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A. B. turned 50 years of age, by Profession a Surgeon & Man Midwife, of a
melancholic Temperament, & never married – complains of
certain Paroxysms, of some Days together, of a Sensation of Heat &
Emanating Pain in the Urethra from the Beginning of the
Perineum up to the Bladder; also of a Feeling as if some
foreign Body pressed upon the Neck of the Bladder producing a
constant Irritation to pass his Urine which is discharged, both
in Quantity & Quality, as in the extream Degree of an hysteric
Paroxysm; & thinks himself much weakened by this Discharge.
Has also at the same Time a considerable Pain in his Loins,
both up & in a Bed, accompanied with a general Langour &
Debility, with Flatulency & extream Dejection of Mind; and when at
the worst, will ↑not↑ get any sleep for several Nights together; but will
be affected with universal Tremors & in particular, violent
spasmodic Contractions & motions of the Bladder Rectum & Genitals
producing the greatest Torment. When these Paroxysms are off
he is much easier; but not quite free from several of the Symptoms.
He complains also, that either sitting or riding for any Time, unless
upon a Chair, or Saddle, which is hollow in the middle, will excite
the Pain in {illeg} & bring on the whole Paroxysm; & also that
whenever he is costive, the Discharge of stools forces a small Quantity
of Liquor from the Urethra of a seminal Appearance.

Pulse 72 but weaker than formerly - Appetite impaired & Digestion
bad. Belly regular for the most Part. Urine passed freely & of natural
Colour, when free from the Paroxysms. Breathing not quite so
easy & regular as formerly. Skin dry, especially the Palms of

He has frequently (particularly when in his Apprenticeship)
being guilty of Pollutio sui; to which he now attributes the
most of his Complaints. About 9 years ago he had
some appearance of venereal Symptoms in Particular
a Paraphymosis: all which went off by the Use of opening
Medicines & some Mercurials; except some Degree of stricture
from the Prepuce behind the Glans, which has remained
ever since, & keeps the Latter preternaturally inlarged.

He has had dyspeptic symptoms at Times near 30 years
but his Hypochondriac Complaints never became very
troublesome & till about 7 years ago, 2 years after the before
mentioned venereal symptoms; nor the Irritation of the
Bladder & Genitals, till about 4 years ago; since which
Time his Complaints have been variable; but rather [inexcepting?]
upon the whole; altho' he has tryed a great many Remedies,
& has had the Advice of several Physicians, both in York &
London. Opiates, Anodyne Glysters, & warm Bathing, have
sometimes given him Relief in the Paroxysms; but thinks
the latter always weakened him. Has in the Intervals
of the Paroxysms used cold Bathing frequently & taken considerable
Quantities of Bark, as Tonics, but without much Relief.

N. B. A Schirrus of the Prostate Gland has been often suspected
as the proximate Cause of his Local Complaints; but both
Dr. Hunter & Mr. Sharp examined the Parts by introducing
a Finger up the Rectum, about 2 Months ago & declare
that all the Parts are natural, & apparently free from
Disease. –––

To
Dr. Cullen

Case of A. B from
Mr Fowler. 22d May 1776