DEP/DUA/1/37/54 (Normalised version)

John Stuart

(1785)

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John Stuart.

Of case of this patient have not I own been able to form any decided opinion.

But can have little doubt in considering his affection as being of complicated nature.

And probably different parts of it little connected with each other.

When first applied for our assistance chief complaint an affection in discharge of urine & pain of back.

From situation of pain, from [scanty] discharge, & from appearance of urine had reason to conclude that this affection of Nephritic kind.

And that depends on Calculus or at least sand of which a considerable discharge takes place with his urine.

Besides this had also an evident & considerable disease of right testicle.

This swelled to very considerable magnitude near four times size of left, while at same time was of hard & indurated feel.

In general had but little pain from it & had also been for very long time in what might be called [static] state.

Hence notwithstanding shooting pains at times, might justly be considered as scirrhous testicle.

Besides these had at times also pains along right thigh, terminating in knee where most severe.

These may have been of Rheumatic kind.

But consider it as more probable that connected either with affection of testicle or nephritic complaint.

And particularly with former for of Nephritis a very common symptom

Besides these affections to which was subjected when came under our care since treatment here another also has supervened.

Has been attacked with severe catarrhal affection particularly indicated by cough & dyspnoea.

And to all this to be added that general appearance of habit exhibits a very [exhausted] figure.

With this idea of disease prognosis you may readily suppose cannot be very favourable.

Would be by no means surprised if in no long time, patient falls victim to affection.

And if this not the case, can hardly expect recovery from at least greatest part of them.

In nephritis, where stone of kidney of any considerable size, utmost to be looked for is mitigation.

And where scirrhous of testicle, so considerable as in present instance rarely to be removed but by operation.

For which, hardly to be doubted that our patient a very unfit subject.

Of catarrhal affection, a complaint but of recent date might indeed look for complete removal.

But at same time, as occurring with an exhausted & debilitated habit, death may readily be consequence of cough dyspnoea & difficult expectoration.

Upon whole then, little more here to be aimed at, than mitigation.

And is solely with this view, since patient came under our care, that practices here employed have been directed.

Began you will observe, by directing for him, use of Cream of Tartar adding as corrigents, small proportion of powder of Cassia.

This directed with view of gently promoting discharge of urine, & by this means removal of sand.

Under use, affection in this respect was for some time alleviated.

But became affected with very violent cough, attended with [distinct] dyspnoea.

And by this, other symptoms, particularly pain of back, were much aggravated.

With view to this affection, had recourse to application of a blister.

And from this also, temporary benefit at least seemed to be obtained.

But on mitigation of these symptoms whether from violence of cough, or any other cause, tumour of testicle we were informed was increased.

And this also attended with more than ordinary pain.

Viewing this as effect, of accidental supervening inflammation have directed saturn poultices.

And am in hopes, that in no long time, may again be brought to former state.

Still however, diseased state, & that too, to very considerable degree, will remain.

If favourable circumstance occurred might with view to removal, try a course of Mercury & Cicuta.

From which in some cases of this kind, have known considerable & even surprising benefit obtained.

But in present state of our patient, very doubtful indeed, whether for such a trial, any proper opportunity will occur.

And as have already said, probable that practice must entirely be directed, merely with view to mitigation of symptoms.