DEP/DUA/1/15/07 (Normalised version)

John Thomas

(1777-1778)

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John Thomas.

Complaint of this patient very simple in nature.

And here while no complication of disease no room for doubt respecting cause

When came under our care only symptom involved discharge of urine.

This however perfectly of passive nature

Did not arise in consequence of any [action] contrary to inclination.

But merely effect of want of power of retention.

This sufficiently evidenced from having taken place only during day.

That is while from erect posture weight of urine in bladder operated as cause producing discharge.

Returned during night as then from horizontal posture would as readily remain in bladder as any where else.

And then of red colour as by absorbing watery parts carried off.

This here traced to particular cause.

And one too with regard to which can be no doubt.

That is operation of Lithotomy.

About 11 years ago patient had a very large stone extracted from bladder

And since that has been constantly [affected] with this complaint.

When large stone to be extracted present affection will occur without any fault on part of operator.

And evidently to be ascribed to injury to bladder & muscles in consequence of size of hard body to be removed.

Such then had been case with present patient.

And in [consequence] find him subjected to this disease which had continued with him for space already mentioned viz 11 years

During this period various remedies tried under direction of able practitioners.

And when consider that is a disease in many cases incurable must own that did not entertain favourable expectations.

Took it for granted that should dismiss patient no better than when came under care.

Yet imagined that without prejudice some trials might be made not commonly put in practice.

And was merely to have opportunity of observing whether these would have any effect that thought of taking this patient under care

Now must own have changed sentiments respecting prognosis.

And at present flatter myself with hopes that shall be able to bring about if not complete cure at least very considerable relief.

Such indeed patient has already received.

And do not see any particular reason for dreading that will not be permanent

If this the case have at least freed patient from a very great inconvenience.

And have introduced a practice, which have never seen tried & which although may possibly have been used by others have never heard of.

In all such affections great objective in cure must be restoring proper power to [sphincter] vesicae

And where does not arise from actual destruction of organ may be attempted on two principles.

By increasing vigour either as simple or as animated solid.

And that either by immediate action on affected part or by action on system in general.

May readily suppose that different means of obtaining these ends had been tried by practitioners under whose care patient before [was].

And particularly that had employed the various astringents & tonics commonly in use against such affections.

In this situation then had nothing to expect from remedies in common practice

By this determined to try what could here reap from electricity as a tonic.

Of action of this remedy which with me I own a favourable one shall have occasion to speak in next case that viz of John Lenin.

May here only observe that hopes of success founded on principles which have elsewhere endeavoured to establish.

That tonic power viz the effect of irritability in consequence of which from ordinary stimulating causes to which muscles subjected constant tendency to contract.

By augmenting this disposition then expected additional force of contraction.

Irritability again unless in as far as is affect of [struct] considered immediately to depend on nervous powers.

And know nothing more effectively increasing nervous influence than electricity.

This does as augmenting general mobility from general action on secretion of nervous fluid

But more especially effect at particular parts when sparks drawn from thence.

As by action on extremity of nerves influence communicated to particular part of brain

And thus probably change in secretion from thence independent of whole.

For hold brain to be not merely one but a collection of secreting organs.

Thus then expected that by means of it might perhaps increase vital power in sphincter vesicae

How far this reasoning well founded may with many be matter of doubt.

Is not however to be denied that has been attended with desired effects.

And unless from return of complaint shall not think either of altering present plan of cure or of having recourse to any other remedy

If patient gets entirely rid of his complaint may perhaps soon dismiss him.

But if continues to have any remaining shall still persist in use of electricity.

Unless perhaps may think it advisable to omit all remedies for short time that may see how does without them.

If obliged to have recourse to any other remedies will probably be trial of cold bathing.

But shall I own be much better pleased if can dismiss patient without it & would fain hope may be the case.