DEP/DUA/1/35/06 (Normalised version)

David Shiels

(1784)

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David Shiels May 29^th.

Disease of this patient consists of but very few symptoms.

And of these that most distressing to him is pain of back.

This in such a situation that may be supposed to proceed from different causes.

And particularly may either originate from deep seated muscular affection or from affection of the ureters.

Is in support of former supposition that so much aggravated on motion.

While in favour of latter may be [urged], that attended with affection in discharge of urine.

But again to be remarked that Nephritic pain often aggravated by motion while from muscular pain discharge of urine affected

These circumstances of themselves therefore not sufficient to lead to any positive conclusion.

And difficulty still increased when contrasted against each other.

While at same time, in other particulars of case, see nothing which can lead us, to positive, or even probable conclusion.

Upon whole however rather disposed to suspect that this pain arises from affection of ureters.

Besides the particulars already mentioned may also remark as in favour of this supposition, course which takes down the thigh.

And still more the appearance of the urine itself.

For on examination, have found it to contain a considerable proportion of sand.

To these circumstances may add still another drawn from treatment to which patient has been subjected.

On idea of pain being muscular several remedies had already been tried in this case before patient came under our care

And particularly both blister & [strengthening] plaster.

But notwithstanding use of these affection continued to increase in violence.

Upon whole then disposed to view this as being a nephritic affection.

And as originating from calculus or sand in urinary passages.

From this idea of disease, could not be disposed to form a favourable prognosis.

For calculus affection, if not frequently fatal well known to be among the most dangerous & obstinate.

And particularly so when seated beyond bladder.

For although sand or small stones discharged yet tendency to [regenerate] continually.

In so much that patients once to high degree affected with them often more or less victims to affection during whole course of life.

This therefore if conjecture as to present affection well founded, with a man already past his 50^th year, which is case with our patient may not improbably take place

But even if such should be the conclusion yet still no reason to think, that present attack will be of so long continuation.

Does not appear, with any very alarming symptoms, either of severe pain ischuria, or the like.

Hence then may hope that this fit of affection at least will in no long time be terminated.

And particularly, if natural tendency to termination, aided by proper remedies.

In this affection remedies employed however must be very much accommodated to circumstances of case.

Where any considerable degree of inflammation excited in urinary organs becomes a first & principle objective to allay this

Where severe vomiting or total suppression of urine these symptoms claim particular attention.

But in general great objective the removal of irritating cause whether depends on calculus or sand.

Was chiefly at least with this intention that had here recourse to the remedy at first directed.

Use viz of compound powder of Cream of Tartar.

This consists Cream of Tartar united to [Flore] of Sulphur

And has very generally the effect of operating both as purgative & diuretic.

Especially when given in [moderate] doses so that not hurried through alimentary canal by brisk catharsis.

Here however given only to extent of ℥i in day.

Which with common run of mankind at least but small dose for an adult.

Here however hoped that might have so much effect in increasing urine, as to promote discharge of sand.

And at same time so much influence as cathartic, as to prevent the occurrence of inflammation, or remove what had already taken place.

In obvious operation at least of this medicine were not disappointed.

For had effect both of gently moving belly & of increasing quantity of urine

Still however pain continued severe, & little change on appearance of urine.

Thought it requisite therefore with view to latter circumstance that quantity of urine should be still farther increased.

And with view to former, that should have recourse to some anodyne application.

With these intentions directed continuation of Cream of Tartar as before

And at same time enjoined also the liberal use of diluent [drink]

But besides these as means of allaying pain had recourse to Liniment anodyne.

Which whether affection muscular or not from sedative influence exerted on neighbouring parts, expected would have some effect.

Accordingly from use some mitigation seems to have been obtained.

For not only followed by relief of pain, but with increased appetite & better rest during the night.

Still however affection of urine continued nearly as before.

And discharge of considerable quantity of sand still obvious.

But from this latter circumstance may remark, that not much to be inferred.

For some with whom such discharge becomes as it were habitual.

And often in worst health when wanting

If therefore difficulty of discharge & pain of back removed shall reckon it [illegible] for him to continue on this account alone

And this I now hope may for present at least soon be the case without employment of any other medicine than already directed.

But if affection continues obstinate have intention of trying with this patient the Vitriolic acid or the mild alkaline.

Principally with view of observing how far have any influence in altering state of urine discharged.

Here also lime water, [illegible] water & various other remedies directed in calculus cases.

But in employment of these [must] be entirely directed by circumstances in which shall find patient after use of remedy already begun