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The Case of Mr Joseph Munro Minister of Eddertown
For Advice of Dr Cullen, & Dr James McKenzie Edinburgh

Mr Munro Will give, from Himself, the Plainest and
fullest Account He can of His Complaints, without Using using
any Terms or Art, or Rhetorical terms that Might Mislead the
Drs by their not Having the same Meaning to these Terms.

[Start of margin text]age[End of margin text]
Mr Munro is Sixty Two years of Age, and has been Gene¬
rally very Healthy, His Situation in Life, & His own Inclination
led Him to be Active & Stirring, & not Given to the Recluse or Seden¬
tary Life, so that the present Appearance of his Complaint may
be the More Difficult to Understand

↑
attacked
with Rhuma¬
tisim ↑
About Seven Years Agoe Mr M: was attacked with a Severe
Rhumatisim, Occasioned by His Drinking Some Drafts of Cold
Punch; when He was overheated & Perspiring Strongly, after a
a long Walk in a Sultry Summers Day. He then Blistered three
or Four times, used the Cold Bath, & flesh Brush to Remove His
Complaint; But to no Effect. At last He made use of the Peruvian
Bark, which Effectually Removed his Rhumatism, at the same time
Litle Hard Bumps appear'd at His Wrists & Ancles which was
judged the Effect of the Bark Lodging the Disease

[Start of margin text]
a flux
Piles [End of margin text]
Mr Munro had also a kind of Regular Evacuation, once in
the five or Six Weeks, by the Bloody Piles, which Disappeared
about the above period. But as Mr Munro found his Health
continue; He only Imputed this Change, to the Aproach of Declining Life

[Start of margin text]Flux[End of margin text]
In January 1777 Mr Munro was Attacked with a kind of Flux
or Disentery, Attended with Severe Greips & pass'd some Blood
But by Some Doses of Rhubarb, he soon got the Better of His
Disease, and Continued Healthy till the 7th Octr 77. only he Obser¬
ved, on His Drinking Warm Punch, that he had frequent passage
by Urine, and Could not Contain it any time

[Start of margin text]
Cause
of the Disease [End of margin text]
The 7th October 77 The Water of Eddertown Overflow'd its banks
Broke in upon the Manse, Drown'd the fire in the Grate, & set the
Bedds in the Low Rooms a Sweeming; Mr Munro Anxious Lest the
Water would Sapp the Foundations of the Manse. was wading
Thigh Deep, thro the Water - Giving Directions to give different
vents to the Water to get it off from the Manse; and Ever since
he has been Affected with his present Complaints on which he
Consults the Drs.

[Start of margin text]
Symptoms
& appearance [End of margin text]
The First Appearance of Mr Munro's Disease was by a frequent
Inclination to make Urine, & very Litle Made at a time, in two or three
weeks afterwards, it became More Uneasie, by a pain at the Anus
and top of the Penis, at the time & After making Water; And from
the Urines coming Away in Drops, with Excessive pain, at which
time there was the Appearance of Blind Piles, or the Jetting out
of the Rectum; And felt something like a Strong pulsation or Rather
a Convulsive motion in the Neck of the Bladder, & top of the Penis

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occasioned by the Sharp pain in discharging the last Drops of
Urine. [Start of margin text]Symptoms[End of margin text]Soon after the first Attack of this Disease, Mr Munro Obser¬
ved, that a day or Two before the Fitt Came on; There was a Rumbling
or Murmuring Noise in His Bowels, under the False Ribbs, as if Wind
pass'd thro the Intestines, & His Stomoch was much oppressed by Wind,
He had Great Evacuations by Eruction, but None the other Way,
His Urine become then More Frequent & Clear, but Readily the Next Day the
Fitt comes on, & then the Inclination to Water Comes on frequently &
only Comes off in Small quantitys, sometimes only Six or Seven Drops
This Fitt Continues Two or Three Days; And then will Wear off by Degrees
but still the pain at the Anus and top of the Penis Continues for some
Days Longer, when he makes Water. He has afterward has some Ease
for four or five Days, & could Walk about without much pain

Mr Munro found it more Easy to Discharge ↑Urine↑ when lying in Bed
than in Erect posture, But Amidst all the Distress he suffers there
was never any Appearence of Stone or Gravil. & very Seldom any
appearence of Sand- yet after the Disease Continued about Six
Months, near the End of the Fitt the Urine Appears with of a
Dark Colour, with something like the Grounds of Coffee and
He passes Clear Blood, two day's after the passing of Blood
stops, Mr M. passes Clotted Blood. During the time the fitt
is Coming on and till it is Over. Mr M. finds his feet exces¬
sive Cold, & will not get them Warmed, tho he Sometimes burns
his stockings to Warm his Feet

Mr Munro Observes that before the fitt Comes on His Spirits
are lower, He has frequent [Yanings?], &when his Water is Clearest
before the fitt, it is Glutanous, as if Mixed with Gumm or Lime
Wind seems to be the Great Sourse of the Disease, for in the severest
time of the Fitt; there are frequent & Hard Belshings, the Rectum is so Great¬
ly Extended, that it is difficult for the Patient to Sitt in his Chair, nay
in the time of the fitt, the Anus, penis, & one of the Testicles seem as
if Blown up or Swell'd; He also Observes after a Severe Fitt, He has
outward pains from the Navil to the Penis Downwards, so that He can¬
not Touch any part of that Region without Pain outwardly

Mr Munro thinks fitt to Acquaint the Drs of the Different things
used for Relief without great success

[Start of margin text]Regimen[End of margin text]
Mr Munro Beleiving that His Disease was Nervous as well as Gra¬
vilish, Gave up wholly the use of Tea, & Spirits of all kinds; & as the
Flatulancy of His Stomoch was Increased by Fermented Liquors.
His Diet was Pottage and Milk for Breakfast; fresk Broath, with
a pice of Roasted Chicken, Kidd, Veal, or anything of Easy Digestion
for Dinner, His Drink Toast & Water. and Gruel for Supper

[Start of margin text]
Means &
Medicine
us'd [End of margin text]
Imagining that part of His Diease flow'd from the Stopage of the
Natural Evacuation by the Piles, & that he seem'd affected with the Blind¬
Piles, He caused put an Issue in his Legg, as a Drain in Vice of the Piles,
& this has Continued since March -78 without any Effect, Except Drawing
some Humors

Mr Munro from the Stoping of his Urine, without seeing Sand or
Gravil, Concluded his Disease a Strangry, & Began the use of Dureticks
such as the Decoction of Burrdock Seed, The Daucus Silvestris. Ground
Eivy, Lime water with Soap. But these brought on a more frequent

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Flux of Urine, with Excruciating pains at the Anus & penis
nay He seem'd threatend with a Diabetis, and therefor the Diureticks
were given Up as he found himself Much Emaciate & got no Ease by them

The Flatulency in his Stomoch, and Rumbling noise in His bow¬
els, Made him Conclude that the Disease was Nervous, & that the
Obstruction in Urine, proceeded from some Ulcer at the Neck of
the Bladder, and therefor He was Advised to begin the Use of the Peru¬
vian Bark; of which He took half a Drahm evry Morning and
afternoon in a Cup of Camamile Tea, at the same time Ten grains
of Rhubarb was added to prevent the Astringent quality of the
Bark. But the Rhubarb Did not qualify the Bark so as to
prevent Costiveness . The Bark therefor was Discontinued in the
after Noon and instead of it a Cup or Two taken of Althaæ Tea

This seem'd at first to have a Good Effect, as the Rumbling noise
in His Bowels subsided, & he had Great Ease for About fourteen Days
without any Fitt: ↑till↑ 14 September The fitt came on with Great Severity
the Convulsive Motions at the Anus & penis, were rather Stronger
and the Fitt ended after Many Injections of Althaæ, in a void¬
ing of Bloody Urine, after Continuing ten Days.

Mr Munro Hearing that Governour Campbel at Fort George
was affected with a Similar Disease, & that he Had got Great Relief
from some prescription of Dr Allexander Munro Physician to the Forts
He sent his Case to Dr Munro- Who prescribed the Constant
use of the [Decoction of Althæa Root?] with Gum: Arabick
and Continuing the use of the Peruvian Bark, only to
Increass the Dose of the Bark According as it agreed with
the Patients Stomoch. He was also Directed to use theDecocti¬
on of Dry'd Roses assidulated with Spirit of Vitriol, when he was
attacked with Bloody Urine; & to use some flour of Sulphur
if the Bark brought on Costiveness; with some Drops of Lauda¬
num to Ease the Pain when Severest

The Same simple Diet was orderd to be Continued only
[Saloup?] ¹ Dissolved in Warm Water, & Sweetened to taste with
some Milk for Breakfast

Mr Munro has Continued this prescription since
the 2d October and had Great Ease for a fourtnight, He had
then a Fitt of Ten Days Continuance, tho not so Severe as
former One's . He had Respite for another fourtnight
one the 18th November he was attacked with another fitt which
has Continued yet 27th November But not so severe as Usuall
Mr Munro voided no Bloody Urine since the 2d October

He has an Apetite for Evry Diet, and he has no Reluctance
to Any Medicine, What he has taken agrees with his Stomoch
But as He finds himself Emaciate, His Strength Decaying and

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pains and Fitts still Continuing. He Wants the Advice
of Drs Cullen & McKenzie that He may not have Himself to
Blame in not having proper Advice from the ablest Hands
knowing in the Multitude of Council there is Safty

✍

Case Mr Joseph
December Munro 1778
9. p. 102.