DEP/DUA/1/33/12 (Normalised version)

Robert Yeats

1783

---

Robert Yeats. December 7^th 1783.

Respecting disease of this patient must own am not without difficulty.

Most urgent symptom pain in back or rather right haunch.

This well known may proceed from very different causes.

And in case before us from situation, as well as some other circumstances, grounds for conjecture, that may in part at least depend on a Rheumatic affection.

Particularly from aggravation by heat of bed.

A cause by which in certain states of Rheumatism well known that pain [augmented]

But if some particulars in favour of Rheumatism others arguing an affection of more serious nature. This particularly the case with respect to discharge of urine.

Especially where those having Calculus there subjected to any violent exertion or uncommon motion by which stone injures tender parts And such a cause our patient assigns as having induced his affection.

For not only uncommon inclination to discharge but urine also with uncommon appearance.

Have evident marks of tinge of blood. Here therefore would naturally suspect that both pain & bloody urine from same cause.

And a cause which well known often operates as producing both at same time is Calculus in kidney.

Here however to be observed that many symptoms of Calculus in kidney wanting.

Particularly affection of stomach.

For very generally at least attended with severe vomiting.

In most cases also stupor of thigh & retraction of testicles are its attendants.

With these symptoms however as far as can learn present patient has never been affected.

And what still more, though mixture of blood in urine yet no sand discovered.

Notwithstanding these difficulties however reckon supposition of Calculus the most probable.

And disposed to consider it as example of Nephritis, or if to design it from appearance of urine of Haematuria Calculus.

If this the case cannot pretend to assert that affection without danger.

Calculus may yet be of such size as to pass into bladder or even be completely discharged from body.

But on other hand may excite inflammation, ischuria, or even suppuration having fatal conclusion.

But if on supposition of truth of this conjecture must deliver doubtful opinion, still more reason to be [guarded] when consider uncertainty of case.

May indeed be much slighter than we imagine it.

But must observe that in present state consider patient as by no means free from danger.

And if in present situation an unfavourable event should even suddenly occur would neither be unexpected nor surprising.

Hope however that disease even if left to itself will not take such unfavourable turn.

And have expectation that may be able to do somewhat towards his relief.

Cannot however say that has derived much benefit from remedies hitherto employed.

When came first under our care one of most urgent symptoms costiveness.

Imagined that by obviating this some benefit might be obtained in relief of pain.

And that by employing as a purgative an article which has also effect as increasing urinary discharge matters lodged in passage might be discharged.

Was on this account that had recourse to the Cream of Tartar

But that might ensure purgative effect added to it a small proportion of Jalap.

But with severity of pain, & grounds for suspecting that local inflammation might occur, could employ stimulating cathartic only to small extent.

This powder had at first so far the desired effect.

While sat easily on stomach had [some] effect also in opening belly.

But produced no change either on pain or on state of urine.

In this situation with continuation of remedy had recourse also to Powder of Uva Ursi

An article for introduction of which into practice are indebted to Dr De Haen.

And although by no means that powerful article in Calculous cases which he represents yet in different affections of urinary passages am inclined to think it of great use.

And here whether conjecture as to calculus well founded or not yet might expect some benefit from it.

For little doubt that from some cause or other urinary organs in diseased state

And whether this excited merely by injury from over straining as he himself suspected or from that excessive action having greater effect in consequence of calculus immaterial.

Still diseased state in urinary organs which if not already landed in suppuration at least with tendency to it, to be overcome

And this hoped might be effected by proper course of Uva Ursi.

When first began use gave some uneasiness at stomach.

This however imagined by slight habit might be overcome

And although had not immediate good effects yet hoped for it from continuation

As found however that from continuation of Cream of Tartar belly not kept open to this substituted Pill extract Colocynth cum Aloe

And as pain still continued severe directed external friction to part with Anodyne balsam.

From all these however expectations disappointed.

For powders in place of sitting more easily on stomach occasioned greater uneasiness.

While costiveness in no degree obviated by pills

And notwithstanding use of Anodyne Balsam pain continued as before.

In this situation was himself desirous of intermitting all medicine for some time.

And must own was for my own part by no means averse to the proposition.

On some occasions indeed must be allowed that patients hurt by neglect or delay of proper remedies.

But perhaps no less frequently the case that injury from doing too much.

And particularly where doubt as to nature of disease.

Intermitting therefore all other medicines, merely directed use of Domestic injection.

From which while hoped that would open belly expected also some benefit as internal fomentation.

In both these however were disappointed.

A circumstance not to be wondered at when consider that were not retained.

To these therefore as considered discharge by belly to be essential necessity substituted use of lenitive electuary.

With no other view however than that of procuring necessary discharge.

During interval however from use of medicine patient has continued very much in same state as before.

While pain nothing diminished urine has still same bloody tinge as before

Have thoughts therefore of having again recourse to some practice at least as palliative.

And while with view of abating pain mean to try opiates, with that of restraining bloody discharge may have recourse to astringents.

Particularly to vitriol acid, from which on supposition even of calculus something perhaps may be expected.

But in case of such urgency as present can hardly lay down any fixed plan of cure with much confidence of following it out.

For future practices must be very much directed by state of occurrence at the time.