DEP/DUA/1/43/60 (Normalised version)

James Short

(1787-1788)

---

N^o34 James Short. at 9.

Case of this patient as well as former not without difficulty.

Symptoms however cannot be represented as numerous.

And probable that diseases simple & uncommon all arising from same cause.

Strong grounds for presuming [likewise] that this cause in kidney.

This may infer both from situation of pain & affection of urine.

But respecting nature of diseased state in kidney more room for doubt.

For both pain & affection of secretion of urine may arise from different causes.

Of all causes however producing these effects most common is calculus.

Well known to induce a disease both frequently dangerous & painful.

And besides circumstances already [mentioned] in fits of pain to which this patient subjected at least some resemblance to it.

Here however must be allowed that other symptoms of Nephritic Calculus wanting.

Such for example as affection of alimentary canal stupor of thigh, retraction of testes etc.

From absence of these at least doubt whether any considerable calculus exists in kidney.

And am I own inclined rather to think there does not.

In these [considerable] changes to which urine subjected in point of colour, have rather evidence of morbid affection in secretion.

And from sand discharged have evidence of that condition of secretion abounding with calcareous matter

In this rather than any proper calculus am inclined to think that disease of present patient consists.

Even supposing this conjecture however to be well founded, can hardly lead us to give favourable prognosis.

At least to hope for speedy recovery.

Not indeed any great reason for being apprehensive of fatal consequences.

At least if such should ultimately occur will not probably be a sudden event

But by no means an easy matter to change condition of an organ so much out of reach as kidney.

And particularly so, when morbid state in that organ, seems to have had foundation as it were in [original] constitution.

For of this strong presumption when consider long continuation of disease, although patient only at early period of life.

Upon whole therefore greater [reason] to apprehend [increase] of affection than grounds for expecting recovery.

Yet at the same time something I apprehend may be done with advantage both with view of preventing consequences most to be dreaded & of alleviating affection

First of these intentions may expect in some degree to [accompanied] by [more] free discharge of urine.

As this calcareous matter more diffused & [illegible] carried off.

[These] [last] again may hope to obtain when pain most severe by occasional use of opiates.

But besides these may also try articles which have been supposed at least to have effect on condition of secreting organ.

Such for example as Uva Ursi. Vitriol Acid or Caustic Alkaline lixivium.

But in practice here a good deal [regulated] by circumstances

And observations respecting it reserve to future occasion.