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[Start of margin text]The Drs[End of margin text] From the Simple Representation of Mr Munros Case
[Start of margin text]Oppinion[End of margin text] Sent Decr 78- The Drs at Edinr Very Justly gave it as
Their Opinion, that it was Chiefly a Spasmodic Affection
of the Neck of the Bladder, but that this Depends upon
an Organic Affection, that is constantly present there

But whither it was Merely a Tumour, or if there was also
a Stone in the Bladder They could not be positive

[Start of margin text]Prescription[End of margin text] They prescribed Taking a full Dose of Laudanum, when
the Fitt Threatned, as also the Constant use of the Uva Ursi
in Powder, The Decoction of Althæa, Gumm Arabick, as also
to keep the Belly open, especially during the Operation of the
Opiates, either with the Flower of Sulph: or Rather the Oleum Resini
if it Could be Had– The Diet prescribed Was Salop for Breakfast
Chicken Broth or Broths of Young Meat for Dinner & Gruel for Sup:

[Start of margin text]Begun the Prescription The Uva Ursi[End of margin text] In the Begin' of Feby 1779 Mr Munro began with Some
Attention to observe Dr Cullens Prescription, & took Two Drachms of
the Uva Ursi in three Different Doses Each day, one in the Morning
one at Noon, & the third at Seven at Night- which for Some time
in Aprill thereafter, He Flatter'd himself would have the Desired
Effect, as he found Greater Ease, & Some Longer Intervals betwixt the
Fitts than he had before; As these fitts only Returned once in the
fourtnight, whereas formerly they Returned once in the Eight
or Ten Days, but the fitts Continued Longer when they Returned

[Start of margin text]The Laudanm[End of margin text] When Mr Munro felt his fitts coming on, He generally
took twenty or 24 Gutts of Laudanum, for two nights after
Each other, & took some Flr Sulph: to prevent Costiveness
this had litle Effect, except to ward off the Spasm for three
Days & generally they were Severer for four days Longer.

[Start of margin text]Ol: Resini[End of margin text] Finding the Sulph: Caused him perspire the night He
took it- He then Got from Edinr Olium Resini, which
he found an Easy Physick & a Great Expeller of Wind
Yet Like other Physicks, was attended afterwards with Constu¬
pation, for two Days afterwards

[Start of margin text]Althæa[End of margin text] Mr Munro Made Use Also of the Decotion of Althæa Roots
with Gum Arabick, but no good Effect from it, Yet He Con¬
tinued the Constant use of these Medicines in the Manner He
Understood Dr Cullen prescribed them - And Tho' He could not Say
but He found Considerable Relief from them, by the pills not being
so Frequent, Yet He did Not find that His Disease Subsided

[Start of margin text]A New attack[End of margin text] 22d Augt Last Mr Munro was Attacked with a Diarrhœa-
which Continued for four Days without any Greiping pains, and as

Mr Munro thought this might be an Effect of Nature, to give Relief, He did
not Discourage it- The Effect was that for two & twenty Days, He had no
Returns of his Fitt; But the one that came on Afterwards was Rather
Severer than Any he had, Since He began the Uva Ursi- As His Call to
Urine, was every ten or twelve Minutes, and the Spasm was Redoubled,
that is after the first Spasm was over, there was in two or three Seconds
an Inclination to More Urine, tho none pass'd except a Drop or Two
Yet the Spasm was as Strong as the first; Mr Munro's Relief after
this fitt was 22 Days Also-

[Start of margin text]A Cold[End of margin text] In the beginning of Novr He was Attacked with a Cold, which made
Him use Honey to Sweeten His Salop for Breakfast, as also his Gruel
for Supper, at the Same time He Continued Still, the Use of the Uva Ursi
and the other Medicines prescribed - He felt the Honey Increass his Urine,
& his belly was Easy During the Interval of his Fitt; Yet the Next Fitt
was Severer than any of the former Fitts, He feeling Three Spasms aft¬
er making Water- This made Him give up the Honey for Sweetning
to his Breakfast & Supper

[Start of margin text]Effects[End of margin text] Mr Munro had a Whole months Interval, in the Month's of Decr
Janry, Feby & March And Tho He has used the Uva Ursi, The Decoc¬
tion of Althœa- Constantly without Intermission; The Laudanum &
the Olium Resini, when Threatned with the fitt- He finds His Disease
not yeilding to these Medicines, only He has now Longer Intervals
betwixt his Fitts, Yet they Continue Alway's Eight Days, The Spasm
had Become Redoubled & the Last the Severest; Yet He finds that if
he Neglects taking the Uva Ursi, any part of the Day, that, the
Stoping in his Urine Comes on or the Calls to it are more frequent;

The Mr Munro had a fitt in Aprile; by taking the Laudanum
Early it Linger'd for Eight Days, & Did not come to the Usuall
Hight, nor had He the Redoubled Spaism, But his Releif was
only fourteen Days, & the Redoubled Spaism Come on the Second
Day of his Attack, tho It Ded not Usually Come on til the fou[rth]
Day, and He is now under that fitt in May; but hopes for Relief
Sooner than the Usual term of Eight Days

[Start of margin text]Further observations[End of margin text] Mr Munro Has further to Observe, That the Flatulency in His
Bowels is not So Noisy as Formerly, Ever Since He began to have
His fitts only at a Month's Interval; He has not felt the Swellings
in the Testicles for Near Six Months; nor is the Jetting out of the
Rectum so frequent, nor so protuberant as Formerly; But He finds
a Hard kind of a Tumour at the Anus, by the Side of the Rectum
on the left Side, Which Increasses gradually with the Fitt & Rises
to the Bigness of a Small Hens Egg, when the fitt is at the Worst
& Subsides when he Gets Relief from the Fitt; It once or Twice
obstructed the Glister pipe, when Mr Munro thought it Necessary
to get an Injection for his Relief in a Severe fitt-

It is Impossible to tell the Different turns of this Disease, as-
Sometimes the fitt Begins with a pain at the top of the Penis, & then

goes Downwards to the Anus, at other times it begins by a pain
in the Low part of the belly; But most frequently by a pain and
obstruction at the Anus, which goes up by Degrees to the Penis
at any of these period Mr Munro finds it very Uneasy to Sitt
in his Chair- Especially when there is any protuberance at the Rect[um]

The Urine is Sometimes Clear, without any Sediment, especially before
the Fitt, & then it is plenty, tho it comes frequently- In the Fitt it is
very Thick & Dark Colour'd the Sediment of a Chalky like Substance

In the Two Last fitts the Sediment was a thick, Slymie kind of
Substance, Like the Mucus, or Defluctions a person has with a Cough,
The Laudanum always alters the Colour of the Sediment & Makes it
Dark and Drumbly

The Greatest Distress during the Fitt Seems to be from Obstructed Wind
which Swells the Penis and anus in the time of Making the litle water that
is got- And If there is any thing Like Hysterical Wind in Men, Mr Munro
Imagines his complaints are attended with these, & has many Symptoms
of the Nervous kind, the Least Sudden Noise affects Him; tho He is Easy
yet thinking on the pain of Making urine brings it on &c

Mr Munro has Still an Apetite for Such Food as he takes, Has Good
Spirits, but his flesh is greatly decayed & his Strength Impared; His former
Cloths, are at least Six or Eight Inches in Circumference too Wide for Him
how, & his Leggs are Like Distaffs

The only part of the prescription that has not been Observed, was
the Applying Leeches to the Anus when the Rectum was protuberant-
But after the most Dilligent Search on Different Countrys, they could
not be Got; which is the only Reason that Prevented their being Used.
Mr Munro had a Return within Twice, within these Six weeks
of the Bloody Piles, but No Evidence of Good Effects from them

Mr Munro has been Rather too particular in his Informati¬
on, & it is by Much too Long- But He could not think of Omitting
any thing for the Information of So Generous Drs tho they would
have trouble in Reading it, as they were at So great a Distance
from Him

{illeg}
Case To
Dr Cullen

May 1780
XI. p. 17