DEP/DUA/1/28/09 (Transcript version)

Robert Cumming

(1781-1782)

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Robt Cumming.

Respect case of this patient when came under care not without doubt.

Then however many sever circum which led me to consid prin affect as consis of calcul. compl.

And on this suppos. began treatm of case.

But from what have now since seen as to progr of disease am now doubtful how far this opin well founded.

And accord. of late have treated the disease on a diff. footing.

This however will more fully app on remarks on pract.

When came under our care most urgent part of compl. consisted in pains in diff parts of body.

These sometimes in fore part occup. region of stomach.

Often in back affect seat of kidneys.

And in this last situat. to shoot downwards in course of ureters.

With this pain there occurd also very consid affect of disch of urine.

Patient indeed did not compl. of greater desire to pass it than nat.

But colour obs to be consid chang.

So much deepned in colour that accord to descript some susp. even that might cont. mixt of blood.

With this change in app. more scanty than natur.

And disch not affected without som pain. – Partic in passing last drops

From all these circum taken togth thought that ground to presume that that disease prin an affect of urin organs.

And that depended on action of calculus or sand.

Had not indeed in this case what could be consid as all sympt of Nephrit. calcul.

Though pain in course of ureters yet not attended with retract of test which common often occurs.

And here no vomiting which a sympt still more freq.

Besides this not affected with [cons] inclin to disch urine.

But although these sympt so often occurr that have in gener. enterd defin of disease yet can by no means be consid as essent.

And often what afterw. [turns] out dist markd inst of this affect, attended with all worst sympt, for long time without any such app. with fewer app of disease than here occurr.

Imag. therefore that at least [safest] pract to use such gentle remed as might be useful on that footing.

And hoped that by these affect might soon be mitig if not entirely remov

For upon suppos of affect being nephrit had every reason to conclud that would not be severe case.

Of this strong ground for presump from sympt themselves.

Still stronger from having already contin for space of ten days without any aggrav.

From these circum concl. that irritat to urin passages did not arise from any powerful stim cause

And supposed it to be rather effect of sand than of calcul.

Hoped therefore that might be removed merely by encr. of quant of urine.

To this pract indeed in some cases of calcul strong obj.

Where by calcul. total obstr to passage of urine must aggrav all sympt

Here however though some pain in disch. yet had regul taken place at usual intervals.

And this pain, as well as high colour, was disp to attrib. more to scarcity of separ. than to any other cause.

For when this the case very gener. saline impregn & conseq. acrim very much encr.

On this ground therefore some of most distress. sympt to be expl. whether scarcity of disch from cal or not.

Hence then was natural indic for use of those med which would augm secret.

Was with this intent that directed for patient the Spt. Nitri dulc.

This as have often had occas to observe consid to be one of best diuret. with which am acquainted.

Do not indeed look upon it to be one of most powerf. for giving very cop disch.

Yet oper. more exped than any of these as giving immed disch.

While at same time, for my own part at least have never obs. from it any inconven as affect stom.

Hence then to such inst as pres pecul. suited.

And wherever urine to be prom in nephrit affect. is I think pref. to any other.

Has in this way some effect even when given in small doses.

And in some habits obv operat even from ten or 12 drops.

May however be given to much greater extent without any inconven.

And not unfreq empl. to quant even of two drams or upwards in course of day.

But always inadvis at least to begin with such doses.

And from half the quant. have often seen equally good effects.

Partic if at same time operat prom by any gentle diluent.

Here therfore began by direct it to extent of thirty drops twic a day.

And to aid influ directed as [dilu] an infus of Junip.

Which even by itself has in this way no inconsid effect.

From use of these med were not disapp.

For while prod of no incon or uneas at stom quant. of urine obs. consid encr.

With this as might natur. indeed have been expected colour also changd

Now became much less red than former

And what still more agreeable [disch] attended with less pain.

Still howver compl. of pain in course of Ureters.

But in every other respect sympt much easier.

Relief therefore already receivd not less than contin of some sympt both ind. to contin

Directed therfore that should persist in use for anoth week.

And at end of this period no more remain sympt, of any affect of urin organs.

Was not however entirely free from all compl.

For now compl of consid pain in back.

This however higher seated than region of kidney.

And as well as pain of hypochond had formerly been was agrav by extr touch.

Was inclind therfore to consid it as of Rheum kind

This the more probab from state of affect at time of attack.

For then all pains prin seated in larger joints.

These had formerly been removed by frict. with Camph. oil

Now therfore had recourse to an applic nearly simil.

viz Anod Bals.

This as had lately occas to obs. consists in Camph. dissolvd in Spr of wine.

But with addit of consid prop of opium.

From this no doubt that immed influ in allaying pain much more consid.

Hoped therefore that might soon be prod of consid relief.

But besides pain of back at this time anoth partic also claim atten.

viz. Bound state of belly.

With view of obv. this sympt had recourse to aloes.

And as most affect means of obt merely effect wanted empl. these in subs. under form of pills.

And in place of simple aloet pill had here recourse to what call pil foetid cum Aloe.

These from addit of prop of Assafo more influ as disch wind.

From which although no cert [illegible] of it reason to pres. that might in some degree depend.

For no doubt that wind in intest canal often cause of pain both in belly & back.

And at any rate this addit would in no degree counteract influ of aloes as obv. costiv.

On contr. has manif tend to prod same effect.

Accord in operat expected from it were not disapp.

For from these pills taken to extent of gr V at bed time, had regul disch by belly.

Expect however from anod Balsm not so fully answ.

For notwith regul. use pains still contin.

These however not so urgent as to indic necess. of having recourse to any other pract.

Was therfore contented, with direct contin of pills & Bals. as before.

In place however of mitig, at next report found this part of affect rather aggrav.

While at same time from exten to shoulder had still strong evid that was of Rheum kind.

In place therfore of anod balsm now substit. as stim & [illegible] the use of the Volat. Linim.

And as belly no tolerab. regul. without any evid that pain aggrav. by wind interm use of pills.

Princip that from long contin habit might not become alway necess

For to be observd that after intest for some time accust. to such stim due perist. motion will not take place without it.

Under use of Lin. Volat. pain somewhat abated.

In so much that at succeed report was prin seated in left should.

Since that however for two weeks past have seen nothing of this patient.

But informd that has been conf. to house from aggrav. of pains.

If therfore returns to attend here shall prob. have occas to treat his case merely as Rheum.

And must own that from this termin of case as well as commen, now begin to susp, that even affect of disch of urine, may have proceed entirely from Rheum.

But even of this suppos. still I think affords evid of advant of gentle diuret in such cases.