DEP/DUA/1/39/34 (Normalised version)

George Pringle

(1785-1786)

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George Pringle April. 8^th

In case of this patient an example of a disease not frequently occurring.

But which when does occur very generally of obstinate & distressing nature

In history of his case a variety of symptoms are mentioned.

But that which most remarkable is the discharge which takes place by urinary organs.

Urine in general both high coloured & scanty.

But this discharge more remarkable [affection] as at times contains a large proportion of blood diffused in it

And on some occasions even discharge of considerable quantity of pure blood.

Which as may readily be supposed when coagulated not passed without great pain.

Little doubt that to this discharge many of other symptoms to which he is subjected are to be ascribed.

Particularly headache, flatulence, impaired appetite thirst, general debility etc.

Indeed, no symptom in history, which may not be considered, as common attendant of disease excepting bloody stool

This we are told has at times occurred with him.

This symptom however, in any case of similar nature, before falling under my care, have not observed.

Nor do I remark, that in general at least mentioned, by those giving history of disease.

Is indeed true, that among other causes, has in some cases been observed to alternate with haemorrhagic affection.

And accordingly one species of the disease, distinguished by Sauvages by title of Haemorrhage [Haemorrhage].

And where this the case, that discharge of blood, should take place both by faeces & urine, cannot seem strange.

But that our patient subjected to this species, is I think very improbable.

For as far as can learn, has not at any former period of life been subjected to Haemorrhagic affection.

And severe pain attending it, so high seated, that would naturally suppose blood afforded from different source

While therefore, must consider this, as more a peculiar symptom & to be explained from some other cause, are naturally led to more important inquiry species viz of Haematuria to which present patient subjected.

Or rather particular cause inducing discharge of blood & particular source from when furnished.

In system of Mr Sauvages no less than 15 species referred to this genus.

And in all these, have at least general symptom of bloody urine, as induced by different accidents, & proceeding from different sources.

Here bloody discharge may arise either from kidneys, ureter, or bladder.

Nay in some cases even from the Urethra.

As for example in these instances, which [style] Haematuria Stillatitia & Ejaculation.

But here, from seat of severe pain, in region of kidneys, as well as from diminishment of secretion of urine, have every reason to believe, that from kidney.

And am inclined to think that with greatest probability at least, may be referred either to Haematuria calculus or Violenta of Sauvages.

May be considered as much in favour of first supposition that, with urine, a considerable quantity of sand, often observed to be discharged.

While again, somewhat in favour of last, that attributed his disease, to overexertion.

But these two causes as inducing this affection, may I think with great propriety be conjoined.

No doubt that of all causes inducing haematuria calculus or sand in kidneys the most common.

And also certain that where these exist any quick motion or overexertion very apt to produce more considerable affects.

Thus many having calculus in kidneys, with whom riding on horseback [constantly] followed by bloody [urine]

And where kidneys in consequence of any accident brought to diseased state seemed when [separate] must act with great violence.

And this I own conjecture which was disposed to entertain, with regard to affection of this patient.

Had certain evidence of separation of calcareous matter from urine in consequence of manifest discharge of sand.

Imagined that this capable of producing bloody urine, in consequence of diseased state, having been induced in kidney by causes mentioned, fatigue & over exertion.

And that from separation of blood, as well as from action of sand itself, all the other symptoms to be explained.

With this view of disease, could have no very favourable opinion as to termination.

Morbid condition on kidney when induced, very difficultly removed.

And no less so to remove what may be called calculous diathesis

That is, secretion on such urine as contains & [separates] large proportion of calcareous matter

But of prognosis here, now unnecessary for us to offer any remarks.

For departure of patient for country prevented from being any longer subject of treatment.

And now very little chance of even accidentally learning anything respecting termination of case.

Shall therefore conclude remarks with few observations on practices employed during course of attendance.

This patient while under our care, treated you will observe; almost entirely with one remedy viz Uva Ursi.

This article I need hardly observe introduced some years ago, on recommendation of Dr De Haen of Vienna as a remedy in calculus.

From his works will observe recommended it as a remedy capable of dissolving calculus.

Besides which considers it also as a remedy capable of producing change in state of urine & alleviating pain though calculus still remains.

Of affection in former way, now very great reason, to entertain doubts.

Nay I believe now hardly anyone, who considers it as having any influence in dissolving calculus.

But for affection in latter way there are at least more adherents.

And not a few cases have occurred where, under use, symptoms from calculus before severe very considerably alleviated.

If however thus advantageous has been still more so in some other affections of urinary passage.

In cases, where even considerable ulceration of these, sometimes manifest advantage.

And in former instances of Haematuria have I think employed it with benefit.

On this ground then led to trial in present instance.

Begun by directing it to extent of Teaspoonful twice a day.

And as from this no uneasiness at stomach soon afterwards ordered dose to be doubled.

For some time after begun use no discharge of blood with urine.

And what might be held as still farther good symptom urine less high coloured.

This however, could not with any degree of confidence, attribute to remedy employed.

For such changes every day occur without any remedy.

And what evidence showed that disease by no means removed, was continuation of pain of back & scanty discharge of urine.

Under employment of uva ursi, became affected with bound state of belly.

For obviating this, had recourse to Cream of Tartar.

Which while laxative also well known to be in general powerful diuretic.

Although however had affect of opening belly, in latter way little influence.

And while employed these remedies in conjunction, with increase of pain of back, had again return, of discharge, of considerable quantity of clotted blood with urine.

In this situation, expressed [desire] of going to his friends in country.

And had I own no such high expectation of his being benefited by continuing here, as to dissuade him from it.

Accordingly, as already observed now removed at such distance from Edinburgh, that shall probably learn nothing farther respecting him.