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

Thomas Fairn

(1776-1777)

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Thos. Fairn

Disease of this patient evid of complic nature

And complic too in several respect of [worst] kind

For affect. conjoind of such nature that neither one nor other readily removed.

Disease most urgent to patient Ischuria.

When occurrs attended with viol pain in Hypo region

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

At same time also little doubt as to cause

So much attended with sympt of calcul that patient oftener than once sounded.

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

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

And little hesit in referring it to obst at neck of bladder from sand.

Probab. howevr more in conseq. of [space] induced by irritat than as blocking up passage.

May indeed perhaps occurr as possib suppos. that anoth disease with which patien affected some concern as inducing this.

This patient affectd with no less than two inguin herniae.

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

But may be connected with other diseased states of intest.

And well known that from compress often obstr. to disch of urine.

Yet little ground for suspecting such a cause in pres. case.

Otherways ischuria a const & unif affection

On contrary here often consid remissions.

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

For hernia preceded Ischuria even for years.

May conclude therfore the two diseases uncon.

And as far as either one or other obj of [practice] requiring diff. treatment

But besides these still a third affect

And one too no less distressing than other

Viz. Catarrhal affection.

Has indeed we may say been prin. part of compl. since came under our care

And manif. of chronic kind.

Presum that may in some measure serve to aggrav. the others.

Yet to be consid as totally unconnected with these

And by no means depending upon them as cause

Thus then pres. patient subj. to a complic of affections

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

For all if not fatal at least ted. compl.

And patient in many respects in unfav. circ.

Already at advanced period of life.

Has passed his 60^th year.

And in point of constit every appearance of being much older

None of compl. of recent date.

Most have already cont. even for years.

And probab. contrib not a little to bring constit to state in which at pres. is.

Now therefore little hopes of recov.

And perhaps even but faint expectat of much allev of complaint

In treatment first obj. whethr are to [attemp] to remed every part of compl.

And what partic parts claim first attent.

Here may observe that Hernia of longest contin

And perhaps after durat which have already had with such a patient as pres. may be reckond incurable.

Besides this give no inconven.

These therefore have not hitherto reckond an object & practice

And intent solely directed to cough & aff of urine.

In obviate first should here be disposed to follow same gener. prin as ment. in other cases

1 To unload breast of mucus already [excret]

2. To restrain farther morbid secret. by dimin. determ. to breast.

In prosecuting these meas. here howevr somwhat restraind.

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

As from agitat danger of encreasing hernia

Cheif endeav therfore with view to catarh on second prin.

And with this intent have aimd at [deter] from breast by issue.

Have likewise in some meas. had same end in view by othr med employd.

Partic different diuretics.

But while these gave determ from breast expected also some benef. on other princip.

For here besides cough state of urine became anoth obj. of attent.

On suppos. already given evid that cure to be effectd on two princip.

viz By discharging dissolving sand already generated. &

By prev. farther generat.

Both one & other howevr ends perhaps [unattain]

Many med indeed held forth at times as solu. of calculi. Partic in Urin. passages.

In so much that supposed to constit a class known by title of Lithontrip.

Would not pretend to say that no such med exis

Or even that not yet already discov.

May howevr venture to say that have not discov. never found any evid of such power in most celeb. of these

On this acct therefore thought rathr of attempting expuls of sand than solutit.

And this imagind might be affectd by encreasing quantit of urine.

Was with this view that had recourse to nitrous powders.

At same time conjoind with G. Arab.

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

While however took this measure for getting rid of sand already gener. wishd also to do something with view of prev. farther gener.

And appreh. that is on this princip alone that any Lithontrip hitherto introd have operated.

In this manner of service even in cases of confirmd calcul.

Certain that by use sympt. before urgent much mitig

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

Before depos. calcar. sedim in consid quant becomes of natural appear.

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

Appears howevr prop of some of absorbent nature ex. Lime water, Caustic Alkali

And from late observat of an ingen. phys. in London also of mild alkali.

At least has found that from these simil change induced in state of urine.

Presum therfore that will have same affect against calcar. compl.

But besides absorb. would seem also prop of astring

At least from late observat contended that is the prop of Uv. Ursi.

And in pres. case reckond trial of this preferable to others.

As not only adapted to calcar. affection but also wishd to observe affect on cough.

Thought that astring qualit might have some tenden to dimin secret.

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

These then gener. princip. on which have heretofore attempt. allev. of this compl.

And will suff. explain meaning which have had in view from diff. med used.

From these must allow that have hitherto reapt very little advant.

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

Yet after all must observe that very little prospect either of remov. or even allev. comp.