DEP/DUA/1/39/34 (Transcript version)

George Pringle

(1785-1786)

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George Pringle April. 8^th

In case of this patient an examp of a disease not freq. occurr.

But which when does occur very gener of obstin & distress. nat

In history of his case a variety of sympt are ment.

But that which by most remark is the discharge which takes place by urin organs.

Urine in gener. both high colord & scanty.

But this disch more remark [affecn] as at times cont. a consid quant large proport of blood diff in it

And on some occas even disch of consid quant of pure blood.

Which as may readily be supp. when coagul. not passd without great pain.

Little doubt that to this disch many of other sympt to which he is subj are to be ascribd.

Partic headach, flatul, impaired app. thirst, gener. debilit &e.

Indeed, no sympt in history, which may not be consid, as com. attend of disease except. bloody [stool]

This we are told has at times occurrd with him.

This sympt however, in any case of simil nature, before falling under my care, have not obs.

Nor do I remark, that in gener. at least ment, by those giving hist of disease.

Is indeed true, that among other causes, has in some cases been obs to altern. with haemorrh. affect.

And accord. one species of the disease, disting by Sauv by title of Haem [Haemm].

And where this the case, that disch of blood, should take place both by faeces & urine, cannot seem strange.

But that our patient subj to this species, is I think very improb.

For as far as can learn, has not at any former period of life been subj to Haemorrh. affect.

And severe pain attending it, so high seated, that would natural. suppose blood afforded from diff. source

While therefore, must consider this, as more a pecul sympt. & to be expl. from some other cause, are natural led to more import inquir. species viz of Haematur. to which pres pat subj.

Or rather particul cause induce disch of blood & partic source from when furnishd.

In syst of Mr Sauv. no less than 15 species referrd to this genus.

And in all these, have at least gener. sympt of bloody urine, as induced by diff accid, & proceeding from diff sources.

Here bloody disch may arise either from kidneys, ureter, or bladder.

Nay in some cases even from the Urethra.

As for examp. in these inst, which [stile] Haemat. Stillatitia & Ejaculat.

But here, from seat of severe pain, in region of kidneys, as well as from dimin of secret of urine, have every reason to believe, that from kidney.

And am inclind to think that with greatest probab. at least, may be referrd either to Haemat [calcu] or Violenta of Sauv.

May be consid as much in fav of first suppos. that, with urine, a consid quantity of sand, often obs. to be disch.

While again, somewhat in fav of last, that attrib his disease, to overexert.

But these two causes as induc this affect, may I think with great prop. be conj.

No doubt that of all causes induc haematur. calcul or sand in kidneys the most common.

And also certain that where these exist any quick motion or overexert very apt to prod more consid affects.

Thus many having calcul in kidneys, with whom riding on horseback const. conseq followed by bloody [urine]

And where kidneys in conseq. of any accid brought to diseased state seemd when separ. must act with great viol.

And this I own conject which was disp. to entert, with regard to affect of this patient.

Had certain evid of separat of calcul. matter from urine in conseq of evid manif disch of sand.

Imagind that this capab. of prod bloody urine, in conseq of diseasd state, having been induced in kidn. by causes ment, fatigue & over exert.

And that from separat of blood, as well as from action of sand itself, all the other sympt to be expl.

With this view of disease, could have no very fav. opin as to term.

Morbid condit on kidney when induced, very diff removed.

And no less so to remove what may be calld calcul. [diath]

That is, secret on such urine as cont & separ. large prop of cal. mat

But of prognos here, now unnes for us to offer any remarks.

For departure of pat. for country prev from being any longer subj of treatm.

And now very little chance of even accid learning any thing respect termin of case.

Shall therefore concl. remarks with few obs. on pract. empl. during course of attend.

This pat. while under our care, treated you will obs; almost entirely with one remedy viz Uv. Ursi.

This artic I need hardly obs. introd some years ago, on recomm of Dr De Haen of Vienna as a remed in calcul.

From his works will obs. recom it as a remed capab. of dissolv calc.

Besides which considers it also as a remed capab. of prod change in state of urine & allev pain though calcul. still remains.

Of affect in former way, now very great reason, to entert doubts.

Nay I believe now hardly any one, who consid it as having any influ in dissolv. calcul.

But for affect in latter way there are at least more adher.

And not a few cases have occurd where, under use, sympt from calcul before severe very consid allev.

If however thus advant. has been still more so in some other affect of urin passag.

In cases, where even consid [ulcer] of these, sometimes manif advant.

And in former inst of Haematur. have I think empl it with benef.

On this ground then led to trial in pres. inst.

Begun by direct it to extent of Teaspoonf. twice a day.

And as from this no uneasin at stom soon afterw. ordered dose to be doubled.

For some time after begun use no disch of blood with urine.

And what might be held as still farther good sympt. urine less high coloured.

This however, could not with any degree of confid, attrib to remed empl.

For such changes every day occurr without any remed.

And what evid shewed that dis by no means removed, was contin of pain of back & scanty disch of urine.

Under empl. of uv. ursi, became affected with bound state of bely.

For obv. this, had recourse to Cream of Tartar.

Which while laxat. also well known to be in gener. powerf. diur.

Although however had affect of opening belly, in latter way little influence.

And while empl. these remed in conjunct, with encr. of pain of back, had again return, of disch, of consid quantity of clotted blood with urine.

In this situat, express [desir] of going to his friends in country.

And had I own no such high expect of his being benef by contin here, as to lead us to dissuade him from it.

Accord, as already obs. now removed at such distance from Ednr, that shall prob. learn nothing farther respect him.