DEP/DUA/1/14/03 (Transcript version)

John Seaton

(1777)

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John Seaton

Regarding disease of this patient must own that at first was & still am very much at a loss.

For although attend now discont. am far from consid him as cured.

And short period for which cont under our hands by no means suffic to afford opport of forming any prop. judgement of it.

Whole of disease evid consisted in morbid state of one of princip excret from body.

The disch viz by urine

And with respect to this three partic claiming attention.

The smallness of the quantity disch.

The diffic of disch. it.

The pain with which that disch. attended.

Affections of this nature well known to proceed from various causes.

These at same time requiring very opposite modes of cure

And with this very great diffic in disting to what cause to be attrib.

In case before us great reason to beleive that affection to be considered as idiopath.

That is not [here] any preceding [diseas] of which it could be consid as conseq.

Might therefore with prop. referr it at least to general title of Ischuria.

By which would understand suppress of urine whether general or partial.

For under this generic appellat would include stranguria dysuria &e

As from same cause giving totall [susp] of urine circum [charact.] these other [affec] will arise.

Whether appearing under form of freq. ineffect inclin to disch. diffic of disch or the like.

When however accept generic term in this sense a very matter. distinct. [claim] notice

Whether viz depends on secreting organ

Or on channels through which to be conducted viz. [Ureter], Bladder & Ureth.

That is whether [properly] to be stild Ischur renalis or vesicalis.

And must own that in pres. [case] in this respect very great diffic.

Several circumstances tending to favour suppos. that disease depended on some obstr. cause in bladder.

And indeed many circum which would serve to favour suppos incline to beleif of its depending on calcul. [there].

Partic pain with which this affect. attendd

Its Urine being sometimes disch. to extent only of few drops at a time.

But above all the sudden stopage to which sometimes subjected during course of free disch.

Here however the most convincing perhaps only certain proof wanting.

Presence or absence of stone had nevr been determ by sounding.

And while some circum favouring suppos of stone others against it.

Among these may enum small [quantity] of urine which is ever observd to be disch.

For although calcul. in bladder prev. [disch] of urine does not obst. secret.

[Hence] therfore on suppos of calcul should have expectd to have found at times very copious disch of urine.

And where after long scarcity this wanting should have expectd to have had of circum distension about region of pubis

This howevr not even said to be case in mornings.

At which time, by the way, are informd that pain most severe.

To all this may add that on suppos. of calcul. should have at times expected bloody appear in urine.

And by no means unfreq to have even disch of pure blood.

A practit of emmin at this place who consid disch of blood in drops from urethra during viol straining as certain charact of calcul.

Are however informed that no such appearances here took place.

And lastly on suppos of calcul. should have expected pain not merly on attempt to disch. but at other times also.

From all circum taken togeth then was disp. to think that more partic against than in fav of suppos. of cal.

And concluded affect. to arise rather from want of due secret. of urine than from any obst during course.

Yet here so far from certainty that could not even form probab. conclus.

Hence but slight foundat for judging with any confid either with regard to prognos or practice.

When however consid obstin & contin of complaint did not look for speedy [termin]

Before came under our care disease had subsisted for space of twelve months

And if underwent any change had during that time encreased in severity.

Might therefore conclude that did not depend on an accid or transit. cause.

And that cause of obstin nature not less probab. from patient being ign. of any circum to which could ascribe it.

These then grounds for appreh. that diseas should prove ted under our care.

And to this still farthr ted as totally at loss to say on what grounds could [expect] to releive our patient.

In this situat was intent to do very little here in an active mannr.

But to attend to every circum which could throw light on nature of affect.

With this view consid it as most prob that was effect of want of secret. thought of trying what would be [affect] of gently encreasing action of kidney.

Was with this intent. that had [here] recourse to Spt. Nit. dulcis.

Than which do not know any med more immed acting as diuret.

And few even in operat more certain.

Was in hopes therefore that if what esteemd most probab. conject well founded would have good effects

But even this med, without farther certainty respecting nature of disease [durst] not venture to exhibit to any great extent.

For on suppos. of calcul. every addit to quantity of urine must give [inconv.]

Wishd therefore to conjoin trial of this with sounding.

By which should at least be determind in conject whether consid calcul in bladder.

But sounding as being a chirur. operat in some meas. an object of terror.

And accordingly found patient very averse to any trial of this kind.

This perhaps might have some share in favour. report which gave us of operat effect of Spt. Nitre

For at next report told told that while urine consid encreased, diffic & pain in disch. greatly allev.

That these circumstances should be connected by no means surprizing.

For on suppos. that affect from want of secretion, would ascribe these partic to affect while little or nothing to disch.

Had there, therefore been no circum to create doubt respecting this report should have consid it as throwing some light on nature of disease.

And might have been employd as addit argum to shw that affect realy arose from want of secret.

But before venturing on such an assertion would have been necess. that should have been informed of conseq. from it at least for second week.

Patient howevr did not again return to us

But whether from affect being so much [easier] that thought it unnecess, or from appreh that sounding would again have been recomded do not know.

But even suppos lattr could hardly look upon him as radic cured.

And suppos disease affect of want of secret which dulcif spt of nitre [power] of removing yet may conclude that will at times be subj to returns.

Of measures howevr to be takn with view of prev [these] need at pres. make no observat.

For probab. is that shall see nothing farther of this patient unless in accid. manner.