The Consultation Letters of Dr William Cullen (1710-1790) at the Royal College of Physicians of Edinburgh
[ID:1330] From: Dr William Cullen (Professor Cullen) / To: [ADDRESSEE UNKNOWN] / Regarding: Mr John Davidson (of Ravelrigg) (Patient) / 1776? / (Outgoing)
Reply 'For Mr Davidson of Ravelrigg'. Substantial working draft of guidance on how to manage his gout in Cullen's hand with his detailed editorial marks indicating revisions to the paragraphing.
- Facsimile
- Normalized Text
- Diplomatic Text
- Metadata
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- People
- Places
Facsimile
There are 16 images for this document.
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Metadata
| Field | Data |
|---|---|
| DOC ID | 1330 |
| RCPE Catalogue Number | CUL/1/2/428 |
| Main Language | English |
| Document Direction | Outgoing |
| Date | 1776? |
| Annotation | None |
| Type | Authorial original |
| Enclosure(s) | No enclosure(s) |
| Autopsy | No |
| Recipe | No |
| Regimen | Yes |
| Letter of Introduction | No |
| Case Note | No |
| Summary | Reply 'For Mr Davidson of Ravelrigg'. Substantial working draft of guidance on how to manage his gout in Cullen's hand with his detailed editorial marks indicating revisions to the paragraphing. |
| Manuscript Incomplete? | No |
| Evidence of Commercial Posting | No |
Case
Cases that this document belongs to:
| Case ID | Description | Num Docs |
|---|---|---|
| [Case ID:655] |
Case of Mr John Davidson of Ravelrigg, who is given a very substantial regimen in order to manage his gout. |
2 |
People linked to this document
| Person ID | Role in document | Person |
|---|---|---|
| [PERS ID:1] | Author | Dr William Cullen (Professor Cullen) |
| [PERS ID:1313] | Patient | Mr John Davidson (of Ravelrigg) |
| [PERS ID:1] | Patient's Physician / Surgeon / Apothecary | Dr William Cullen (Professor Cullen) |
Places linked to this document
| Role in document | Specific Place | Settlements / Areas | Region | Country | Global Region | Confidence |
|---|---|---|---|---|---|---|
| Place of Writing | Edinburgh | Edinburgh and East | Scotland | Europe | inferred | |
| Destination of Letter | Ravelrigg | Edinburgh and East | Scotland | Europe | inferred |
Normalized Text
For Mr Davidson of Ravelrigg
It is sufficiently evident that there is a gouty disposition
in his body & I am well persuaded that all his late ailments
& the present flatulency of his stomach entirely depend upon
it.
These ailments are of difficult management but I am
persuaded that the difficulty arises from our not knowing the
nature of them & from persons not being steady enough in
persuing the proper means for avoiding them.
It is necessary in the first place to know that in every
person of a gouty disposition there is a ballance to be main¬
tained between the internal & external parts; and more
particularly between the stomach &
joints of the extremi¬
ties. When the tone of the stomach is firm & there is no
preternatural resistance in the joints
↑in the shape of inflammation↑
the disease is thrown
upon the latter; but when the tone of the stomach is weak¬
ned or any resistance prevails in the joints the disease
appears in a variety of anomalous symptoms in the inter¬
nal parts but more especially in the stomach itself with
[Page 2]
symptoms which denote a loss of tone in it: as want of ap¬
petite, indigestion, flatulency,spasmodic pains & perhaps
vomitings. After giving this general idea we must observe
that this balance is often in a nicely vibrating state & is ea¬
sily determined to turn on one side or other.
It might be supposed that this might be the case of certain
times only, when the gouty
disposition prevails more considerably
in the system & it may be so; but it is not easy to observe those
times & in many persons there is reason to believe that the
gouty disposition is so consistently present & the balance in so
vibrating a state as to require a constant attention.
It is therefore a first & very universal rule with regard to
all gouty persons that they study a very uniform manner of life.
The human body is naturally suited to a great inequality & vi¬
cissitude in the manner of living & Celsus's rule of varium
habere vitae genus 1 is certainly a proper one for preserving the health
of all sound & entire persons but in all persons who have
got into a gouty disposition & have a nice ballance to maintain
it is a very dangerous rule because every considerable change
of manner may turn the balance too much one one side.
[Page 3]
To be more particular with regard to the circumstances
of this uniformity it is especially to be studied with regard
to the stomach & the quality of ailments have
a considerable influence. After a person ↑has been↑ as most gouty persons
have been, accustomed to a large proportion of animal food
they cannot abstain from it entirely without letting down the
tone of the stomach & that of the system depending upon it
to a dangerous degree. I believe it is true that persons have
been cured of the gout by a total abstinence from meat but
I am at the same time persuaded that it is only in persons
of youth & vigour in whom the balance is entirely in favour
of the internal parts; & however that may be; the practice is
certainly not admissable in persons in whom the balance has
been observed to incline already to the other side. This is cer¬
tainly Mr Davidson's case & therefore I advise him to per¬
sist in the use of animal food but at the same time as
the stomach can be very much weakened by being frequent¬
ly overloaded he should always make a choice of the quality
& be moderate in the quality of his animal food. If he
[Page 4]
knows any particular kind which to him is of difficult
digestion such he ought to at all time to avoid & in general
as it is oily & fat meats that are of difficult digestion
these in general he ought to avoid or take very sparingly.
Whatever be the quality of animal food the sharp ap¬
petite of gouty persons is ready to make them take too
much. & This is to be guarded against & as I do not trust
to any man's rising as they say with an appetite, I would
rather advise it being cheated, as it may ↑be↑ in many persons
by taking a quantity of broth before the meat & in
all ↑persons,↑ by
filling up the meal, that is, in part satisfying the ap¬
petite by pudding roots or greens. The two latter are apt
to be troublesome by their flatulency &
such kinds ↑ as↑ are
particularly disposed to be so, as cabbage, should be en¬
tirely avoided; but I am well persuaded that every man
who takes animal food should take as large a propor¬
tion of vegetable as he can digest without acescency or
flatulency. I have said nothing of the difference of flesh &
[Page 5]
fish because I think it of little importance; But I think
the latter is rather less safe than the former because we
are both liable to take them in greater quantity & because
they are less perspirable & therefore continue longer to load
the system which is especially to be applied to Salmon
herring & some other of the heavier kinds.
I have said nothing either of the simplicity or mix¬
ture of Diet because I think the latter is no otherwise
hurt full than as it engages to take more upon the whole
than we would otherwise do & that effect is certainly to be
avoided.
If it be just as we have said before that it is oily &
fat meats which are of difficult digestion it will apply
to all fat & heavy sauces. Here take in what stands at A.
G With regard to the moderation necessary in diet we
have only to add that meat is to be taken but once a day &
therefore to be entirely avoided at supper & I consider eggs
as a species of animal food of the richest kind.
[Page 6]
It is at supper that milk is especially to be admitted
in all persons who can digest it tolerably. The animal food
is to be avoided, vegetables alone & especially the more acces¬
cent kinds of roots, greens & fruit are not to be taken &
the most proper is milk & farinacea as the proper medium
between the purely animal & vegetable aliment. With
respect ↑N L↑ 2 With respect to drink it is in the first place
to be observed that acids are among the most powerful
means of weakening the tone of the stomach & therefore
not only acids themselves but all liquours are ready to become
acescent & acid are to be avoided. This comprehends the
whole of fermented liquors & especially those of the weaker
kinds & particularly the most part of malt liquours as more
ready to become acesant than Wines. To persons however
who have been long accustomed to some quantity of strong
drink every day, it would be very dangerous to abstain
from it entirely & therefore as we have not yet found out
a safe substitute for wine I would advise Mr Davidson to
[Page 7]
to contine to take a moderate quantity of it every day
at dinner but it should be of the stronger kinds only &
which perhaps have a little brandy in them, as genuine
made↑i↑ra, good sherry, or moderately old red port. These
if taken very moderately may be taken plain but more safely
still if diluted with water & for ordinary draught they
should be largely so diluted. The weather & more acesant
wines as claret, Burgundy ↑Champaign↑ & Hock are in my opinion
dangerous for every gouty person whose stomach is in
any degree affected. Most other wines as being brewed &
of uncertain quality are to be intirely avoided. When
I excluded above all kind of malt liqurs as too readily
acescant I might have made an exception as many
people do, of Porter & I own that this liquour is frequently
in a condition to be safe with respect to its acesency,
but it is frequently of uncertain quality & therefore re¬
quires caution & I observe that the most part of people
who use it take it in ↑a↑ larger quantity than they ought
↑ to take↑ of any strong drink. Here take in what is at B
[Page 8]
E On the subject of drink I must observe that ↑both↑ tea &
coffee both of them weaken the tone of
the stomach &
dispose to acescency: they are therefore to be avoided by
gouty persons or the first is to be taken very weak. If
Mr Davidson be much attached to tea or something in
the form of it he may continue to use it but must either
take the Indian tea or a tea made of some herb of homegrowth
↑such↑ as
sage, rosemary, balm &c. Go to H.
B (I should have said before that Besides wine the
other form of strong drink to employ is of punch.
This if taken moderately, pretty strong & with little
fruit & sugar may be aften tolerably safe but if punch
whether weak or strong be taken with much fruit &
sugar it does as much harm to the stomach as any
wine whatever. In certain stomachs of great delicacy
with respect to acidity we are obliged to have recourse
to spirits & water & this certainly secures against the
[Page 9]
acidity &flatulency of drinks & in some measure of
meats but it is so liable by habit to lead to an increase of the
spirit & is otherwise so liable to hurt the tone of the stomach
that I advise every body to abstain from it as long as they
can.) Here take in what is marked at D ---
The effects of stimulating & heating things upon the
A stomach puts me in mind of saying that ↑N.L.↑ Spiceries moderate¬
ly taken may be useful & at least allowable but the East In¬
dian practice of high seasoning & large use of Cayenne
is certainly hurtful. Mustard is much safer than the
spiceries of the torrid zone & Pickles of all kinds as chiefly
acid are to be avoided & any free use of vinegar is also
improper.) Go to G
H Nothing is so necssary to support the vigour & due ballance
of the sytem & a full determination to the extreme vessels as
Exercise & therefore people in constant labour never have
the gout. People however of better condition will not subject
themselves to this & very often their occupations will not
allow them; but every man must admit of it in some measure
[Page 9]
or be subject to the disease & this is particularly the case
of the gouty. Let Mr Davidson therefore devote some part
of his time to exercise & as much of it as he conveniently
can but at the same time let him avoid getting into the
habit of any certain measure. Let him some days take
more sometimes less & somedays none at all.
Walking is very proper but it should be moderate for
an excess of it is likely to excite the gout &
at the same time
it is not favourable to its taking the proper course. I have
known a day in the Moors bring on a violent fit & I
have known the same, throw it on the stomach.
Riding ↑on horseback↑ therefore is a much safer & more effectual
exercise. It may be pushed farther but it is necessary in
pushing it to avoid both cold & fatigue. Here take in what is marked at C
F It is proper to observe here that Cold is to be very stu¬
diously avoided by all gouty persons. They should alway
be warmly cloathed & never make any change from thick
or to thinner, not even from winter to summer, in this
climate. They would always be safer in having woollen every
[Page 10]
where next to their skin. This is particularly necessary with
respect to the lower extremities: they should always wear
two pairs of stockings & the under ones of worsted. With
sufficiently thick shoes. These precautions are not only ne¬
cessary by day, but it will be useful also to wear worsted
footsocks during the night & to have while the whole of
their body is well covered, to have their feet & legs covered
a little better than the rest.
Every other precaution against cold is to be taken but
the particulars need not be mentioned to Mr Davidson;
but one not always viewed in the light I must take
notice of & that is the use of the flesh brush every mor¬
ning. This guards against cold by supporting the vigour
of the perspiration & is particularly useful to gouty per¬
sons in supporting the vigour of the circulation in the
extremeties; so that I believe that Sir William Temple's
maxim is nearly true that no person, who has a slave to
employ the flesh brush sufficiently, need to have the gout. 3
Let Mr Davidson take the hint & have the flesh brush em¬
[Page 10]
ployed in the morning, if not constantly at least frequently.
I think the using of it in the Evening is not necessary.
It is of the utmost consequence to gouty persons to go
to bed by times at night & not to lye too long in the morning
tho in the latter article more indulgence may be granted.
While the exercise of the body is so necessary that of the
mind is rather to be avoided or to be managed with
great discretion. It is proper for the health of every
man to have some occupation, pursuit or attachment
but the occupation should be with little labour & still
less of anxiety of mind & that is the best which leads
to some exercise of the body. Of all other employments
farming is the most healthful. ↑N.L.,↑ I would willingly bid
my patients avoid all vexation of spirit but I leave it
to Philosophers & Divines for I dont find that my prea¬
ching has any effect unless the disposition & discretion
of the patient is very favourable & that will do without
pre any preaching at all. Tho it be indeed very difficult
to guard upon every occasion against vexation of spirit
[Page 11]
there are however some occassions which may be avoided:
& I mean here particularly gaming; against which to cau¬
tion Mr Davidson I take to be extremely unnecessary
but to make my system couplet 4 I must say that chess is
almost as bad as fluxions & if games of chance are at¬
tended with any emotion or agitation of passions they
are very hurtful.
I think I have touched most of the articles of
Regimen & on the subject of Medicine I can be very short.
When his appetite is bad & he has any reason to
think his stomach full of acidity or loaded with phlegm
a gentle vomit may prevent more troublesome ailments;
but I would have him avoid the frequent practice of
them & as long as he can possibly find that some fas¬
ting & a good deal of riding may supply the place of a vomit.
Nothing hurts the functions of the stomach more
than costiveness & every approach to it should be obviated
[Page 12]
with care. Mr Davidson's own skill & experience will
suggest the proper means.
It has been usual in all complaints of the stomach to
employ bitters & tonic medicine & I have no objection to
Mr Davidson's taking sometimes a little bark or what I
think more safe a chalybeate medicine: but I am very
certain that the frequent & long continued use of bitters &
bark is pernicious to gouty persons & therefore I would
have Mr Davidson to use them very seldom & never long
at one time.
There is another sort of remedies that may perhaps
also be carried to abuse but they are generally more safe
& these are Alcalines. A dose of Magnesia employed
as a laxative is often proper.
A draught of lime water
taken pretty frequently has often a good effect & I have
often found excellent effects from the caustic lixivium in
gouty persons but I cannot think it necessary for Mr Davidson
at present.
[Page 13]
C. Going in a Single horse Whisky or Chaise which a man
drives himself is an exercise nearly as usefull as riding
on horseback and in some respects as in guarding against
cold and wet it may be better. A close & easy
four wheeled carraige may be employed in Winter but
unless the Journey made is long it does not go so far
by half as riding on horseback. Go to F
D. I believe it is necessary to tell Mr Davidson that moderation
in strong drink is proper but the observation of it is of such
importance that I cannot altogether ommit it. I have said
that some quantity of strong drink is proper & even neces¬
sary to persons who have been accustomed to it: but any quan¬
tity that can heat a man is hurtfull & every dgeree of intoxi¬
cation may be pernicious. The effects of one trespass may
not be observed but its tendency to weaken the system & in
particular the stomach, & repetition must ↑at length↑
destroy it altogether. Go to E
[Page 13]
✍
Directions
for
Davidson of Ravelrig.
Gout.
1776
Notes:
1: The phrase is taken from the Roman writer Aulus Cornelius Celsus (c.25-50 BC). The extant parts of his De Medicina are a primary source for Roman medicine. Cullen is quoting from his discussion of how a healthy man has no need for a physician but to keep well he should "vary his way of life". In a contemporary translation the passage reads: ''Tis good for him to diversify his way of life; to be sometimes in the country, sometimes in the city...'. See A. Cornelius Celsus of medicine. In eight books. Translated, with notes critical and explanatory, by James Greive, M.D. (London: 1756), p. 21.
2: Part of Cullen's editorial mark-up for revising his draft. It presumably means start a "new line" here.
3: ''Tis a saying among the Indians, that none can be troubled much with the Gout, who have Slaves enough to Rub them...' (Sir William Temple, 'An Essay Upon Heath and Long Life', Miscellanea; The Third Part (London, 1701), p. 156).
4: Error in the original for 'complete'.
Diplomatic Text
For Mr Davidson of Ravelrigg
It is sufficiently evident that there is a gouty disposition
in his body & I am well persuaded that all his late ailments
& the present flatulency of his stomach entirely depend upon
it.
These ailments are of difficult management but I am
persuaded that the difficulty arises from our not knowing the
nature of them & from persons not being steady enough in
persuing the proper means for avoiding them.
It is necessary in the first place to know that in every
person of a gouty disposition there is a ballance to be main¬
tained between the internal & external parts; and more
particularly between the stomach &
joints of the extremi¬
ties. When the tone of the stomach is firm & there is no
preternatural resistance in the joints
↑in the shape of inflammation↑
the disease is thrown
upon the latter; but when the tone of the stomach is weak¬
ned or any resistance prevails in the joints the disease
appears in a variety of anomalous symptoms in the inter¬
nal parts but more especially in the stomach itself with
[Page 2]
symptoms which denote a loss of tone in it: as want of ap¬
petite, indigestion, flatulency,spasmodic pains & perhaps
vomitings. After giving this general idea we must observe
that this balance is often in a nicely vibrating state & is ea¬
sily determined to turn on one side or other.
It might be supposed that this might be the case of certain
times only, when the gouty
disposition prevails more considerably
in the system & it may be so; but it is not easy to observe those
times & in many persons there is reason to believe that the
gouty disposition is so consistently present & the balance in so
vibrating a state as to require a constant attention.
It is therefore a first & very universal rule with regard to
all gouty persons that they study a very uniform manner of life.
The human body is naturally suited to a great inequality & vi¬
cissitude in the manner of living & Celsus's rule of varium
habere vitae genus 1 is certainly a proper one for preserving the health
of all sound & entire persons but in all persons who have
got into a gouty disposition & have a nice ballance to maintain
it is a very dangerous rule because every considerable change
of manner may turn the balance too much one one side.
[Page 3]
To be more particular with regard to the circumstances
of this uniformity it is especially to be studied with regard
to the stomach & the quality of ailments have
a considerable influence. After a person ↑has been↑ as most gouty persons
have been, accustomed to a large proportion of animal food
they cannot abstain from it entirely without letting down the
tone of the stomach & that of the system depending upon it
to a dangerous degree. I believe it is true that persons have
been cured of the gout by a total abstinence from meat but
I am at the same time persuaded that it is only in persons
of youth & vigour in whom the balance is entirely in favour
of the internal parts; & however that may be; the practice is
certainly not admissable in persons in whom the balance has
been observed to incline already to the other side. This is cer¬
tainly Mr Davidson's case & therefore I advise him to per¬
sist in the use of animal food but at the same time as
the stomach can be very much weakened by being frequent¬
ly overloaded he should always make a choice of the quality
& be moderate in the quality of his animal food. If he
[Page 4]
knows any particular kind which to him is of difficult
digestion such he ought to at all time to avoid & in general
as it is oily & fat meats that are of difficult digestion
these in general he ought to avoid or take very sparingly.
Whatever be the quality of animal food the sharp ap¬
petite of gouty persons is ready to make them take too
much. & This is to be guarded against & as I do not trust
to any man's rising as they say with an appetite, I would
rather advise it being cheated, as it may ↑be↑ in many persons
by taking a quantity of broth before the meat & in
all ↑persons,↑ by
filling up the meal, that is, in part satisfying the ap¬
petite by pudding roots or greens. The two latter are apt
to be troublesome by their flatulency &
such kinds ↑ as↑ are
particularly disposed to be so, as cabbage, should be en¬
tirely avoided; but I am well persuaded that every man
who takes animal food should take as large a propor¬
tion of vegetable as he can digest without acescency or
flatulency. I have said nothing of the difference of flesh &
[Page 5]
fish because I think it of little importance; But I think
the latter is rather less safe than the former because we
are both liable to take them in greater quantity & because
they are less perspirable & therefore continue longer to load
the system which is especially to be applied to Salmon
herring & some other of the heavier kinds.
I have said nothing either of the simplicity or mix¬
ture of Diet because I think the latter is no otherwise
hurt full than as it engages to take more upon the whole
than we would otherwise do & that effect is certainly to be
avoided.
If it be just as we have said before that it is oily &
fat meats which are of difficult digestion it will apply
to all fat & heavy sauces. Here take in what stands at A.
G With regard to the moderation necessary in diet we
have only to add that meat is to be taken but once a day &
therefore to be entirely avoided at supper & I consider eggs
as a species of animal food of the richest kind.
[Page 6]
It is at supper that milk is especially to be admitted
in all persons who can digest it tolerably. The animal food
is to be avoided, vegetables alone & especially the more acces¬
cent kinds of roots, greens & fruit are not to be taken &
the most proper is milk & farinacea as the proper medium
between the purely animal & vegetable aliment. With
respect ↑N L↑ 2 With respect to drink it is in the first place
to be observed that acids are among the most powerful
means of weakening the tone of the stomach & therefore
not only acids themselves but all liquours are ready to become
acescent & acid are to be avoided. This comprehends the
whole of fermented liquors & especially those of the weaker
kinds & particularly the most part of malt liquours as more
ready to become acesant than Wines. To persons however
who have been long accustomed to some quantity of strong
drink every day, it would be very dangerous to abstain
from it entirely & therefore as we have not yet found out
a safe substitute for wine I would advise Mr Davidson to
[Page 7]
to contine to take a moderate quantity of it every day
at dinner but it should be of the stronger kinds only &
which perhaps have a little brandy in them, as genuine
made↑i↑ra, good sherry, or moderately old red port. These
if taken very moderately may be taken plain but more safely
still if diluted with water & for ordinary draught they
should be largely so diluted. The weather & more acesant
wines as claret, Burgundy ↑Champaign↑ & Hock are in my opinion
dangerous for every gouty person whose stomach is in
any degree affected. Most other wines as being brewed &
of uncertain quality are to be intirely avoided. When
I excluded above all kind of malt liqurs as too readily
acescant I might have made an exception as many
people do, of Porter & I own that this liquour is frequently
in a condition to be safe with respect to its acesency,
but it is frequently of uncertain quality & therefore re¬
quires caution & I observe that the most part of people
who use it take it in ↑a↑ larger quantity than they ought
↑ to take↑ of any strong drink. Here take in what is at B
[Page 8]
E On the subject of drink I must observe that ↑both↑ tea &
coffee both of them weaken the tone of
the stomach &
dispose to acescency: they are therefore to be avoided by
gouty persons or the first is to be taken very weak. If
Mr Davidson be much attached to tea or something in
the form of it he may continue to use it but must either
take the Indian tea or a tea made of some herb of homegrowth
↑such↑ as
sage, rosemary, balm &c. Go to H.
B (I should have said before that Besides wine the
other form of strong drink to employ is of punch.
This if taken moderately, pretty strong & with little
fruit & sugar may be aften tolerably safe but if punch
whether weak or strong be taken with much fruit &
sugar it does as much harm to the stomach as any
wine whatever. In certain stomachs of great delicacy
with respect to acidity we are obliged to have recourse
to spirits & water & this certainly secures against the
[Page 9]
acidity &flatulency of drinks & in some measure of
meats but it is so liable by habit to lead to an increase of the
spirit & is otherwise so liable to hurt the tone of the stomach
that I advise every body to abstain from it as long as they
can.) Here take in what is marked at D ---
The effects of stimulating & heating things upon the
A stomach puts me in mind of saying that ↑N.L.↑ Spiceries moderate¬
ly taken may be useful & at least allowable but the East In¬
dian practice of high seasoning & large use of Cayenne
is certainly hurtful. Mustard is much safer than the
spiceries of the torrid zone & Pickles of all kinds as chiefly
acid are to be avoided & any free use of vinegar is also
improper.) Go to G
H Nothing is so necssary to support the vigour & due ballance
of the sytem & a full determination to the extreme vessels as
Exercise & therefore people in constant labour never have
the gout. People however of better condition will not subject
themselves to this & very often their occupations will not
allow them; but every man must admit of it in some measure
[Page 9]
or be subject to the disease & this is particularly the case
of the gouty. Let Mr Davidson therefore devote some part
of his time to exercise & as much of it as he conveniently
can but at the same time let him avoid getting into the
habit of any certain measure. Let him some days take
more sometimes less & somedays none at all.
Walking is very proper but it should be moderate for
an excess of it is likely to excite the gout &
at the same time
it is not favourable to its taking the proper course. I have
known a day in the Moors bring on a violent fit & I
have known the same, throw it on the stomach.
Riding ↑on horseback↑ therefore is a much safer & more effectual
exercise. It may be pushed farther but it is necessary in
pushing it to avoid both cold & fatigue. Here take in what is marked at C
F It is proper to observe here that Cold is to be very stu¬
diously avoided by all gouty persons. They should alway
be warmly cloathed & never make any change from thick
or to thinner, not even from winter to summer, in this
climate. They would always be safer in having woollen every
[Page 10]
where next to their skin. This is particularly necessary with
respect to the lower extremities: they should always wear
two pairs of stockings & the under ones of worsted. With
sufficiently thick shoes. These precautions are not only ne¬
cessary by day, but it will be useful also to wear worsted
footsocks during the night & to have while the whole of
their body is well covered, to have their feet & legs covered
a little better than the rest.
Every other precaution against cold is to be taken but
the particulars need not be mentioned to Mr Davidson;
but one not always viewed in the light I must take
notice of & that is the use of the flesh brush every mor¬
ning. This guards against cold by supporting the vigour
of the perspiration & is particularly useful to gouty per¬
sons in supporting the vigour of the circulation in the
extremeties; so that I believe that Sir William Temple's
maxim is nearly true that no person, who has a slave to
employ the flesh brush sufficiently, need to have the gout. 3
Let Mr Davidson take the hint & have the flesh brush em¬
[Page 10]
ployed in the morning, if not constantly at least frequently.
I think the using of it in the Evening is not necessary.
It is of the utmost consequence to gouty persons to go
to bed by times at night & not to lye too long in the morning
tho in the latter article more indulgence may be granted.
While the exercise of the body is so necessary that of the
mind is rather to be avoided or to be managed with
great discretion. It is proper for the health of every
man to have some occupation, pursuit or attachment
but the occupation should be with little labour & still
less of anxiety of mind & that is the best which leads
to some exercise of the body. Of all other employments
farming is the most healthful. ↑N.L.,↑ I would willingly bid
my patients avoid all vexation of spirit but I leave it
to Philosophers & Divines for I dont find that my prea¬
ching has any effect unless the disposition & discretion
of the patient is very favourable & that will do without
pre any preaching at all. Tho it be indeed very difficult
to guard upon every occasion against vexation of spirit
[Page 11]
there are however some occassions which may be avoided:
& I mean here particularly gaming; against which to cau¬
tion Mr Davidson I take to be extremely unnecessary
but to make my system couplet 4 I must say that chess is
almost as bad as fluxions & if games of chance are at¬
tended with any emotion or agitation of passions they
are very hurtful.
I think I have touched most of the articles of
Regimen & on the subject of Medicine I can be very short.
When his appetite is bad & he has any reason to
think his stomach full of acidity or loaded with phlegm
a gentle vomit may prevent more troublesome ailments;
but I would have him avoid the frequent practice of
them & as long as he can possibly find that some fas¬
ting & a good deal of riding may supply the place of a vomit.
Nothing hurts the functions of the stomach more
than costiveness & every approach to it should be obviated
[Page 12]
with care. Mr Davidson's own skill & experience will
suggest the proper means.
It has been usual in all complaints of the stomach to
employ bitters & tonic medicine & I have no objection to
Mr Davidson's taking sometimes a little bark or what I
think more safe a chalybeate medicine: but I am very
certain that the frequent & long continued use of bitters &
bark is pernicious to gouty persons & therefore I would
have Mr Davidson to use them very seldom & never long
at one time.
There is another sort of remedies that may perhaps
also be carried to abuse but they are generally more safe
& these are Alcalines. A dose of Magnesia employed
as a laxative is often proper.
A draught of lime water
taken pretty frequently has often a good effect & I have
often found excellent effects from the caustic lixivium in
gouty persons but I cannot think it necessary for Mr Davidson
at present.
[Page 13]
C. Going in a Single horse Whisky or Chaise which a man
drives himself is an exercise nearly as usefull as riding
on horseback and in some respects as in guarding against
cold and wet it may be better. A close & easy
four wheeled carraige may be employed in Winter but
unless the Journey made is long it does not go so far
by half as riding on horseback. Go to F
D. I believe it is necessary to tell Mr Davidson that moderation
in strong drink is proper but the observation of it is of such
importance that I cannot altogether ommit it. I have said
that some quantity of strong drink is proper & even neces¬
sary to persons who have been accustomed to it: but any quan¬
tity that can heat a man is hurtfull & every dgeree of intoxi¬
cation may be pernicious. The effects of one trespass may
not be observed but its tendency to weaken the system & in
particular the stomach, & repetition must ↑at length↑
destroy it altogether. Go to E
[Page 13]
✍
Directions
for
Davidson of Ravelrig.
Gout.
1776
Notes:
1: The phrase is taken from the Roman writer Aulus Cornelius Celsus (c.25-50 BC). The extant parts of his De Medicina are a primary source for Roman medicine. Cullen is quoting from his discussion of how a healthy man has no need for a physician but to keep well he should "vary his way of life". In a contemporary translation the passage reads: ''Tis good for him to diversify his way of life; to be sometimes in the country, sometimes in the city...'. See A. Cornelius Celsus of medicine. In eight books. Translated, with notes critical and explanatory, by James Greive, M.D. (London: 1756), p. 21.
2: Part of Cullen's editorial mark-up for revising his draft. It presumably means start a "new line" here.
3: ''Tis a saying among the Indians, that none can be troubled much with the Gout, who have Slaves enough to Rub them...' (Sir William Temple, 'An Essay Upon Heath and Long Life', Miscellanea; The Third Part (London, 1701), p. 156).
4: Error in the original for 'complete'.
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