Part of a Letter from Mr. Bussiere to Dr. Sloane, wherein He Gives an Account of the New Way of Cutting for the Stone by the Hermit, with His Opinion of It

being brought from a foreign Country, and a common vogue and esteem they have got in the World, then from any intrinsick virtue they have in the cure of Diseases; and that which seems most to recommend them is their extravagant Price: Whereas we can name twenty Medicines in the Materia Medica, that each of them is as effectual, if not more, in the Cure of Diseases, and to be procured at less Charges. VIII. Part of a Letter from Mr. Bussiere to Dr. Sloane, wherein he gives an Account of the new way of Cutting for the Stone by the Hermit, with his Opinion of it. Here is the Description of the way of performing the Operation, for the extraction of the Stone out of the Bladder, by Brother James an Hermit in France, as I received it from Paris. He maketh use of a Steel Staff, much bigger and shorter than those which are commonly made use of; it is shorter from the top to the bending of it, it bends more than ours, he hath but two, one for Men and another for Children. His Conductor is slender and longer than ours, the point whereof, which goes into the Bladder, being of the Figure of a Lozenge, is wide and open in the extremity. His Forceps have longer branches than ours; but the holds of them are shorter and wider, with many large Teeth within. The Eurethra with which he draweth the Sand or Gravel, which remain sometimes in the Bladder after the Stone is out, is shorter than ours. His Knife is much longer and slenderer than ours. He causeth the Patient to ly flat upon his back, either upon his Bed, or upon a Table, whereupon is a soft Quilt, in such a manner, that the Fundament is three or four Fingers over the Table, some Servants supporting his Thighs and Legs. He useth no Ligature to fasten the Patient, giving him more liberty than we do; he causeth his Legs to be bent against the Thighs, but not the Thighs against the Belly, except the left, which in his Operation he useth more or less as he thinks fit. Then he introduceth the Catheter or Staff into the Bladder; which though bigger and shorter than ours, yet seemeth to run in easier: Very often he holdeth it himself with his left Hand, pressing it close toward the Fundament, in order to dilate and extend the Membranes of the Bladder; then he feeleth with the Fingers of his right Hand, to find out the staff through the Skin; so having felt it, he runneth his incision Knife at the bent of the left Thigh, upon the fat protuberancy below the Ischium Bone, directly upward by the rectum to the Bladder, which he pierceth by its neck, and sometimes a little above it. When he Cutteth, the cutting parts of his Knife are turned upward and downward; having thus pierced the Bladder, which he knoweth when the Urine runneth out; then he turneth his Knife, and thrusteth it a little further, in order to open the Bladder wide enough, that his Finger may go in easily; then he withdraweth his Knife, and enlargeth the Wound in the outward ward Parts, of the length of two or three inches; after which he thrusteth his Finger into the Bladder, in order to know more precisely the bigness and situation of the Stone, and make it loose, but chiefly to dilate the Overture of the Bladder, by tearing its Membranes. Then he introduceth his Conductor into the Bladder, along this Finger which is in it. When the Conductor is in the Bladder, he taketh the Staff out, and introduceth the Forceps by the Conductor into it, with which he gets hold of the Stone, and draweth it out. If he find any difficulty, either in getting hold of the Stone or in drawing it out, he useth all the ways commonly used, raising the left Thigh more or less, putting his Finger in the Fundament, and sometimes into the Bladder, in order to examine the situation of the Stone, and loosen it, in case there might be any adhesion with the Membranes of the Bladder. Having found out and removed the Cause of the difficulty, he thrusteth the forceps again into the Bladder, and gets hold of the Stone, and pulls it out. It is to be observed, that this second time, nor on any other, he useth no Conductor, the Forceps running in very easily. He never thrusteth either his Finger nor any instrument into the Bladder, without steeping them in Oyl of Roses. He never useth any Dilatatorium, nor Canula, or Tents in the Wound, except sometimes small Doffs in the Lips of the outward Wound to keep them open for a little while. He useth no Oyntment at all for the Wound, applying only a Pledget steep'd in Oyl of Roses upon it, for he understands derstands nothing at all in the way of dressing Wounds, nor in the Dyet which the Patient is to observe, which things he doth not value. In this way he Operateth as dexterously as any of our best Operators. Very often he Cutteth the Patient upon the Gripe, almost in the same manner as was used formerly, except that he maketh the Incision in the same place as for the former; this way he liketh better than the other, and it seemeth to be more favoured by him, and indeed it is surer, though the pressing upon the Belly, which he doth, is a very bad Method. He Cutteth Women upon the Staff, and in the same place as Men; he did perform this Operation in my Presence upon Three, One whereof was but a Girl of Eleven years old; which maketh me believe that he useth the same way in all, though in them he did cut the internal Neck of the Uterus. But to tell you my Opinion, That way, neither in Men nor in Women, is not so sure as the ancient way, by reason that the point of his Knife not being directed by the Staff, he is always in danger of piercing all the Membranes of the Bladder through and through; and besides the place whereupon he maketh the Incision, being full of considerable Vessels, one can hardly avoid the cutting some of them, we have observed in almost all that dyed in his Hands, that there was a great deal of Blood in the Bladder, and in some, in the Cavity of the Abdomen. He succeedeth better when the Stone is big and large, than when it is small, by reason that a big Stone not only extendeth the Bladder, but it stoppeth the point of the Knife; He did refuse to cut one, in whose Bladder Bladder there was but a small Stone; which confirmeth me in the Opinion, that the unsuccessfulness of his Operations proceedeth from the point of his Knife, not being stopt neither by the Staff nor Stone; for when there is but a small Stone, the Bladder being empty, he must necessarily cut the whole Bladder throughly, and consequently cut some of its own Vessels, which causeth the Hemorrhage, which is the better voided when the Stone is very large. Now, Sir, to tell you my Opinion, though I cannot approve that way on all occasions; yet, I think it might be successfully improved in some particular Cases; give me leave, Sir, to give you an Account of my Observations about it, since I received the former Account. I took a Body, in the Bladder of which I put a Stone, the Staff being in the Bladder, I did press it downward, hard enough as to be felt through the Te- guments, and made the Incision upon it in the bent of the Thigh, in order to know whether it would not be a surer way by securing the point of the Knife; by that way I got my Conductor and Forceps into the Bladder, and drew the Stone very easily; but afterward, by the Dissection of the Body, I found that the Artery of the Penis, and the Vesiculae seminales were cut through and through, which cannot be avoided, because the Artery and Vesiculae lye immediately under that part of the Bladder which the Staff presseth upon. I took another body, and having put in the Bladder a small Stone, I made the Incision much lower, and pierced the Bladder under the Staff, by which Incisi- on I drew the Stone; then dissecting the Body, I found the Bladder cut through, and its Arteries, which can hardly be avoided, the Bladder being then so much Contracted, that both sides of the Bladder are cut, before the Operator either feel the Stone, or see any Urine running out. I took a third Body, in the Bladder of which I put a very large Stone, the Staff being in it, I made the Incision upon the fat Protuberancy, under the Ischium Bone; and piercing the Bladder below the Staff, I found immediately the Stone with the point of the Knife, with which I cut the Bladder, the length of an Inch; through which having introduced the Conductor, and then the Forceps, I got hold of the Stone and drew it out very easily. Then I did Dissect the Body, and found, that neither the Vesiculae Seminales, nor any Artery had been cut, by reason that the weight of the Stone pressed the bottom of the Bladder; lower than the Vesicula's and Arteries. My Opinion is then, that this way might be made use of when the Stone is very big, and willingly, I would prefer it to the old way; for by this way we avoid that extraordinary and violent dilatation of the Neck of the Bladder, which the Stone causeth when it is very big, and which is the cause of the Inflammation and Mortification of the Bladder that killeth the Patient. But when the Stone is small, or of but an indifferent bigness, the old way is easier and surer. Though I have not tried this way upon Women, yet I cannot approve it at all, since one cannot avoid cutting the Neck of the Uterus, the Catrix catrix of which might prove to be of some ill Con- sequence, in case the Woman should come to be with Child. In Women, when the Stone is but indifferent big, the old way is preferable to any other; but if it was very big, then I had rather to thrust my Fin- gers into the Vagina, and bring the Stone as near the neck of the Bladder as can be, and cut the Mem- branes of the Vagina and Bladder upon the Stone: I did cut a Woman in Hambourgh by that way, of which I drew a Stone, weighing five Ounces and a half, who did Recover very well. By this way we prevent the incontinency of Urine, which fol- loweth always the Extraction of great Stones in Wo- men. I cannot approve neither the cutting upon the Gripe, as it is practised by some Mountebanks; Because in that way one cutteth through the Prostates, which destroyeth the parts of Generation. I have observed that all those which have been cut by that method, were never fit for Generation.