DEP/DUA/1/14/03 (Normalised version)

John Seaton

(1777)

---

John Seaton

Regarding disease of this patient must own that at first was & still am very much at a loss.

For although attendance now discontinued am far from considering him as cured.

And short period for which continued under our hands by no means sufficient to afford opportunity of forming any proper judgement of it.

Whole of disease evidently consisted in morbid state of one of principle excretions from body.

The discharge viz by urine

And with respect to this three particulars claiming attention.

The smallness of the quantity discharged.

The difficulty of discharging it.

The pain with which that discharge attended.

Affections of this nature well known to proceed from various causes.

These at same time requiring very opposite modes of cure

And with this very great difficulty in distinguishing to what cause to be attributed.

In case before us great reason to believe that affection to be considered as idiopathic.

That is not [here] any preceding [disease] of which it could be considered as consequence.

Might therefore with propriety refer it at least to general title of Ischuria.

By which would understand suppression of urine whether general or partial.

For under this generic appellation would include stranguria dysuria etc

As from same cause giving total [suspension] of urine circumstances [characterising] these other [affections] will arise.

Whether appearing under form of frequent ineffective inclination to discharge difficulty of discharge or the like.

When however accept generic term in this sense a very material distinction [claims] notice

Whether viz depends on secreting organ

Or on channels through which to be conducted viz. Ureter, Bladder & Urethra.

That is whether [properly] to be styled Ischuria renalis or vesicalis.

And must own that in present [case] in this respect very great difficulty.

Several circumstances tending to favour supposition that disease depended on some obstructing cause in bladder.

And indeed many circumstances which would incline to belief of its depending on calculus [there].

Particularly pain with which this affection attended

Urine being sometimes discharged to extent only of few drops at a time.

But above all the sudden stoppage to which sometimes subjected during course of free discharge.

Here however the most convincing perhaps only certain proof wanting.

Presence or absence of stone had never been determined by sounding.

And while some circumstances favouring supposition of stone others against it.

Among these may enumerate small [quantity] of urine which is ever observed to be discharged.

For although calculus in bladder prevents [discharge] of urine does not obstruction secretion.

[Hence] therefore on supposition of calculus should have expected to have found at times very copious discharge of urine.

And where after long scarcity this wanting should have expected to have had [circumstantial] distension about region of pubis

This however not even said to be case in mornings.

At which time, by the way, are informed that pain most severe.

To all this may add that on supposition of calculus should have at times expected bloody appearance in urine.

And by no means unfrequently to have even discharge of pure blood.

A practitioner of eminence at this place who considered discharge of blood in drops from urethra during violent straining as certain characteristic of calculus.

Are however informed that no such appearance here took place.

And lastly on supposition of calculus should have expected pain not merely on attempt to discharge but at other times also.

From all circumstances taken together then was disposed to think that more particulars against than in favour of supposition of calculus.

And concluded affection to arise rather from want of due secretion of urine than from any obstruction during course.

Yet here so far from certainty that could not even form probable conclusion.

Hence but slight foundation for judging with any confidence either with regard to prognosis or practice.

When however consider obstinacy & continuation of complaint did not look for speedy [termination]

Before came under our care disease had subsisted for space of twelve months

And if underwent any change had during that time increased in severity.

Might therefore conclude that did not depend on an accidental or transitory cause.

And that cause of obstinate nature not less probable from patient being ignorant of any circumstance to which could ascribe it.

These then grounds for apprehending that disease should prove tedious under our care.

And to this still farther tedious as totally at loss to say on what grounds could [expect] to relieve our patient.

In this situation was intention to do very little here in an active manner.

But to attend to every circumstance which could throw light on nature of affection.

With this view considered it as most probable that was effect of want of secretion thought of trying what would be [affect] of gently increasing action of kidney.

Was with this intention that had [here] recourse to Spirit Nitre dulcis.

Than which do not know any medicine more immediately acting as diuretic.

And few even in operation more certain.

Was in hopes therefore that if what esteemed most probable conjecture well founded would have good effects

But even this medicine, without farther certainty respecting nature of disease [durst]¹ not venture to exhibit to any great extent.

For on supposition of calculus every addition to quantity of urine must give [inconvenience]

Wished therefore to conjoin trial of this with sounding.

By which should at least be determined in conjecture whether consider calculus in bladder.

But sounding as being a chirurgical operation in some measure an object of terror.

And accordingly found patient very averse to any trial of this kind.

This perhaps might have some share in favourable report which gave us of effect of Spirit Nitre

For at next told that while urine considerably increased, difficulty & pain in discharging greatly alleviated.

That these circumstances should be connected by no means surprising.

For on supposition that affect from want of secretion, would ascribe these particularly to affect while little or nothing to discharge.

Had there, therefore been no circumstance to create doubt respecting this report should have considered it as throwing some light on nature of disease.

And might have been employed as additional argument to show that affection really arose from want of secretion.

But before venturing on such an assertion would have been necessary that should have been informed of consequences from it at least for second week.

Patient however did not again return to us

But whether from affection being so much [easier] that thought it unnecessary, or from apprehension that sounding would again have been recommended do not know.

But even supposing latter could hardly look upon him as radically cured.

And supposing disease affect of want of secretion which dulcified spirit of nitre [power] of removing yet may conclude that will at times be subjected to returns.

Of measures however to be taken with view of preventing [these] need at present make no observations.

For probability is that shall see nothing farther of this patient unless in accidental manner.

---

Explanatory notes:

1) Archaic or regional past of dare.