Numb. 222. there is inserted an Account of the largest Stone I have yet heard of bred in a Man's Bladder: That mentioned by Mr. Wood the Chirurgeon, Numb. 209. of the same Transactions, taken out of a Woman, and as he thought, of a Prodigious Size, does not amount to near a Fifth Part of this: However, that is extraordinary in Mr. Wood's Relation, that though it was extracted by Section, and the Mem- Membranous part of the Bladder, as he says, cut in the Operation, yet the Patient recovered and became perfectly well. But these, and such like surprising Cures, I take to be erratick or Anomalous, if I may so call them; because they happen seldom, and when they do, seem to be contrary to the settled Rules of Physick; and therefore can little avail in guiding a Man's Practice, according to the Saying, Quæ Rara sunt, not sunt Artus: And notwithstanding several such rare Cases, daily Experience will vouch for the Authority of that Aphorism of Hippocrates, Κύσιν διακοπέντι Ἰανατάδες, cui Secta est vesica lethale est, as not being founded on a few Examples or a Notion, but what commonly holds true, or as Hippocrates often expresses it, ὡς ἐπὶ τὸ πολὺ, for the most part, which is a sufficient, and indeed the only Principle on which we may constitute a standing Rule in Physick; for as the Judicious Celsus has truly observed in his Preface to his Book de Re Medica, Vix ulla Perpetua Præcepta Medicinalis, Ars recipit. IV. Eclipse Lunaris Observatio, facta Roterdami die 29. Octobris Anni 1697. N. S. A Jacobo Cassini, R. Ac. Parisiensis Socio. Eclipse Lunæ diei 29 Octobris anni 1697. observata est Roterdami per Telescopium quatuor fere pedum Parisiensium oculari convexo in cujus foco erant fila quatuor sese in axe intersecantia ad angulos rectos & semirectos, ad Phases dimetendas, macularumque Lunarium situm determinandum. Hoc Telescopium impositum erat fulcro habenti axem in situ parallelo axi mundi constitutum, ut postquam ad Lunam directum effet ad unius phasis observationem, possit ad alias phales Observandas per Lunæ semitam ad occasionem revoluti.