DEP/DUA/1/23/21 (Normalised version)

James Cairns

(1780)

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James Cairns.

Case appears to me less difficult than shall probably find it both troublesome & obstinate.

At the same time however is by no means without doubt.

Pains of [loins] shooting toward Coccyx & down thigh, which constitute great part of it, occur in many different affections

But when to these add bloody appearance often observed in urine, & indeed large discharge of blood, by urinary passages, have great reason to presume that is an affection of kidney.

And that to be considered as an instance of Haematuria.

Haemorrhage from this organ either of active or passive kind.

When of former however for most part occurs with those in early life & of plethoric habit.

But case of our patient occurs in very contrary circumstance.

Hence then reason to conclude it of passive kind.

And this rendered the rather probable both by pain with which attended, & by accident to which attributed.

For according to account, first arose from severe sprain of parts.

And to this also probably to [arousing] bloody vomiting, with which at times affected.

With this view of nature of affection to which patient subjected could not look for expedient cure.

For no medicine by which can expect to exert immediate, & certain action on viscus so much out of reach as kidneys.

At same time however patient without any alarming symptoms.

And unless in consequence of sudden change in affection no reason I think to dread immediate danger.

Here I think great objective in cure is restoration of due vigour to [ruptured] vessels.

And for this purpose might here I think employ astringents both from vegetable & mineral kingdom.

And perhaps in future treatment of this case, now transferred to Dispensary latter may be employed.

Thought it however more advisable to begin with former.

Because if more gentle in nature, exposed to less hazard from sudden check to discharge.

Among the vegetables many possess astringency to very great degree.

Here however made choice of the Uva Ursi.

A vegetable which has but lately obtained place in Materia Medica¹.

And which on first introduction as will observe by experience of Dr De Haen, was celebrated for a very different purpose.

Cure viz of Calculus.

Or at least as means of alleviating pain arising from calculus although cause should still remain.

In these cases, may venture to say, has by no means been found to answer expectations.

Yet from frequent employment of it in such, many led to think that of service against ulceration, & similar affections of Urinary passage

This I think have in more than one instance [seen] confirmed by my own experience.

And accordingly led to trial in present instance.

Cannot however say that here any considerable benefit as yet derived from it.

And from tendency to bind belly obliged to have recourse to Cream of Tartar as means of obviating costiveness

This has in some degree at least had desired affect

And patient in such situation at last report, that reason to hope for best effects from continuation.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).