DEP/DUA/1/25/04 (Normalised version)

John Frazer

(1780-1781)

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John Frazer.

Disease consists of but few symptoms.

Even by these however disease sufficiently marked

No doubt that affection Gonorrhoea.

Here all the symptoms in general attendant on disease in slight cases.

And none present, which not frequently occurring in that affection.

Disease also but of recent date

And distinctly traced to cause from which Gonorrhoea arises viz Infection.

Can be no doubt then that here example of Venereal Gonorrhoea

An affection which am inclined to consider as depending on a matter [illegible] [general]

And even as essential [difference] from another Venereal infection that viz of Syphilis

Of this subject shall have occasion to speak more fully in practical course

And indeed sentiments published at full length Medical cases selected from records of Dispensary¹

Do not pretend that all have been able to say has gained many [converts].

And must allow that many circumstances render a doubtful matter.

But may still observe that those who most strenuously contend that diseases the same, yet act both in Prognosis & Practice as if were different.

For unquestionable that no practitioner gives [as] judgement to event, & or directs same treatment in Gonorrhoea as in Syphilis

In instance before us considering it as simple venereal Gonorrhoea may pronounce it free from danger.

And after subsisted for eight days without distressing symptoms may conclude that will be slight case

At least strong presumption of such unless in consequence of improper management on part of patient.

But how far attention bestowed on own [part] cannot pretend to say.

Rather I think reason to presume will be wanting.

At least this may infer from irregularity since applied for assistance here.

For have of late seen nothing of him

Hence then observations on prognosis in good measure superseded.

May only observe that although attendance had been continued with greatest regularity although should have expected [slight] effect, yet could not have promised very expedient cure.

For inclined to think that have even more in our power artificial termination of Syphilis, than of Gonorrhoea.

At least in slighter cases of [these] affections.

In cases indeed of confirmed Lues cure very tedious matter & often disease not without danger.

But in slight cases by aid of Mercury in general speedy termination.

This however does not happen with respect to Gonorrhoea.

For although virulence overcome yet running will often remain.

And that too, not less frequent when disease slight, than when appears under more violent form.

This mention only by way of caution in prognosis in Gonorrhoea.

Is a circumstance which every practitioner should have in view in giving opinion to patient as to termination.

Particularly necessary with those who practice in warm climates.

For there much more than here disease apt to run on to great length

In so much that surgeons can depend on more expedient cure of worst Syphilis than of slightest Gonorrhoea.

What however may be, or has been termination of present case, unless from accident, shall not be able to learn.

And patient so short time under care that little grounds for practical observations.

May in general however remark, that at period of disease when came under our care too late to attempt anything by way of prevention.

Here consider disease as already well advanced in inflammation stage.

And of this symptoms so moderate as not to require employment of any powerful measures for allaying inflammation

Where these however can be avoided is always a desirable practice.

For no doubt that from use of very powerful evacuants, atonic stage rendered in general more obstinate.

From this then will understand reason why here neither directed general nor topical bleeding, catharsis nor like.

Advised only employment of general aptiph. regimen.

And at same time the avoiding all causes by which inflammation might be aggravated.

With this likewise ordered for patient, powders consisting of mixture of equal parts of Nitre, in Gum Arabic.

Here nitre useful as refrigerant.

From diminishing [impetus] of circulation has tendency to forward resolution of inflammation.

But here, also farther useful as gentle diuretic.

For by increasing flow of urine the heat in passing, is somewhat diminished.

Same intention also in some measure answered by Gum Arabic.

Or at least has tendency to diminish ardor urinae from [sheathing] acrimony.

These advantages have often I think in former practice derived from this medicine.

And accordingly where disease slight none to which during inflamed stage have more frequent recourse

Where even more active remedies employed given with advantage at intermittent times.

And very properly conjoined with bleeding cathartic or like.

Where these not necessary is one of safest practices to which can have [recourse]

And while some advantage to be expected from it serves also good purpose of engaging attention of patient.

Was intention therefore in present instance to continue it during inflamed stage, if no occurrence requires other measures.

After continuation for space of week, patient as might indeed have been reasonably expected, no inconvenience from it.

And symptoms somewhat abated.

Not however so far as to lead me to think of employing other measures.

Directed therefore that should still be persisted in.

Hoped that by succeeding report inflammation would have been so far abated that could have ventured on use of tonic

For this purpose was intention to have tried patient with Peruvian Bark.

A remedy from which as short course of Gonorrhoea have often I think derived great advantage.

And which hold to be upon whole, much safer than astringent injections.

Although therefore these prove powerful consider it as deserving [first] trial.

But as patient has not since returned, no opportunity of having [recourse] even to this measure.

And farther observations at present unnecessary.

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Explanatory notes:

1) Andrew Duncan, Medical cases, selected from the records of the Public Dispensary at Edinburgh : with remarks and observations : being the substance of case-lectures, delivered during the years 1776-7 (1778).