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I am favoured with yours of the 25th. past got
only on the 9th. Current. I am happy in the first place to
know that you yourself are alive and well and you may
depend upon it that my regard for you will engage my
utmost attention to any Case you are pleased to Consult me
in.

The Case you have described is such as is quite familiar
to me though it has been very little taken notice of in
[Books?] of Physic. It is formally mentioned in but one book
that I know of and this is Lieutauds Synopsis Praxeo
medicæ. ¹ There it is under the title of Catarrhus Vesicæ but
he seems t[o hav]e met with but one instance of it and he
[refers?] to another in Hoffmans Consultations Cento II. Case
{illeg} [where?] it is named Rarus Vesicæ morbus. ² I have met
[with] twenty or thirty instances of it and long ago gave a
[lecture] upon it in my Clinical Lectures at the Infirmary

It is of different kinds as it proceeds from Nephric
Gouty, Hæmorrhoidal affections and most frequently
all are a consequence of Venereal affections of Urethra.
[Why it?] has not been taken notice of by Practitioners and
[Practical?] Writers appears to me because it has been
[commonly?] mistaken for a purulent discharge from an
[abcess?] or Ulcer at the neck of the bladder and I have
{illeg} constantly met with that supposition among our
[practitioners here till I undeceived them?]

I hold the disease to consist in an exsudation or {illeg}
{illeg} in unusual quantity from the mucous [follicles which?]
are in a great number at the neck of the bladder. [In some?]
persons this is constant and appears in every portion of
urine that is voided but in most cases as in your Pa¬
tient it is only or chiefly voided in consequence of Spasmodic
and Strangurious affections of the neck of the bladder.
The quantity and other circumstances of the mucous voided
is very various and so are the symptoms of pain and
difficulty attending it. You seem to think that your
Patients distress is owing to the great viscidity or {illeg}
of the mucous rendering it difficult to be voided and
must be positive that it is otherwise but I have [commonly?]
found that the quantity and viscidity was generally in p of the
mucus voided was generally in proportion to the Strang[urious]
pains which preceeded and brought on the discharge. [While?]
these explain the chief part of your patients complaints
I am not so clear in explaining the other part of them,
that is, his being liable to paroxysms of fever, and The
only explanation I can offer is that they are some how
connected with the ailment at the neck of the bladder,
for in several instances of the latter I have known
at the times of some suppression of feverish paroxysm[s]
come on which in its cold stage and the sweating whic[h]
followed exactly resembled the fit of an Ague. I have
known this in some persons several times repea[ted]

This is all I can say towards explaining your Pa¬
tients disease and I wish I could direct you more clearly
to the Cure of it. This however I find more difficult for
when the Urethra has been formerly much affected and the
spasmodic and Strangurious fits have been frequently repea¬
ted the disease is commonly obstinate and in some instances
every kind of remedy has disappointed me: Happily how¬
ever this has not been always the Case and in many
I have found great relief from the use of Uva Ursi and
of Balsam Capivi and I have directed Mr. Johnstone
to enquire after a Case which had been long treated as
an abcess of the neck of the bladder but in which to
[the surprise?] of the Faculty I made an entire Cure by
[the remedies?] just now mentioned and I can do nothing
[better?] to your Patient than a trial of the same.

Please get a quantity of the leaves of the Uva Ursi
and clean them from all the withered and decayed leaves
and sticks commmonly mixed with them. Let the sound
leaves be reduced to fine powder and of this powder
let your patient take at first half a drachm three
times a day but let the dose every second day be increased
[by] 10 grains till it comes to be a drachm and at this
[amount] let him continue it for three weeks. In this time
[if he?] does not make water in a full stream and does

When your patient has taken the Uva Ursi for a
fortnight he may begin the use of the Balsam Capivi
beginning with a dose of thirty or forty drops but increasing
it gradually till he can take sixty. Such a dose is to
be taken every night at bed time and the most agreeab[le]
way of taking it I have found to be the following. Put
a tea spoonful or two of powdered Sugar into a teaCup

I have no particular advice to give with respect to
Diet. It may be of ordinary fair except that acids of all
kinds are generally hurtful and even acescents should be
[taken?] sparingly.

In Drinking let him avoid Claret, Champaigne
and all small French white wines. He may take a few
glasses of Port or Sherry and perhaps a little Spirits
and water as safely as any of them but with respect
to every kind of strong drink the strictest temperance
is absolutely necessary.

Sitting much at business is bad for your patient
and travelling much in an easy Carriage is always of
service in the Catarrhus Vesicæ.

You certainly expect that I should say something
about avoiding the feverish fits your patient is so liable

I have only to add what I should have said in the
beginning that your patients bearing Exercise of all
kinds so very well shows clearly that there is nothing
Nephritic or Calculous in his case.

If it shall be convenient for you to let me know
what further happens in this Case I shall be obliged to
you and I shall be very willing to contribute further any
thing in my power to his relief.