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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

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

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 -

For
Doctor Cullen

Mr. David Watson
Novr. 1783
XV p.128