Cullen

The Consultation Letters of Dr William Cullen (1710-1790) at the Royal College of Physicians of Edinburgh

 

[ID:2368] From: William Elliot / To: Dr William Cullen (Professor Cullen) / Regarding: Mr David Watson (Patient) / 16 November 1783 / (Incoming)

Letter from William Elliot concerning the case of David Watson, a schoolmaster. Mr Watson had suffered recurring bouts of dysuria ever since he had been afflicted with a 'Fever of the Typhus kind in Summer 1778'.

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Metadata

FieldData
DOC ID 2368
RCPE Catalogue Number CUL/1/2/1424
Main Language English
Document Direction Incoming
Date16 November 1783
Annotation None
TypeAuthorial original
Enclosure(s) No enclosure(s)
Autopsy No
Recipe No
Regimen No
Letter of Introduction No
Case Note No
Summary Letter from William Elliot concerning the case of David Watson, a schoolmaster. Mr Watson had suffered recurring bouts of dysuria ever since he had been afflicted with a 'Fever of the Typhus kind in Summer 1778'.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:1604]
Case of David Watson who has bouts of dysuria since recovering from a typhus-like fever a few years ago.
1


People linked to this document

Person IDRole in documentPerson
[PERS ID:3464]Author William Elliot
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:3465]PatientMr David Watson
[PERS ID:3464]Patient's Physician / Surgeon / Apothecary William Elliot
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing Jedburgh Borders Scotland Europe certain
Destination of Letter Edinburgh Edinburgh and East Scotland Europe certain
Mentioned / Other Edinburgh Edinburgh and East Scotland Europe certain

Normalized Text

[Page 1]


Mr. David Watson a Schoolmaster at about 60 has had
three Attacks of Dysuria within these few years, the first of
which occurred after a very long Fever of the Typhus kind in
Summer 1778. There were some slight affections of it about the
Crisis or towards the decline of this Fever, but it encreased after
the Fever had gone of and continued molesting him pretty se¬
verely during several weeks. From this time he remained
free of (↑from↑) any Complaints of this nature & enjoyed his usual good
state of Health till some time in Spring 1782, when he was
again afflicted with the same disorder continuedly for two
Months or more. After this he possessed an entire state of Health
till the Month of April this present year when the Dysuria re¬
turned attended with Symptoms similar to those he had formerly
suffered but severer in degree. His disorder too has been of much
longer duration than at any of the former Periods having con¬
tinued with encreasing vehemence from this last Attack to the
present Hour so as to render the Patients Life very unhappy
& miserable


The Urgings to make Water are described to be a forcing strain¬
ing irresistable Impulse
but often ineffectual or producing on¬
ly a few Drops or a scanty stream of Water.
The Conflict begins
about the Neck of the Bladder where the Patient feels a severe burn¬
ing Pain
that passes along the Urethra & from that sometimes to
the Glans. But the forcible strainings communicate to the neigh¬
bouring parts very violent pains which not only adds greatly to the
Patients agony during the time of passing the Urine
but continue
to afflict him for a long time after. These Pains These pains do often
strike to the Groins and from that to the Thighs along the fore parts of
them downwards to a little below the middle occasioning great tor¬
ture to the Patient. But he suffers still as much from stimul
sensations in the Lumbar Region the whole of which appears to be
affected by communication with the local seat of the Disorder. The
Pains afflict generally the upper part of this Region & they some¬
times advance a little above the Head but seemingly never go
so far up as the Kidneys. The Pains will sometimes rage both in
the Lumbar Region & in the Thighs at the same time but not in e¬
qual degree so that when very severe in one part they are less so



[Page 2]

in the other and they will sometimes seem to shift from the low
parts of the Back to the Thighs & vice versa. The left side appears on
the whole to suffer less (↑more↑) than the right. The Distress or Agony from these
Pains is great nor does it ever seem to be entirely away, but the pains
abate in violence in a gradual manner from the first exacerbation
on passing the Urine or, after the Stimulus to make it ceases till this
Stimulus returns again. During these afflicting Complaints the Bo¬
dy of the Bladder
is far from being unaffected but the uneasy feeling
here the Patient cannot so easily give an account of and they seem
more liable to occasion Deception He appears however to have always
more or less distressing Spasmodic Strictures in the Bladder accompany¬
ing the Accession of Pains in the neighbouring or remoter parts and
he describes them mostly as a general sensation over the Bladder un¬
less at times that he feels a particular twang of Pain towards the
Right Side of it. He insists that he sometimes has a sensation of the
Urine dripping into the Bladder.


The painful stimulus to make water & all the other Complaints
occur most frequently in the Night-time and are generally severest
about Midnight on awaking from his first sleep which as the longest
he enjoys and if by any means his sleep has been protracted be¬
yond the usual period when he awakes from these longer contin¬
ued sleeps he always finds his Complaints recur with greater vi¬
olence ↑at↑ Whatever ↑time↑ he awakes from his first sleep he seems to have
but little repose afterwards, the violent Complaints then coming on
& their consequences continuing to harrass to such a degree as often
to make it impossible for him to keep in one posture for any time to¬
gether, or even to keep in Bed, To the Liquids that he drinks during the day¬
time it may partly be oweing that he enjoys longer Respite & intermissions
from his Troubles, for it would seem that the more Liquids he drinks he is
able to retain his Urine longer and he passes it with less pain. He can
keep his Urine for instance for about four hours or so after Breakfast
which is made of Bread & Tea; and whether he drinks Tea or Water Gru¬
el, or Weak Punch, as he will sometimes do, these Liquids do not seem
to pass suddenly off but by replenishing the Bladder this Organ seems
to be thus enabled to discharge its Contents with more ease; and it is
when the Bladder is nearly empty that the painful & irresistable im¬
pulse to make Urine
comes on occasioning all the excruciating
Symptoms that have been enumerate, - He does not find that his
Complaints are at any time brought on by Motion or using easy ex¬
ercise such as he is able for whether on Foot or Horseback. -


The first time the Patient laboured under this disorder there was no
Blood came away with the Urine but during the second period of it
he frequently passd Blood and rather more in quantity than dur¬
ing this last & severest one. The quantity passd is indeed very in¬
considerable nor does it seem at all to depend on the irritation
of the Pain. When he passes Blood it sometimes comes with the



[Page 3]

the Urine in little clotts or in a congealed sort of state, at other times
it is equally diffused in it. But the Urine for the most part has
no Blood mixd with or contained in it and it is generally of a
natural Colour limpid & clear when it comes off copiously more
high coloured & turbid when in smaller quantity.. There is never
any Mucus mixd with it, nor has any particles of Sand or any purulence
been observed in the Sediment, but on (↑after↑) standing any time in a Vessel
there is often an incommon appearance on the Surface a fine or very
thin coat overspreading it, variously coloured very much resembling
the Scum or Crust that forms over some Mineral Waters as they appear
Stagnating in the neighbourhood of the Fountain. This Coat when exa¬
mined on the finger loses its variegated shining hue & resolves itself almost
entirely into the form of a very fine white Powder.


No Feverish Commotions have attended this Illness, at least none have ap¬
peared when the Pulse has been examined which is generally exceeding
languid & often intermitting & irregular, The Patient is much reduced
in strength
& emaciate, He has little or no Thirst, and his Appetite is
not thought to be much impaired {illeg} when he has ease from Pain
The Bowels are a good deal disturbed with wind. He is generally disposed
to be costive "On going by Stool he feels a severe bearing against the
Os Pubis which seems rather a Repletion in the whole Bladder" - These are
the words of the Patient in some account of his disorder he gave in writing.
When examined formerly as to this particular he seemd to express himself
as if the Rectum had some difficulty in extending the ffæces when they were
in a hardned or lumpy state & that his uneasy sensations at that time arose
from the inability of the Rectum to perform its Office & from the pressure of the
Fæces. -


The Patient, a great many years ago was severely afflicted with Calculous
Complaints
from which he was delivered by the Extraction of a very large
stone a good dale rugged in its surface. The Operation was performed
in the Infirmary of Edinburgh so far back as the year 1756 in the month of
February He had a very easy & perfect recovery, & enjoyed good health
nor had never any Complaints that could indicate the slightest return
has been mentioned of his feeling at times a Twang of pain in the right
side
of the Bladder being just about the part as he thinks from which
the stone was extracted


The Disease has been treated much after the manner that succeeded what
formerly, consisting principally in Demulcents occasional east laxatives
& Emollient Injections & Opiates -


This State of a very deplorable Case with all its many Imperfecti¬
ons is submitted with the greatest Deference & Respect to
Doctor Cullen.

Wil Elliot

Jedburgh
16th. November 1786.



[Page 4]


For
Doctor Cullen


Mr. David Watson
November 1783
XV p.128

Diplomatic Text

[Page 1]


Mr. David Watson a Schoolmaster at about 60 has had
three Attacks of Dysuria within these few years, the first of
which occurred after a very long Fever of the Typhus kind in
Summer 1778. There were some slight affections of it about the
Crisis or towards the decline of this Fever, but it encreased after
the Fever had gone of and continued molesting him pretty se¬
verely during several weeks. From this time he remained
free of (↑from↑) any Complaints of this nature & enjoyed his usual good
state of Health till some time in Spring 1782, when he was
again afflicted with the same disorder continuedly for two
Months or more. After this he possessed an entire state of Health
till the Month of April this present year when the Dysuria re¬
turned attended with Symptoms similar to those he had formerly
suffered but severer in degree. His disorder too has been of much
longer duration than at any of the former Periods having con¬
tinued with encreasing vehemence from this last Attack to the
present Hour so as to render the Patients Life very unhappy
& miserable


The Urgings to make Water are described to be a forcing strain¬
ing irresistable Impulse
but often ineffectual or producing on¬
ly a few Drops or a scanty stream of Water.
The Conflict begins
about the Neck of the Bladder where the Patient feels a severe burn¬
ing Pain
that passes along the Urethra & from that sometimes to
the Glans. But the forcible strainings communicate to the neigh¬
bouring parts very violent pains which not only adds greatly to the
Patients agony during the time of passing the Urine
but continue
to afflict him for a long time after. These Pains These pains do often
strike to the Groins and from that to the Thighs along the fore parts of
them downwards to a little below the middle occasioning great tor¬
ture to the Patient. But he suffers still as much from stimul
sensations in the Lumbar Region the whole of which appears to be
affected by communication with the local seat of the Disorder. The
Pains afflict generally the upper part of this Region & they some¬
times advance a little above the Head but seemingly never go
so far up as the Kidneys. The Pains will sometimes rage both in
the Lumbar Region & in the Thighs at the same time but not in e¬
qual degree so that when very severe in one part they are less so



[Page 2]

in the other and they will sometimes seem to shift from the low
parts of the Back to the Thighs & vice versa. The left side appears on
the whole to suffer less (↑more↑) than the right. The Distress or Agony from these
Pains is great nor does it ever seem to be entirely away, but the pains
abate in violence in a gradual manner from the first exacerbation
on passing the Urine or, after the Stimulus to make it ceases till this
Stimulus returns again. During these afflicting Complaints the Bo¬
dy of the Bladder
is far from being unaffected but the uneasy feeling
here the Patient cannot so easily give an account of and they seem
more liable to occasion Deception He appears however to have always
more or less distressing Spasmodic Strictures in the Bladder accompany¬
ing the Accession of Pains in the neighbouring or remoter parts and
he describes them mostly as a general sensation over the Bladder un¬
less at times that he feels a particular twang of Pain towards the
Right Side of it. He insists that he sometimes has a sensation of the
Urine dripping into the Bladder.


The painful stimulus to make water & all the other Complaints
occur most frequently in the Night-time and are generally severest
about Midnight on awaking from his first sleep which as the longest
he enjoys and if by any means his sleep has been protracted be¬
yond the usual period when he awakes from these longer contin¬
ued sleeps he always finds his Complaints recur with greater vi¬
olence ↑at↑ Whatever ↑time↑ he awakes from his first sleep he seems to have
but little repose afterwards, the violent Complaints then coming on
& their consequences continuing to harrass to such a degree as often
to make it impossible for him to keep in one posture for any time to¬
gether, or even to keep in Bed, To the Liquids that he drinks during the day¬
time it may partly be oweing that he enjoys longer Respite & intermissions
from his Troubles, for it would seem that the more Liquids he drinks he is
able to retain his Urine longer and he passes it with less pain. He can
keep his Urine for instance for about four hours or so after Breakfast
which is made of Bread & Tea; and whether he drinks Tea or Water Gru¬
el, or Weak Punch, as he will sometimes do, these Liquids do not seem
to pass suddenly off but by replenishing the Bladder this Organ seems
to be thus enabled to discharge its Contents with more ease; and it is
when the Bladder is nearly empty that the painful & irresistable im¬
pulse to make Urine
comes on occasioning all the excruciating
Symptoms that have been enumerate, - He does not find that his
Complaints are at any time brought on by Motion or using easy ex¬
ercise such as he is able for whether on Foot or Horseback. -


The first time the Patient laboured under this disorder there was no
Blood came away with the Urine but during the second period of it
he frequently passd Blood and rather more in quantity than dur¬
ing this last & severest one. The quantity passd is indeed very in¬
considerable nor does it seem at all to depend on the irritation
of the Pain. When he passes Blood it sometimes comes with the



[Page 3]

the Urine in little clotts or in a congealed sort of state, at other times
it is equally diffused in it. But the Urine for the most part has
no Blood mixd with or contained in it and it is generally of a
natural Colour limpid & clear when it comes off copiously more
high coloured & turbid when in smaller quantity.. There is never
any Mucus mixd with it, nor has any particles of Sand or any purulence
been observed in the Sediment, but on (↑after↑) standing any time in a Vessel
there is often an incommon appearance on the Surface a fine or very
thin coat overspreading it, variously coloured very much resembling
the Scum or Crust that forms over some Mineral Waters as they appear
Stagnating in the neighbourhood of the Fountain. This Coat when exa¬
mined on the finger loses its variegated shining hue & resolves itself almost
entirely into the form of a very fine white Powder.


No Feverish Commotions have attended this Illness, at least none have ap¬
peared when the Pulse has been examined which is generally exceeding
languid & often intermitting & irregular, The Patient is much reduced
in strength
& emaciate, He has little or no Thirst, and his Appetite is
not thought to be much impaired {illeg} when he has ease from Pain
The Bowels are a good deal disturbed with wind. He is generally disposed
to be costive "On going by Stool he feels a severe bearing against the
Os Pubis which seems rather a Repletion in the whole Bladder" - These are
the words of the Patient in some account of his disorder he gave in writing.
When examined formerly as to this particular he seemd to express himself
as if the Rectum had some difficulty in extending the ffæces when they were
in a hardned or lumpy state & that his uneasy sensations at that time arose
from the inability of the Rectum to perform its Office & from the pressure of the
Fæces. -


The Patient, a great many years ago was severely afflicted with Calculous
Complaints
from which he was delivered by the Extraction of a very large
stone a good dale rugged in its surface. The Operation was performed
in the Infirmary of Edinr. so far back as the year 1756 in the month of
Febry. He had a very easy & perfect recovery, & enjoyed good health
nor had never any Complaints that could indicate the slightest return
has been mentioned of his feeling at times a Twang of pain in the right
side
of the Bladder being just about the part as he thinks from which
the stone was extracted


The Disease has been treated much after the manner that succeeded what
formerly, consisting principally in Demulcents occasional east laxatives
& Emollient Injects. & Opiates -


This State of a very deplorable Case with all its many Imperfecti¬
ons is submitted with the greatest Deference & Respect to
Doctor Cullen.

Wil Elliot

Jedburgh
16th. Novr. 1786.



[Page 4]


For
Doctor Cullen


Mr. David Watson
Novr. 1783
XV p.128

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