1137 DIAGNOSING THOMAS JEFFERSON: LOWER URINARY TRACT SYMPTOMS IN 1825

Abstract

You have accessJournal of UrologyHistory of Urology1 Apr 20101137 DIAGNOSING THOMAS JEFFERSON: LOWER URINARY TRACT SYMPTOMS IN 1825 Erin Grantham and John Phillips Erin GranthamErin Grantham More articles by this author and John PhillipsJohn Phillips More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2373AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thomas Jefferson (1743-1826) kept records of all the letters he sent or received. Among his papers are correspondence with two physicians, Thomas Watkins and Robley Dunglison. From these documents, we explore etiological beliefs and available treatments of the early seventeenth century for lower urinary tract symptoms (LUTS). METHODS Information was gathered from Library of Congress and National Library of Medicine records, including some reproductions of original documents. Historical uses of medicines were identified via 17th century pharmacy texts re-published by google books. RESULTS In May 1825, Watkins wrote Jefferson a letter regarding Jefferson's symptoms. Dysuria, he states, is caused by a chronic state of inflammation or ulceration of the prostatic part of the urethra or neck of the bladder. Over the next paragraph, he enumerates possible causes: gonorrhea; stricture; obstruction; ulceration; infection seeding from an eruption elsewhere; riding on horseback; stimulant diet; and all wines. For treatment, he suggests: opium, prescribed for almost all medical problems in that era; mercury, a treatment for syphilis but not gonorrhea; hemlock, a muscle relaxant; castor oil to obviate costiveness from the opium; slippery elm, an anti-inflammatory; and gum arabic, used to sooth irritations. Interestingly, despite suggesting gonorrhea as a possible etiology, he does not propose silver nitrite or lead, which were commonly used at that time as anti-gonorrheals. If medical therapy were to fail, he states the application of Bougies may be indispensable. Shortly after receipt of that letter, Jefferson met Dunglison. Unlike Watkins' medicinal suggestions, he went straight to the heart of Jefferson's urinary difficulties and prescribed urethral dilation with a bougie, teaching Jefferson how to self administer treatments. Jefferson writes of his improvement to Dunglison in November 1825: My intervals have averaged thro' this month an hour during the day and 3/4 in the night. While an inadequate treatment response by today's standards, Jefferson glows I rode about my garden half an hour without any inconvenience. CONCLUSIONS Jefferson's stature as historical figure, the preservation of his papers, and his misfortune to suffer from severe LUTS allow us to gain insight into early perceptions of the issue. Going through these letters gives us the experience of what it was like to diagnose and treat urological problems in the 1820s. Valhalla, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e440 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erin Grantham More articles by this author John Phillips More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...