DEP/DUA/1/35/06 (Transcript version)

David Shiels

(1784)

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David Shiels May 29^th.

Disease of this patient consists of but very few sympt.

And of these that most distress to him is pain of back.

This in such a situat that may be supposed to proceed from differ. partic. causes.

And partic may either origin from deep seated musc affect or from affect of the ureters.

Is in support of former suppos. that so much aggrav. on motion.

While in fav of latter may be [urged], that attended with affect in disch of urine.

But again to be remarkd that Nephrit pain often aggrav by motion while from musc pain disch of urine affected

These circum of themselves therfore not suffic to lead to any pos. conclus.

And diffic still encr. when contrasted against each other.

While at same time, in other partic of case, see nothing which can lead us, to pos, or even prob. conclus.

Upon whole however rather disp. to susp. that this pain arises from affect of ureters.

Besides the partic already ment. may also remark as in fav of this suppos, course which takes down the thigh.

And still more the app of the urine itself.

For on examin, have found it to contain a consid prop of sand.

To these circum may add still anoth drawn from treatm to which patient has been subjected.

On idea of pain being musc. several remed had already been tried in this case before patient came under our care

And partic both blister & [strengh] plaster.

But notwith use of these affect contin to encrease in viol.

Upon whole then disposed to view this as being a neph. affect.

And as originat. from calcul or sand in urin passages.

From this idea of disease, could not be disp to form a fav. progn.

For calcul affect, if not freq. fatal well known to be among the most danger & obstin.

And partic so when seated beyond bladder.

For although sand or small stones disch yet tenden to [regenerat] contin.

In so much that patients once to high degree affected with them often more or less victims to affect during whole course of life.

This therefore if conject as to pres affect well founded, with a man already past his 50^th year, which is case with our pat. may not improb. to take place

But even if such should be the conclus. yet still no reason to think, that pres attack will be of so long contin.

Does not app, with any very alarm sympt, either of severe pain ischuria, or the like.

Hence then may hope that this fit of affect at least will in no long time be termin.

And partic, if natural tenden to termin, aided by prop remed.

In this affect remed empl. howev must be very much accomod to circum of case.

Where any consid degree of inflam excited in urin organs becomes a first & princip obj to allay this

Where severe vomiting or total suppress of urine these sympt claim partic attent.

But in general great object the removal of irrit. cause whether depend on calcul. or sand.

Was chiefly at least with this intent that had here recourse to the remedy at first directed.

Use viz of compound powder of Crem of Tart.

This need hardly obs. consists of two parts of Crem of Tart & one of Jallap united to [Flore] of Sulph

And has very gener. the effect of operat both as purgat & diuret.

Especially when given in [moder] doses so that not hurried through alim canal by brisk catharsis.

Here however given only to extent of ℥i in day. in which cont. Jii of Crem of Tart & one of Jallap.

Which with common run of mankind at least but small dose for an adult.

Here however hoped that might have so much effect in increas urine, as to prom disch of sand.

And at same time so much influ as cathart, as to prev. the occurr of inflam, or remove what had already taken place.

In obv. operat at least of this med were not disapp.

For had effect both of gently moving belly & of encr. quant of urine

Still however pain contin severe, & little change on app. of urine.

Thought it requis therefore with view to former latter circum. that quantity of urine should be still farther encr.

And with view to former, that should have recourse to some anod applic.

With these intent directed contin of Crem of Tart as before

And at same time enjoind also the liberal use of diluent [drin]

But besides these as means of allaying pain had recourse to Linim anod.

Which whether affect muscul or not from sedat influ exerted on neighb parts, expected would have had some influ effect.

Accord. from use some mitig seems to have been obt.

For not only followed by relief of pain, but with encr. appetite & better rest during the night.

Still however affect of urine contin nearly as before.

And disch of consid quant of sand still obv.

But from this latter circum may remark, that not much to be inferrd.

For some with whom such disch becomes as it were habit.

And often in worst health when wanting

If therefore diffic of disch & pain of back removed shall reckon it [illegible] for him to contin on this acct alone

And this I now hope may for pres at least soon be the case without empl. of any other med than already directed.

But if affect contin obstin have intent of trying with this patient the Vitriol acid or the mild alk.

Princip with view of observ. how far have any influ in altering state of urine disch.

Here also lime water, [illegible] water & various other remd directd in calcul cases.

But in employ. of these [must] be entirely directed by circum in which shall find patient after use of remed already begun