#Urinary Stones #People have a misconception that urine is inherently dirty. Under normal circumstances, this yellow fluid produced in the kidneys is not exposed to any pathogen until it is excreted through the urethra

#泌尿结石 #

There is a misconception that urine is inherently dirty. Under normal circumstances, this yellow fluid produced in the kidneys is not exposed to any pathogen until it is excreted through the urethra. Therefore, it is not normal to have bacteria in the urine, which can cause bleeding from the bladder, suppuration, and then produce a hard precipitate. As long as the sediment is small enough to be excreted through the urine, you won't feel it at all. But if bladder infections occur continuously, the sediment may become so large that it cannot be excreted from the urethra, and then it forms a stone. Moreover, once the stone forms in the bladder, it is too large to be discharged, and often induces new infections.

So once you get a stone, you can never get rid of it, and with each infection, the stone will get bigger. As a result, bladder stones have a typical layered structure, like an onion. Therefore, bladder stones are caused by bacteria, which is a direct result of not paying attention to hygiene.

"AEGER SIBI CALCULUM praecidens" literally translates to "a sick man cuts the front of his body and takes out a stone". This is the title of a chapter in the book of Nicolas Dopp, the 17th-century master surgeon and mayor of Amsterdam. Dupp described a wide variety of diseases and other wonderful medical phenomena he encountered in the city, including burps for 12 days in a row, gangrene of the thumb after bloodletting therapy, rare triggers for bad breath, pregnant women who ate 1400 salted herring, perforation of the scrotum, peeing out worms every day, pain after 4 hours of defecation, pubic lice and quite terrible burning red iron scalding the buttocks. He wrote Observational Medicine in Latin for young surgeons and physicians. But without his knowledge, the book was translated into Dutch and became a bestseller sought after by non-medical readers. Among them, the story of a blacksmith named Jane de Dot cutting open his bladder to take a stone is presumably the most popular, because he is painted on the title page of the book.

Jean de Dort lost faith in Dupp's peers and decided to solve the problem himself. He suffered from bladder stones for many years, and the surgeon tried twice to remove the stones from his body, but both failed, and he almost lost his life. This procedure is called lithotripping, as it literally means "cutting open to take the stone.". In those days, the mortality rate of lithotripsy, the probability of a patient dying from surgery, was 40 percent. One of the most important signs of a successful stone collector is having a good horse so that he can run far before the patient's family members settle accounts with him. Therefore, the trade of stone takers is essentially a traveling profession, just like tooth extraction and cataract treatment. The advantage of this nomadic practice is that the next village will always have poor people who are suffering from disease and are willing to take risks – and of course, pay for it.

Jean de Dort had tried stone extraction twice at great risk, and statistically, the combined risk was as high as 64%, so he was lucky to survive. The unbearable sharp pain and discomfort made it impossible for him to sleep at night. Bladder stones have existed since ancient times, they have been found in ancient mummies, and there are also records of "stone taking". Pain from bladder stones used to be a daily symptom like scabies and diarrhea, so you can liken it to a common condition today, such as headaches, back pain, or irritable bowel syndrome.

Why were bladder stones so easy for people in the 17th century, and very rare today? In a city like Amsterdam, houses are cold, damp, and airy, with wind blowing in through cracks in door frames and window frames, walls wet with moisture, and snow burrowing into the house from under the doors. People were helpless to do anything about it, and had to wear thick clothes day and night. Rembrandt's painting depicts people in fur coats and hats. In those days, it was impossible for people to bathe with clean water every day. The water in the canals is dirty, dead rats float on the surface, people defecate and throw garbage into the water, and tanners, brewers and painters discharge chemicals into it. The canals of the Jordanian district of the city are nothing more than extensions of muddy ditches crisscrossing the surrounding pastures, where cow dung flows slowly into the Amstel River. You can't take a decent bath in the river, or wash your underwear, and toilet paper hasn't even been invented yet. This makes their groins and private parts always dirty. The urethra, the cavity that drains urine from the body, is only a small barrier for bacteria to enter the bladder. For this invasion from the outside, the best measure is to urinate as much as possible to flush the urethra and bladder. This means drinking a lot of water, but clean drinking water is also rare. The water pumped is also not always trustworthy. The best way to ensure water safety is to use it to make soups, and it can also be made into wine, vinegar and beer for a long time. Around 1600, each Dutch citizen drank an average of more than 1 liter of beer per day. However, this is not suitable for children, so bladder infections usually begin in childhood, so that the stones are larger and larger for a long enough time.