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Mr. K––––s Case ––

Mr K ag'd about 30 is of a spare
habit of body – inherits the gouty dia¬
thesis from both of his parent – & seems
to be of that temperament describ'd
by Boerhaave under the title of tem¬
peries biliosa. ¹ The first commence¬
ment of his ill health was in ye. year
64 – and ye. most obvious source ↑of↑ it was an
obstinate intermittent, which seiz'd him
while at school at an academy in Dub¬
lin – A dry cough attended with some
pain of ye. right side – a remarkable sal¬
lowness of complexion – loss of appetite
& emaciation were ye. sequels of it. He
pass'd ye. winter of ye. year 66 in Glasgow,
where he had a severe Angina. The cough
& pain of his side still subsisted, & he
was subject to frequent complts. of his sto¬
mach & head – wch. were usually appeas'd

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or terminated by more or less of a vomit¬
ing of bilious matter. His appetite – di¬
gestion & spirits were now much impair¬
ed, & he was most commonly costive.
Some aperients & deobstruent medicines
were prescrib'd for him here & he was
recommended exercise on horseback &
change of air. I had no opportunity of
seeing him again 'till ye. year 74 in Dub¬
lin – whither the encrease of his former
complaints (from which he never experi¬
enced a total freedom) with ye. addition
of some others – such as universal debi¬
lity – tremors, languors & wandering
pains of his body & limbs determin'd
him to goe for ye. sake of consulting ye.
physicians of eminence. I did not learn
precisely what their ideas were of ye. na¬
ture of his ailments, but concluded
from ye. medicines employ'd by 'em (wch.
were chiefly of ye. tonic & antispasmodic
class) that they consider'd 'em as prin¬

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cipally depending on a universally weak
& irritable state of ye. nervous system.
Be this as it may, very little permant.
change was wrought by 'em, & in about
a year and a half after I was applied to, &
found his already discrib'd complaints
aggravated by ye. addition of an almost
incessant involuntary seminal effu¬
sion, accompanied with vast debility –
sense of lassitude, pain & weakness of ye.
small of ye. back, & very frequently also,
with [dead?] pain, torpor, & sense of weight –
& coldness in ye. back of ye. head. He
complain'd much at times of stricture
& pain extending from his right side
across his stomach. These affections
did not preserve any uniform tenour –
but became at times as considerable
as to oblige him to keep to bed for a day
or two – during which time he was to¬
tally enervated, & destitute of appetite
& spirits, had flying pains all over &

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thro' him, and an insuperable listless¬
ness, and aversion from every exertion
whatsoever of mind & body – Mr K:
led usually an active life, & very rarely
committed excesses of any kind – except
in point of violent exercise on horseback
being exceedingly given to fox hunting.
My treatment of him was in general
address'd to ye. obviating the universal
debility, & atonia of his nervous system
& ye. particular one of his stomach & di¬
gestive organs – while in ye. meantime
particular attention was paid to the
special relax'd & irritable state of his
seminal organs, and as some suspicion
occurr'd that his liver & biliary passa¬
ges were somewhat obstructed – I occa¬
sionally directed such medicines as
are reputed to act in removing obstruct¬
ions of these organs, and may at the
same time keep his belly is a proper¬
ly soluble state. With a view to ac¬

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complish ye. first of these ends he took
from time to time various forms of ye.
Cortex with bitters, & astringents, & also
several medicines of ye. nervous: seda¬
tive & antispasmodic kind – such as
Æther, Castor, Valerian, Musk, Elix¬
ir paregor. join'd with the Tinct. Castor. c.
& Spir. vol. fœtid. and ye. fœtid gums –
which for ye. last purpose were combi¬
ned with soap, Aloes Socotorin. Rhu¬
barb, Gum. Ammon.Ammoniac &c – To assist to¬
wards ye. same end, He tried a plaister
of ye. Epithem. vol. & then one compos'd
of p.a. ye. Emplastr. ex Ammon. cum
Mercur. & ye. Emplastr. gummos. to ye.
pain'd side – Fomentations & Embroca¬
tions were also employ'd – For ye. semi¬
nal weakness particularly, he took
the bark in substance with allum
& Sal. Mart., and on ye. presumption
of it's great astringency, I was willing
to give ye. Tinctur. e gummi Kino Ph:

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Edinb. 2 a tryal, but it disagreeing wth.
his stomach, he was oblig'd to discont¬
inue it before any judment of it's ef¬
ficacy cou'd be form'd – Gentle exercise
cold bathing, a light nutritive & resto¬
rative regimen, ye. use of Spa water &
red wine accompanied this course, &
he was enjoin'd a total abstinence from
tea & all relaxants, & sedatives. Such
as much intercourse with his wife –
laborious & fatiguing exercises of body
& mind, soft beds, warm & crowded
rooms &c – Finding at length that his
complaints were little dispos'd to give
way to these & other means employ'd at
different times for his relief, & suspect¬
ing partly from his hæreditary predis¬
position, but especially from my ob¬
serving latterally yt. ye. affections of
his head & stomach alternated with
those of his limbs – that a latent gou¬
ty seminium may have some share

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in ye. production of his complaints, I
concurr'd with his friends in advising
him a trip to Bath – He accordingly
passed ye. greatest part of ye. last sum¬
mer there, & drank ye. waters under the
direction of a physician. For some
time after he commenc'd their use, he
experienc'd some good effects, especially
an improvemt. of his appetite – digesti¬
on & spirits – but latterally they disa¬
greed with him much. He consulted
during his stay in England – Doct. De
la Cour of Bath, and Doctors Jebb &
Warren of London, who order'd some
medicines, principally of ye. tonic &
stomachick kind for him – and advi¬
sed him to use saltwater bathing.
He has try'd ye. latter for some weeks
past, but not regularly or constant¬
ly – and he is now taking by my direct¬
tions, some pills compos'd of Extract.
Cort. Peruv. –––– Gentian, Olibanum

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Rhabarb. Turcic. & Sal. Mart. for
his gleet – But I do not hear yt. with
this – or ↑his↑ other complaints are material¬
ly affected by either ––