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H. Lochhead.
February 1778.
8 p. 69 ✍

I returned here sooner than I expected and yesterday
Mr Marshall gave me your letter – As I am about to leave this
country uncertain if I shall ever return I must beg your
patience a little farther till I say for the last time what oc¬
curs to me on my case

In summer 73 when I had recovered from the Rheumatism
& the operations that were performed for the more acute disorders
I was in order to get fully established in my health sent a long
journey for the Bath with a supply of injection for the ve¬
nereal runing which by this time had [occured?] – by the various
accidents however to which I was exposed I got a relapse in
the Rheumatism & the injection was of no use in stopping
the runing – In this state I got home in October when purg¬
ing was renewed & the injection continued for about 6
weeks, then mercury was tried to a degree that salivated
me & some was put up the urethra as far as it would go
but all to no purpose, or rather to a bad one for my urinary
complaints grew rather worse – In this state January 74 Doctor
Bland (a pupil of yours) waited on me. He seems to have
taken up the same idea of my case that you now have
of it - He directed all medicine to be laid aside, except
what should be necessary for preventing costiveness – to drink
barley water with gum arabic plentifully & occasionally to
inject a weak solution of sugar of lead & large proportion of
the gum – to observe just such a regimen in eating & drink as you
now direct, to avoid venery & all exercise to any degree
that would heat or fatigue me – & not to try bougies which
were then thought of – By attention to these & keeping warm
I found the most sensible good effects in the urethra by

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month of April I found I had gained considerably in regard
to the frequency of making water & seemed then to do it with
as much or more strength & briskness than I ever since have
done – & the weather then setting in warm by May I had nearly
↑got↑ rid of all Rheumatick complaints – But I broke through
his rules too soon & from this time confiding in the train
I was in with the summer being before me I gave way to
indulgence in living every ↑way↑ nearly nearly as if nothing had
ailed me. I continued this way till fall 76 when becoming
very impatient under my urinary weaknesses which
had by this time increased much & hoping for absolute
releif from the Bougie which I had made a few attempts with
by this time but could not succeed I resolved on coming home

Upon the whole it seems that if I either had not used so
much of the injection at first, or used it more properly by
not sending it up the urethra so ↑far↑ as it could be sent which I was
bid to do – or had passed a Bougie when the disorder was
more recent which its plain I might have done as the catheter
then met no resistance – or if after all I did & suffered I
had for a much longer time paid great attention to Dr. Bland's
directions & never indeed wholly laid them aside – or when
I did transgress instead of coming home to get the Bougie past
(which I then thought was indispensible) I had recurred to moder¬
ation & temperance I am led to beleive it would have been
better for me – Thus far I have troubled you again by repeating &
supposing – but I go on – The part of the urethra where the ca¬
theter meets with obstruction is about six inches up as near as
I can guess it must have got this length I apprehend from my
taking pains always to send the injection up as far as it would
go – whether this obstruction be an excrescence which is apt to grow
larger or a disposition in the part to contract without the assiss–

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tance of the Bougie to keep under & dilate I know not – But I
now come to chief question which arises from your direction as to
the use of Bougie – I am not to use the Bougie when from any
accidental irregularity I may fear an increase of obstruction
I am only to use it in urgent cases & when there is pain & dif¬
ficulty in making water – now here is the dilemma this is the
very time when I fear I shall not be able to use them – hence
arises my anxiety for always having it in my power to pass them
& to know the proper time & degree for using them – After my
late journey ↑to &↑ from London when I was so alarmed at not being
able to get one past, having then disused them 6 weeks – it
was more to obtain some satisfaction this way than from
any apparent increase of the obstruction – for I could per¬
ceive little or no alteration in making water either as to
pain difficulty or appearance in the stream – Indeed in
Virginia from the time I broke through the rules laid down to
me I did not feel pain in making water, but according as
I made more or less free so I recollect the incontinence
was greater & the urine past more slowly in a smaller stream
& more strangurously If I may be allowed the word – since
I came home I have got a greater degree of health & strength
than I ever had since the commencement of my complaint
& perhaps it may be owing to this & not the use of Bougie
that I am now more continent & make water faster tho
still with the peculiarity of a broad stream & tendency to
divide at the last –– or what I have gained may be owing
to both –– I would then beg to ask whether when from any
accident & from cold fatigue intemperance or accidental
weakness the urethra as lately shall not admit a Bougie I
should have recourse to & expect releif from a strict atten¬
tion

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to those rules ↑for temperance & moderation↑ you have laid down & hope by this the part may
get restored – or should I also add moderate trials for ad¬
mission of the Bougie certain or if there is not absolute
certainty of success this way & as a mechanical power of
dilation seems to be the confessed use of the Bougie
should I not endeavour by experience to find out what
may be the safest degree of using them when the urethra
is in its best state so as to prevent increase of ailments*
–– I shall not be surprized if you shall not think any answer
to this either verbal or written necessary – but that I am
just as well as my case will admit to be left with the
directions I have had to my own management & experi¬
ence –– if tho you shall think any thing farther either to
be said or written necessary I shall be glad to have it
which will be adding to the obligations I am already under
to you – If you chuse to write to sent to Mr Marshalls any
time this fortnight to come will do – or if to see me – I shall
be at Mrs Nicholsons Richardson's Nicholson Street till
Monday next, & always within, except in the evening and
betwixt three and five for a walk sometimes – I trouble you
with no farther apologie I know & own I have been a teazing
troublesome patient but I beleive it has been more owing
to the peculiarity of my case than any natural disposi¬
tion that way –– If anything material should happen me in A¬
merica I shall write you from thence –