Title: Historical Article THE HISTORICAL ORIGINS OF INTERSTITIAL CYSTITIS
Abstract: Purpose: We identify early descriptions of interstitial cystitis and trace its evolution as a clinical entity during the 19th century. Materials and Methods: Primary and secondary source documents relating to interstitial cystitis, bladder inflammation and bladder stones were reviewed. Results: What is believed to be the earliest published record of interstitial cystitis appeared in an 1836 textbook by the Philadelphia surgeon Joseph Parrish, who documented a syndrome of chronic frequency, urgency, dysuria and pelvic pain he called “tic doloureux of the bladder.” Tic doloureux was a contemporaneous diagnosis used to describe painful, idiopathic disorders of nerves. Parrish attributed this term to his mentor, Dr. Phillip Syng Physick, who applied it to patients with severe lower urinary tract symptoms with no discernible etiology, with the most common etiology during the 19th century being bladder stones. A review of archival material from the Philadelphia College of Physicians indicates that by 1808 Physick had developed a concept of bladder inflammation, a “bladder ulcer,” that produced lower urinary tract symptoms in the absence of bladder stone. Conclusions: By 1808 Philip Syng Physick had described an inflammatory condition of the bladder producing the same lower urinary tract symptoms as a bladder stone. By 1836 he had expanded this concept to include a chronic frequency, urgency and pain syndrome occurring in the absence of demonstrable etiology. We propose that these are the earliest known descriptions of bladder inflammation and interstitial cystitis. Characterized by vague, nonspecific urinary and pelvic complaints, early interstitial cystitis (IC) is a subtle illness that often escapes detection. The presentation of severe, late stage IC is far more distinctive with chronic, debilitating lower urinary tract symptoms and pelvic pain occurring in the absence of other identifiable pathology. Not surprisingly then, it was the patient with severe, long-standing symptoms in whom physicians first discerned the syndrome that would later evolve into modern definitions of IC. Hunner of The Johns Hopkins Hospital in Baltimore produced the most well-known early report on IC in 1915, describing erythematous bladder lesions characteristic of end stage disease in 5 patients.1 Yet the same spectrum of urinary symptoms had already been documented by clinicians during the previous century, including Skene (who coined the term interstitial cystitis in 1887) of New York and Tait of London (1870).2 Indeed, what is believed to be the earliest published report of IC appeared in an 1836 textbook by the Philadelphia surgeon Parrish, who documented a syndrome of paroxysmal frequency, urgency, dysuria and pelvic pain in 3 patients.3 Unable to identify a specific etiology for the symptoms, Parrish diagnosed these patients with “tic doloureux of the bladder,” which was a vague term borrowed from contemporaneous descriptions of facial nerve disorders. We explore the origins of the term tic doloureux of the bladder, trace the relationship between tic doloureux and the diagnosis of bladder stones during the 19th century, and identify what we believe are the first known descriptions of bladder inflammation and interstitial cystitis by the surgeon Phillip Syng Physick. Within this framework we demonstrate that the clinical characterization of severe IC has remained essentially unchanged for 170 years.
Publication Year: 2004
Publication Date: 2004-01-01
Language: en
Type: article
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