DEP/DUA/1/40/68 (Normalised version)

David Smith

1787

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David Smith. February 3^d 1787.

In history many symptoms.

But no doubt that most material affection of discharge of urine.

And reason to presume that from this most if not all others arise.

Formerly observed some doubt as to name.

Would seem entitled to appellation both of ischuria & dysuria.

For from diminishment of discharge evidence of affect of secretion.

Hence great characteristics of Ischuria Renalis.

While again from pain & difficulty of discharge may pronounce Dysuria present.

But these am inclined to think merely consequence of state in which [ser]

For will observe often even with mixture of blood.

And probably from small quantity of watery part always very considerable [impression] of saline matter.

To this would ascribe great [sense] of heat in urethra.

For here no evidence that severity less than natural.

Hence to be ascribed to increased stimulation.

To which probably also to refer great degree of pain.

A consequence of action of urine [thus] acrid on sensible parts at neck of bladder.

Here then though symptoms from action on bladder yet would consider disease as originating in kidney.

And to this, cause to which ascribed gives additional probability.

For affection referred to injury done to [trunk] of body, by which told several ribs fractured.

And which probably produced injury of kidney itself.

To local disease in this [then] am inclined chiefly to refer present affection.

At same time would by no means assert that kidney only organ diseased.

Or that bladder entirely [sound].

Yet think that symptoms may be explained without this.

And relief derived from [practice] employed renders it more probable that no [affection] of bladder

While without supposition of affection of kidney phaenomena not to be [explained]

For this equal cause of scarcity & of bloody discharge.

But supposing kidney alone in morbid state, yet disease to be considered both as important & alarming.

For well known that in many instances ischuria a fatal affection.

While at same time almost every local disease of kidney obstinate

For organ very much out of reach.

Hence when formerly spoke of case represented as one where little hope of complete recovery.

And that the rather to be feared as of several years standing

While occurred in man of very advanced age already in 72^d year.

Would however appear that this prognosis at least so far contradicted by events

For patient already dismissed if not free from affections at least with all symptoms considerably relieved.

And enjoying at least that state of health which did before applied for assistance.

This however I own consider only as effect of temporary increase of quantity of Urine.

Not of removal of disease in kidney.

Hence I own inclined to look upon it rather as temporary than radical cure.

Yet disposed to look upon it, as to considerable degree at least, effect of medicine employed with this patient.

Here from idea of disease [concern] great means of immediate relief to depend on increase of secretion of urine.

And with this view it was that prescribed Vinum Nicotiana.

An article formed by infusion [Folium] Nicotiana Viz. ℥ i in Vinum Alb. Hisp pound i.

A menstruum by which activity of this powerful article fully extracted.

Nicotiana long known to be a substance possessing very active powers.

And these depend both on Phlogistic or oily & Saline impregnation.

Hence requisite for extraction a menstruum in which both ardent spirit & water united

Nicotiana in different forms long employed in medicine & with various intentions.

But of its diuretic powers very little or rather no mention made by [practical] medical writers.

For discovery of these consider [us] as indebted to that ingenious & diligent observer of nature Dr Fowler of Stafford.

Recommend with this view to attention of [practice] in late publication Medical Reports¹.

[There] many striking examples of benefit in different cases of Dropsy & Dysuria.

Since that as Diuretic a good deal employed by other practitioners.

And many satisfied that justly merits very high character.

For my own part have not before employed it in cases of Dysuria or Ischuria

But have frequently used it as diuretic in other affections.

Particularly in Dropsy & Chronic Catarrh.

From experience I have had convinced that often does operate as powerful diuretic

At same time like all other [diseases] its operation uncertain.

And indeed this not wonderful when consider situation of secreting organ.

For matter can only reach it in course of circulation.

Hence liable to [such] changes [are] on many occasions to be rendered altogether effete before reaching kidney.

And this depends on infinite number of accidental circumstances.

Hence what succeeds in one case will often fail in another.

And what esteemed weaker, frequently product of desired effect where stronger employed in vain.

As far as my observation goes Nicotiana subjected to same uncertainty with others

But from having found it often a powerful diuretic had here recourse to use.

And in affects not disappointed.

For from time that began employment urine at least somewhat increased.

And all symptoms particularly heat in discharging it considerably diminished

This however must acknowledge could not entirely ascribe to Nicotiana.

For at same time directed another diuretic viz Infusion Juniper.

Made by extracting active parts of Juniper particularly essential oil by water.

Diuretic power of this article long known.

And under form of water infusion effects increased also by diluent.

Hence consider it as one of best drinks to be [employed] with other diuretics

To this therefore not improbable that part at least of good effects here obtained to be ascribed.

Although however under these considerable relief yet urine still scanty.

And at same time Nicotiana as not unfrequently case had effect of exciting considerable sickness at stomach

Omitting therefore Nicotiana had recourse to powders of Cream of Tartar with Mixture of Nitre & Cassia.

From this soon still farther augmented.

And was now free from all other symptoms.

And finding himself in as good health as had been at any time for some years before desired to be dismissed.

To which I own not [averse] since now as well as ever expect him to be.

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Explanatory notes:

1) Thomas Fowler, Medical reports, of the effects of tobacco, principally with regard to its diuretic quality, in the cure of dropsies and dysuries (1785).