DEP/DUA/1/12/05 (Normalised version)

Thomas Fairn

(1776-1777)

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Thomas Fairn

Disease of this patient evidently of complicated nature

And complication too in several respects of worst kind

For affections conjoined of such nature that neither one nor other readily removed.

Disease most urgent to patient Ischuria.

When occurs attended with violent pain in Hypogastric region

Would argue that of kind to be distinguished by title of vesicalis.

At same time also little doubt as to cause

So much attended with symptoms of calculus that patient oftener than once sounded.

As nothing found may presume that does not depend to large calculus.

While at same time discharge of sand can leave no room to doubt that is affection of such a matter.

And little hesitation in referring it to obstruction at neck of bladder from sand.

Probably however more in consequence of space induced by irritation than as blocking up passage.

May indeed perhaps occur as possible supposition that another disease with which patient affected some concern as inducing this.

This patient affected with no less than two inguinal hernia.

Little reason to imagine that these would of themselves give compression to bladder.

But may be connected with other diseased states of intestines.

And well known that from compression often obstruction to discharge of urine.

Yet little grounds for suspecting such a cause in present case.

Otherwise ischuria a constant & uniform affection

On contrary here often considerable remissions.

Besides did not begin so early as from this cause would have done.

For hernia preceded Ischuria even for years.

May conclude therefore the two diseases unconnected.

And as far as either one or other objectives of practice require different treatments

But besides these still a third affection

And one too no less distressing than other

Viz. Catarrhal affection.

Has indeed we may say been principal part of complaint since came under our care

And manifestly of chronic kind.

Presume that may in some measure serve to aggravate the others.

Yet to be considered as totally unconnected with these

And by no means depending upon them as cause

Thus then present patient subjected to a complication of affections

And of such nature too that can by no means pronounce favourable prognosis.

For all if not fatal at least tedious complaints.

And patient in many respects in unfavourable circumstances.

Already at advanced period of life.

Has passed his 60^th year.

And in point of constitution every appearance of being much older

None of complaints of recent date.

Most have already continued even for years.

And probably contributed not a little to bringing constitution to state in which at present is.

Now therefore little hopes of recovery.

And perhaps even but faint expectation of much alleviation of complaint

In treatment first objectives whether are to attempt to remedy every part of complaint.

And what particular parts claim first attention.

Here may observe that Hernia of longest continuation

And perhaps after duration which have already had with such a patient as present may be reckoned incurable.

Besides this gives no inconvenience.

These therefore have not hitherto reckoned an objective & practice

And intention solely directed to cough & affection of urine.

In obviating first should here be disposed to follow same general principles as mentioned in other cases

1 To unload breast of mucus already excreted

2. To restrain farther morbid secretion by diminishing determination to breast.

In prosecuting these measures here however somewhat restrained.

Thus for example with view of unloading breast could not with freedom employ emetics.

As from agitation danger of increasing hernia

Chief endeavour therefore with view to catarrh on second principle.

And with this intention have aimed at determination from breast by issue.

Have likewise in some measure had same end in view by other medicines employed.

Particularly different diuretics.

But while these gave determination from breast expected also some benefit on other principles.

For here besides cough state of urine became another object of attention.

On supposition already given evident that cure to be effected on two principles.

viz By dissolving sand already generated &

By preventing farther generation.

Both one & other however ends perhaps unattainable

Many medicines indeed held forth at times as solution of calculi Particularly in Urinary passages.

In so much that supposed to constitute a class known by title of Lithontriptic.

Would not pretend to say that no such medicine exists

Or even that not already discovered.

May however venture to say that have never found any evidence of such power in most celebrated of these

On this account therefore thought rather of attempting expulsion of sand than [solutition].

And this imagined might be affected by increasing quantity of urine.

Was with this view that had recourse to nitrous powders.

At same time conjoined with Gum Arabic.

Which from being thrown off by excretion of urine might serve to sheath acrid matters.

While however took this measure for getting rid of sand already generated wished also to do something with view of preventing farther generation.

And apprehend that is on this principle alone that any Lithontriptic hitherto introduced have operated.

In this manner of service even in cases of confirmed calculus.

Certain that by use symptoms before urgent much mitigated

And that this relief attended with change in state of urine.

Before deposited calcareous sediment in considerable quantity becomes of natural appearance.

By how many medicines such a change may be affected cannot pretend to say.

Appears however proportion of some of absorbent nature example Lime water, Caustic Alkali

And from late observations of an ingenious physician in London also of mild alkali.

At least has found that from these similar changes induced in state of urine.

Presume therefore that will have same affect against calcareous complaints.

But besides absorbing would seem also properties of astringent

At least from late observations contended that is the properties of Uvi Ursi.

And in present case reckoned trial of this preferable to others.

As not only adapted to calcareous affections but also wished to observe affect on cough.

Thought that astringent qualities might have some tendencies to diminish secretion.

And while other means at same time followed, without any bad affects.

These then general principles on which have heretofore attempted alleviation of this complaint.

And will sufficiently explain meaning which have had in view from different medicines used.

From these must allow that have hitherto reaped very little advantage.

And at same time own that do not know what to be tried with greater probability of success.

Yet after all must observe that very little prospect either of removing or even alleviating complaint.