DEP/DUA/1/45/12 (Normalised version)

James Shulbread

(1788-1789)

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N^o31 James Shulbread at 59

Complaint of this patient consists entirely in an affection of urinary discharge.

But cannot I own, form decided opinion with regard to nature.

Among symptoms mentioned not a few which frequently observe to be consequence of calculus in Bladder

Particularly pain striking to glans penis.

And relief in discharge of water from change of [position].

For while pain & difficulty in discharge of water, & bloody or mucus appearance in water discharged may arise from different causes, these more particularly, give presumption of this cause being calculus.

From these considerations then thought it proper to determine by more accurate trial, [whether] calculus present or not.

And with this view directed patient to be sounded.

But on this examination no stone felt.

Hence evidence of non-existence at least [stronger] than circumstances giving suspicion of presence.

And led to conclusion therefore that is an example of Dysuria arising from some other cause.

Here some reason for conjecture that depends rather, on state of kidney than of bladder.

At least circumstances also favouring that supposition.

Particularly deep red colour observed in urine & pain about region of loins.

In these indications of some morbid affection in [secreting] organ.

And well known that from diminished & morbid secretion pain & difficulty in the discharge often produced.

On this conjecture respecting disease practices hitherto directed have proceeded.

For as a means of removing irritation & promoting discharge, have had recourse to a mucilaginous mixture combined with a gentle diuretic.

And with view to alleviation of pain add to this a proportion of an opiate.

While at same time, still more to forward discharge of urine, directed for common drink an infusion of Juniper.

An article operating not merely as diluent, but also from essential oil it contains, in some degree as diuretic.

Since these medicines begun, patient we are informed, in every respect better.

Not only discharge of urine with less pain & difficulty, which perhaps might be ascribed to mere operation of sounding, but also nothing of deep colour or preternatural appearance.

Circumstances arguing change in state of secretion.

But how far these favourable changes in any degree effect of practice [here] employed, am I own very doubtful.

Any observations however on this subject fall to be mentioned when again treat of case, in order of list.