DEP/DUA/1/35/04 (Normalised version)

Charles Campbell

(1784)

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Charles Campbell May 28^th

In case of this patient several obvious & distressing symptoms.

And with regard to nature of affection in some respects at least am inclined to think but little doubt

But name with propriety to be given it more a matter of controversy.

Here three morbid conditions from each of which might be disposed to seek for name of disease.

First frequent inclination to discharge urine.

Secondly Pain & difficulty with which that discharge attended.

And thirdly The condition of the urine as discharged particularly as uniformly contains a large proportion of white viscid mucus

Were we to name affection from first of these would naturally give it appellation of Stranguria.

If from second again, pain vizr with which discharge attended, would give it appellation of Dysuria.

And this latter appellation given to the affection to which our patient subjected in system of Dr Cullen.

For I think no doubt that it exhibits to us an example of that affection which in his system distinguished by title of Dysuria mucosa.

At least have no doubt that it affords us an example of that Genus to which Linnaeus in his system has given name of Glus. or of what Mr Lieutaud has described under title of Catarrhus Vesicae.

These however mentioned by Dr Cullen as synonymous With his Dysuria Mucosa.

But in my opinion he has done wrong in considering this affection as a species of Dysuria.

And neither with propriety to be [named] from pain & difficulty of discharge, nor from frequent inclination.

These indeed intimately connected with the disease.

But both of them in my opinion merely symptoms of state of discharge.

And if wish to give the disease a name in any degree conveying idea of its nature, must derive it from that source

Here however similar discharge takes place from bladder, as in Leucorrhoea from the uterine vessels.

And hence has I think with great propriety been named Cystorrhoea

This appellation will find given to it in an inaugural dissertation lately published on this subject by Dr Parnham¹ which contains many excellent observations both with respect to History & Cure

This appellation then consider as [preferable] either to Catarrhus vesicae of Sauvages or Dysuria mucosa of Cullen.

That case before us an example of that affection evinced by all symptoms.

But particularly as have already observed by large white mucous sediment which the urine contains.

Where this combined with pain & frequent inclination to discharge of urine, no other affection from which can suppose it to arise but actual ulceration.

And indeed same appearance in some degree given by purulent matter.

But where this takes place, constant heat & sense of [burning] at particular part.

While at same time, present [diffusion] in urine much less viscid & glutinous than mucus.

From these particulars then all doubt respecting present case in my opinion was removed.

The matter diffused in the urine nothing more than morbid secretion of mucus separated from follicles within bladder particularly about its neck.

And in consequence of this vitiated secretion though quantity increased yet proper lining & defence to bladder wanting.

Hence arises pain as well as frequent inclination to discharge.

From this view of nature of affection might be concluded that should not be expected to be a very obstinate disease

At least increased mucus discharged from other parts as for example Gonorrhoea, Catarrh etc often even spontaneously terminate.

From [fact] however [appears] that in Cystorrhoea case by no means so favourable.

For when once induced very generally observed to prove both an obstinate, & troublesome disease.

Probably the consequence of being increased & aggravated by continual stimulation of saline impregnation in urine.

Particularly liable to be an obstinate disease when occurs at late period of life.

And especially if at early period proper remedies be not employed to combat it.

When all circumstances then taken together obstinacy viz of disease, age of patient already past 70^th year, its continuation for space of several weeks, & during that time its increase in violence have I think reason to believe that will prove obstinate.

Shall not therefore be surprised to find that all our efforts ineffective.

At same time different modes of cure which may at least be tried with some prospect of success

Here no doubt that disease very much increased by stimulation of [urine]

And although in any state will have some effect in that way yet this very much augmented by proportion of saline matter to watery part.

Hence then by means augmenting the discharge affection often very considerably alleviated.

And thus opportunity at least afforded for most advantageous use of those remedies by which chance of combating.

This circumstance therefore led me in entering upon treatment, to have recourse to powder of Cream of Tartar.

Given however to quantity only, of Tea spoonful twice a day.

To this extent, could expect from it, but little influence in moving belly.

But when thus gradually introduced has best chance of operating as diuretic.

And although here wished, that belly should be kept gently open yet influence in way of diuresis was what chiefly wanted.

This effect however did not at first produce.

Or at least if any [increase], so inconsiderable as to escape observation.

While at same time no change in state of inclination to discharge, & in pain with which attended.

And quantity of viscid mucus continued nearly as before

Notwithstanding want of success however did not think of entirely deserting plan.

But while continued Cream of Tartar, wished also to employ another medicine more particularly calculated for [counteracting] cause of affection.

As such had recourse to Uva Ursi

This medicine need hardly observe first introduced on recommendation of Dr [D Ha] of Vienna as a remedy in Calculous cases.

And although in these, by no means found to answer expectations entertained, yet from repeated experiments, observed product of good effects, in cases of affections of urinary organs.

Often product of advantage even where reason for suspecting ulceration in these

But particularly have found in some other instances of this disease very considerable benefit from use.

This therefore has led me on present occasion to think of employment.

On what principle indeed here operates must own am very much at a loss to say.

In way of sensible qualities shows very considerable degree of bitterness & astringency.

And with this would seem also to contain a proportion of vegetable [matter].

But from all these combined activity cannot be inferred

Or at least from other articles possessing them to equal or even greater degree, have never been able to observe same effects.

Till therefore farther light thrown upon it, must consider it, as operating, in manner which [cannot] explain.

But if really producing effect, of diminishing discharge, & alleviating symptoms, this at least a matter of [illegible] consequence.

And here must confess that had recourse to it on empirical footing, or rather that of former experience than any other.

Only form under which have for my own part employed this article is that of powder of dried leaves.

And indeed am acquainted with no [other] under which has been used by any practitioner.

While at same time from powder, which very generally at least sits easily on stomach, may expect all affects which is capable of producing.

Here employed at first to extent only of ℥p taken in the morning.

But with intention of increasing quantity if found that borne with ease.

Accordingly now you will observe taken to same quantity thrice a day.

While at the same time as belly rather loose Cream of Tartar entirely omitted.

Cannot say that from this article more than former, patient has [yet] derived any considerable advantage.

But this not to be expected in very short time.

And for fair trial will require still longer continuation.

Mean therefore to persist in employment & if not product of inconvenience even increase quantity used.

If however in the end disappointed, which from what already said of prognosis by no means an [improbable] event have next thoughts of trying another active vegetable viz Hyoscyamus.

And if this also shall fail may have recourse in succession to Balsam Copaiba, Vitriolic Acid, or to Electricity.

In all these however must be regulated by circumstances at the time & by situation in which shall find patient after trial already begun

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Explanatory notes:

1) John Parnham, Dissertatio inauguralis de cystirrhoea (1772).