DEP/DUA/1/11/22 (Transcript version)

William Knight

(1776-1777)

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William Knight.

Case of this patient in all probab. a complic affection.

First sympt mentiond in case would indic local affect of some abd. viscer.

One of prin. compl. const acute pain of epigast. region.

And respecting cause no room for doubt.

A tumour felt there inclin towards left side

On press. of this pain augm

Yet evid not an affect of abdom [integ.]

Otherwise should discov. both local rising & probab. also change of colour.

To which of viscer. to be referrd not clear.

From seat some ground for suspecting stomach

And this susp. corrob. by two circum.

viz Freq. nausea & loss of appetite.

Farther to be observd that schirri of stomach no unfreq. occurr.

Sometimes affecting pylorus sometimes [cardiac]

An affect. occurring at earliest as well as latest periods of life.

This suppos. however not altog. without diffic

For patient not affected with vomiting

Which if not const. is at least very freq. sympt. of that affection.

And affect of stomach not only possib. suppos

May dep. on diseased state of part of chest or spleen.

Or even notwith situat. on an affect of liver.

Upon whole however equal if not greatr probab. of affect. of stomach than any other viscus

And can by no means think that [vomitin] to be consid as an attend sympt unav. necess

When happens must be consid as conseq. of an affect of nerves on interm surface.

These however may be but little if at all affected [where] [shirros] or tum. extern.

Would then entertain this conject respect local affection.

This from acct given us seems to have been first & is perhaps still princip part of compl.

At pres. however by no means only one

Other sympt. mentiond in case at least not immed connected with this.

As such may mention, flatul. tinnit aurium & sense of ball rising to throat threatning suffoc.

Would not contend that these have in no degree derivd origine from dis. already ment.

Certain however that in by much great. number of cases in which occurr take place without any such local affect.

Daily exampl. with hyster girls.

And merely affect of debil. & irrit. state.

Presumpt. therefore is that in pres. case the two affect. totally unconnected.

But besides these probab. subj. to still another affect.

State of urine in morbid condit in diff ways.

This disch. we are told takes place in uncommonly small quantit.

And gave such descript of colour that induced to desire him to bring some for exam

As far as could judge from appear had evid mixt. of blood.

Very exactly resemb. what mentiond by Mr Vogel in defin of Haematur.

Urina exquisite permixto sanguine perfunditur, ut ea quasi dilutus & tenuis sit sanguis.

Could have no reason in this case to suspect any decept.

Patient to gain nothing by it which could be of any use to him.

And of some of other compl. most unques evid

That here however mixt. of blood appeard took place not merely from colour. & appear.

Appeard still more manif from sedim.

For on being allowd to stand some time depos. grimous black colourd sedim.

Which perhaps strongr test of mixt of blood than even appear.

As serving to point out partic matter on which colour depends.

Besides other affect therefore must [conc] that patient also lab. under Haematuria of Nosol.

This indeed by some as Dr Cullen not ranked among gener.

But consid always as symptom.

This opin howevr can by no means adopt.

May be indeed true that most freq a haemat of passive kind.

Yet even admitt it to be always so can see no reason, why passive haemorr. shold not constit & give name to dis as well as active.

Besides cannot suppos. that bloody disch from kidneys always to be reckond sympt.

Nothing pecul. in this organ which could be supposed to prev. haemorr.

Vessels as liable to have action [encreasd] & as tender as most others in body.

Disch of blood takes place also to as great quantit.

In so much as to endangr life from [inan]

Can have no doubt therefore in conclud haematuria a genus as done by Sauv. Vog. & Lin

And next occurrs as quest whether bloody disch. here of active or passive kind.

Whethr depends on kidneys [ureter] or bladder.

In solving first little to guide judgm.

May be observd howevr, that if expect thirst, no febrile sympt.

And that no sense of augm impetus at any partic part.

Presum therfore that of passive kind.

While at same time from scarcity of urine may conclude that dep. on kidney

This then idea respecting this part of patients compl.

How far connected with other parts diffic to say

Should not readily suppose that any dep. on flatul. occas. sense of suffoc.

Not that wind in intest may not affect kidney

But will give merely a tempor. affect.

Or at least one with remarkab. remiss & exacerbat.

For such suppos. therefore pres in its nature too perman.

More reason to suspect that may be connected with tumour & pain in epigas

To this indeed situat of tumour some object

But from place where felt cannot possib determine extent.

Partic towards infer. parts of abdom.

Not improbab. therefore that from this tum some degree of compr. on kidneys.

But respecting this, at utmost, can only conject

And from every view of case must pron it a complic. affection.

On this ground prognos. can be by no means favour.

Especially with patient in many respec in most unfav. circum.

Compl. already of very consid durat.

And has resisted whatever med hitherto employd

Besides, med when taken cannot have every advant.

Patient both aged & indigent.

And state of stomach by no means well suited for retent of such as in any degr. nauseous.

Father from many excluded.

As while may seem useful for one part of sympt. by no means so for others.

On these diff. consid then little hope of speedy cure by aid of med.

And no reason to look for fav. natural termin.

On other hand how far threatening of immed danger a matter of doubt.

From contin which disease has already had should not be inclind to fear worst

Yet reason to appreh. that even severit of some sympt might prove sudd. [fatal]

Partic to be dreaded from affect of urine.

No reason indeed to be affraid of very great disch. of blood.

But scarcit of urine may soon be [converted] into totall ischuria.

Especially if as some reason to suspect be effect of compress on kidney.

But even suppos encreas of tumour may yet take diff. turn

And patient may hold out under it even for very consid time.

Yet little probab that state of health will admitt of regul. attend here.

And were he even to give regul. attend. would probab be followed by no great degr of advant.

Shall howevr briefly point out plan of cure which would here be cheifly inclind to follow

Great obj in this affect take to be removal of tumour in abdom viscr.

And perhaps little varied whether stom or any other viscus.

In formr inst indeed more immed applic

But perhaps aftr all cheif releif to be expected from entering system.

Remov of such compl. well known to be partic obstin.

And no remed. yet discov. on which dep can be absol. put

Among most powerful may justly rank Cicuta & Mercury.

And in pres case chief expect. from these

Patient however by no means in prop. situat for use of either.

Reckond it of more conseq. therefore to attempt in first inst allev. of sympt.

And partic as most urgent to encrease quantity of urine.

With this intent had recourse to the nitrous powders

United howevr with consid propor of G. Arab

By this means hoped that in first inst. might less affect the stom.

And farther that might act as demul. as thrown off by urin passages.

Besides this ordered also friction with camph. oil to paind part.

But without any other view than that of affording temp releif.

These intent however not answerd.

Nor I own did this by any means surp.

From having found indeed that from nitrous powders no uneasin at stom. might have encreased dose.

But must still with respect to some of compl. at least have been doubtf. med.

Wishd rather therfore to try here what might be effects of Uv [Ursi].

A remed not many years ago introd with very high charact against compl of urin passages even against calcul.

Certain however that although may give ease in calcul cases no influ in removing [stone]

And now cheifly employd where reason to suspect ulcerat. relaxat or simil affect of kidney

Must own that from all I have seen of it could never think that desired charact which has obtaind.

In situat of this patient however seemd to have some pecul. advant.

For could never suspect it of any effect as encreasing morbid irritab. or [laxit.] of [illegible] [illegible]

On contr. from sensib qualities should presume it a med of service against [these].

For on whatever prin influ. on urin [passage] to be explaind little doubt that as acting upon stom will exert astring. power.

Thus then expected that might be of some service with double intent.

And proposed at least trial for space of a week

According to affects was intent to regulat future conduct.

And if patient shall again be able to visit us still mean to do so.

If from first trial any benef. shall persist in use in encreased dose without any addit.

If sits easily in stomach with contin of scarcity of urine mean to try combin with some of quickest diuret.

Partic with dulcif. spt of Nitre.

At same time while gives no inconven. contin friction with Camph. oil.

If these means of allev. sympt shall fail may have recourse to others.

In which howevr rather to be directed by circum than by any gener. plan.

If howevr any consid mitig of sympt obtaind shall next direct attent to tumour

And with this view give at least trial to use of Cicuta.

Should this be found not to disagree may cont. use even when attended by no remark effect.

For from persev. alone that can expect any benef [frequent] an affect of so long stand

If patient unable to bear it might perhaps think of giving trial to Mercur.

At same time much to be doubted [whether] could be pushd to such extent as to give any hopes of cure.

And must conclude, as have before observd, that pres a case in which expect of being serviceable to patient very faint.