DEP/DUA/1/33/12 (Transcript version)

Robert Yeats

1783

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Robt Yeats. Decr 7^th 1783.

Respecting disease of this patien must own am not without diffic.

Most urgent sympt pain in back or rather right haunch.

This well known may proceed from very diff causes.

And in case before us from situat, as well as some other circum, ground for conject, that may in part at least depend on a Rheum affect.

Partic from aggrav. by heat of bed.

A cause by which in cert states of Rheumat. well known that pain [augm]

But if some partic in fav of Rheum others arguing an affect of more serious nature. This partic the case with respect to disch of urine.

Especially where those having Calcul there subj to any viol. exert. or uncom motion by which [stone] injures tend parts And such a cause our pat assigns as having induced his affect.

For not only uncomm inclin to disch but urine also with uncom app.

Have evid marks of tinge of blood. Here therefore would naturally susp. that both pain & bloody urine from same cause.

And a cause which well known often operates as prod both at same time is Calc in kidney.

>+

Here however to be obs. that many sympt. of Calc in kidney wanting.

Partic affect of stomach.

For very generally at least attended with severe vomiting.

In most cases also stupor of thigh & retract of testic are its attendants.

With these sympt however as far as can learn pres. patient has never been affected.

And what still more, though mixt of blood in urine yet no sand discov.

Notwith these diffic however reckon suppos of Calc. the most probab.

And disp to consider it as example of Nephrit, or if to design it from app of urine of Haemat. Calcul.

If this the case cannot pretend to assert that affect without danger.

Calcul. may yet be of such size as to pass into bladder or even be compleat disch from body.

But on other hand may excite inflamm, ischuria, or even supp. having fatal conclus.

But if on suppos of truth of this conject must deliver doubtful opin, still more reason to be [guard] when considr uncert. of case.

May indeed be much slighter than we imagine it.

But must obs. that in pres stat considr patient as by no means free from danger.

And if in pres. situat an unfav. event should even suddenly occur would neither be unexpect nor surpr.

Hope however that disease even if left to itself will not take such unfav. turn.

And have expect. that may be able to do somewhat towards his relief.

Cannot however say that has derivd much benef from remed hitherto empl.

When came first under our care one of most urgent sympt costiveness.

Imagind that by obv. this some benefite might be obt in relief of pain.

And that by empl as a purgat an artic which has also effect as encr. urin disch matters lodged in passag. might be disch.

Was on this acct that had recourse to the Cream of Tart

But that might ensure purgat effect added to it a small propor of Jallap.

But with sever of pain, & grounds for suspect that local inflam. might occurr, could empl. stim cathart only to small extent.

This powder had at first so far the desired effect.

While sat easily on stom had [some] effect also in opening belly.

But prod no change either on pain or on state of urine.

In this situat with contin of remedy had recourse also to Powder of Uv Ursi

An artic for introd of which into pract are indebted to Dr De Haen.

And although by no means that powerful artic in Calc cases which he repres. yet in diff affect of urin passages am inclind to think it of great use.

And here whethr conject as to calcul well founded or not yet might expect some benef from it.

For little doubt that from some cause or other urin organs so far in diseased state

And whether this excited merely by injury from over straining as he himslf susp. or from that excess action havin greater effect in conseq of calcul. immat.

Still diseased state in urin organ which if not already landed in supp. at least with tenden to it, to be over come

And this hoped might be effected by proper course of Uv Ursi.

When first began use gave some uneasin at stom.

This however imagind by slight habit might be over come

And although had not immed good effect yet hoped for it from contin

As found however that from contin of Cream of Tartar belly not kept open to this substit. Pil. ex Colocynth cum Aloe

And as pain still contin severe directed extern frict to part with Anod. balsam.

From all these however expect disapp.

For powders in place of sitting more easily on stomach occasioned greatr uneasiness.

While costiv in no degree obv. by pills

And notwith. use of Anod Balsam pain contin as before.

In this situat was himself desir of intermitting all med for some time.

And must own was for my own part by no means averse to the prop.

On some occas indeed must be allowed that patients hurt by neglect or delay of prop remed.

But perhaps no less freq. the case that injury from doing too much.

And partic where doubt as to nature of disease.

Interm therfore all other med, merly directed use of Domest. inject.

From which while hoped that would open belly expected also some benef as intern inflamm. fomentation.

In both these howevr were disap.

A circum not to be wondered at when consider that were not retaind.

To these therfore as consid disch by belly to be essent necess substit use of lenit elect.

With no other view however than that of procur necess. disch.

During interval however from use of med patient has contin very much in same state as before.

While pain nothing dimin urine has still same bloody tinge as before

Have thoughts therfore of having again recourse to some pract at least as palliat.

And while with view of abating pain mean to try opiates, with that of restraining bloody disch may have recourse to astring.

Partic to vitriol acid, from which on suppos even of calcul something perhaps may be expected.

But in case of such urgency as pres. can hardly lay down any fixd plan of cure with much confid of following it out.

For future pract must be very much directed by state of occurr at the time.