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Doctor William Cullen

The enclosed case ¹ is that of an intimate
acquaintance, & worthy Friend of mine. He has been frequently in
Edinburgh & says he knows you. He has begged of me to draw up a
state of his Case for your advice, & to send it to none but you. In this
I am the more happy as his sentiments in this respect coincide entirely
with my own. Had I been left at Liberty to choice the Physician, you
would have been the gentleman. I am only vexed he did not give
me more time; I have only had a day & a halfs time with ↑only↑ what assist¬
ance my memory could afford, & my other necessary avocations to
attend to. I am ashamed to offer the case in so diffuse & prolix
a manner, My want of time put it entirely out of my power to
put it in the method I would have wished to have presented it to
you. For which I most beg your Excuse. I earnestly wish I may
have given you such leading Symptoms as may discover the
nature of the disease. ---- This Gentleman is the Husband of

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the Lady whose case I represented to you in Spring 1778 who
died of a galloping Consumption. He is Brother in Law to me.
This letter will be delivered by you by my Brother Lieutenant Henry
Edmondston of the Navy now in Edinburgh He will pay the Fee
& get your advice as soon as your time will permit, that it may
be transmitted here by the first occasion. My wife pains in more
respectfull Compliments to you & with the highest esteem I am

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Doctor William Cullen Professor
of the Practice of Physic in the
University of
Edinburgh

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✍

Mr. Edmondstone
Concerning Basil Scott
April 1786
V. XVIII. p. 80

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Mr. Basil Scott aged about forty years, from Infancy of a thin
delicate habit of Body, yet sprightly & pretty vigorous, which led
him when very young, & he continued, to use more freedom with his
Constitution to the vicissitudes of heat & cold. By too free an indulgence
in these with a habit & frame of Body disposed to Pulmonary
disorders, he was seized about the age of sixteen or seventeen with
a spitting of Blood which has continued more or less to this
day, but at no stated periods. The Intervals were often long.
and in the Intervals he was healthy. --- It is to be noticed that the
Pthisis Pulmonalis has been particularly fatal both to the mother
& fathers familys. --- When first seized with the spitting of Blood
he discharges a great deal of it, which reduced his strength much,
& it was then clear & unmixed. But after several attacks of it,
a cough came on, & it changed to a suppuration in the Lungs.
These Suppurations were more or less severe, & generally attended with
a mixture of Blood. ---- These suppurations seemd ↑not↑ to be deep
seated nor of great extent, as the matter was commonly dis¬
charged in a short time, & then he would have pretty good health,
till by innatention, he was exposed to cold, wet, or fatigue,

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Which generally borught on a feverish uneasiness with a
pricking pain ↑in↑ the right side a little below the Breast, & ended in a
Suppuration which was discharged as before --- From the time the
spitting of Blood came on, he was attacked with a difficulty of
Breathing at times, & this has continued ever since. It would often
come on without any Cause he could Assign, but was more troublesome
when the Suppuration was forming in the Lungs or when the Sto¬
mach was oppressed. --- He could lye on either side, but not so easily
on the right as left. He generally Sleeped soundest on the left side.
About this time too he was attacked with a natural Salivation. He
had never taken mercury before this, which I am assured of from
very good Authority. -- This Salivation has continued ever since,
but attended with no uneasiness, except its being troublesome and
disagreeable to himself. --- Whether it proceeded from a habit of
Spitting when he had the spitting of Blood & consequent suppuration,
or from a weakness of his Stomach, or from both I cannot say,
as it has continued for some years before I saw him. --- His
Stomach has been weak since the Suppurations came in his
Lungs. --- What I mean is, Altho his Stomach at times was keen,
it has never been able indiscriminatly to agree different kinds

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of food with ease; He was often troubled with flatulency in his
Stomach, & for a long time back he has been of a Costive habit. ---
In this state he has been from the first attack of the spitting of blood;
The symptoms attending it becoming more severe as he advanced in
years; and of Consequence he has had many severe Attacks, but confined
himself with very few of them. -- From his Spirit & sprightliness,
he often went abroad when many would have been confined to
the house. -- During the above period he took few or no medicines,
as I have been told. --- It is now time to come to a later Period
& bring his Complaints more immediately under your view. ---

In April (↑Spring↑) 1777 he was seixed with a feverishness, loathing of
food, headach, want of rest, a frequent dry Cough, & pain at his side;
At times a little matter mixed with Blood was spit up. At last
he became hectic & lose his Strength & Spirits. --- These appearances
afforded too just grounds to fear a confirmed Pthisis Pulmonalis.
Having tryed many Medicines without effect, I advised him to take
a sea voyage, which he agreed to, & a small vessel being ready to go
from this to Hamburgh he took passage with her. And altho
the vessel was very small & the accommodation bad, yet he had not
been at sea two days, till he found all his Complaints considerably
relieved. His appetite was in a high degree mended, & his Spirits

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much better; to that by the time they arrived at Hamburgh,
which might have been ten or twelve days, he was in every respect
greatly recovered. He stayed there three or four weeks, & did not
feel his Complaints recur. This vessel at the end of that time sailing
for Shetland he returned with her & arrived here, comparatively well,
at least much better than he had been for some years before. I
shall observe here that he always found himself amazingly relieved
on being at Sea, even in an open boat, for a few hours. -- After
this voyage he continued in pretty good health till Spring 1778
when his wife was seized with a Consumption of which she died
in a few months. This brought on him great distress of mind,
and all his Complaints recurred but in no severe degree. He con¬
tinued from this time in a poor state of health till 1780 when he
went to Edinburgh & was there fifteen months, during which time he
enjoyed much better health than he had done for some time here,
So that when he returned here he was in pretty good health,
But never altogether free from a Cough from the first time it
attacked him, & he had more or less of all the other Complaints that
seized him on the first attack of the Cough -- After being here
about halfa year he got more of the Cough & ↑of↑ his other Complaints
but

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5

but not so much as to confine him, altho they were frequently
very troublesome --- In Spring 1782 he catched the Influ¬
enza which confined him a considerable time, attended with a great
encrease of his Cough. -- In Summer he recovered pretty well. But
always from this time he had more of his Cough, yet better & worse.
In Spring 1785 he catched a severe cold, with a great degree of Cough.
This fit of illness confined him above a forthnight. From this
time the Cough has been generally troublesome & often distressing.
From this time too, his Stomach has often been distressed with
flatulency, & his digestion very irregular. Sometimes costive for
two or three days, & at the end of that time, gripes & a looseness
would come on, which generally went in twenty four hours,
sometimes it would continue longer. --- After this he would be
easier & his digestion better. --- But unless he keeped his Belly
in a regular way with Sacred Tincture, Aloetic Pills or an Elec¬
tary of Sulph Crem. Tart. &c --- costiveness would come on, which
commonly ended in a looseness as before mentioned. ---- For years
back his Stomach Complaints & weakness of digestion required as
much attention as those of his Lungs, & it was not always that the
one could be relieved without in some degree injuring the other.
The only means that relieved both was a Sea voyage, & accordingly

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last Summer I Strenously advised a Sea Voyage, which
he seemed inclinable to take; but by some means or other it was
neglected too long. --- In October last his Cough & other Com¬
plaints had become very severe & he was to have gone to Edinburgh
with a Sloop from this, but the vessel not being ready when he ex¬
pected, he was attacked with some degree of the Piles, which he con¬
cealed, as thinking it no Consequence, having been often distressed
with them before; And having above that time been much exposed
travelling in open boats, then came on a Swelling near the Anus, which
increased rapidly to a great degree affecting all the neighbouring parts
& also the Bladder, attended with intense Pain, so that no posture was
tollerable but lying on his Back. In ten or twelve days it came
to a Suppuration, & was opened closs at one side of the Anus. It
discharged plentifully, on being opened, of well [concocted?] Pus, but after
that slowly, nor did the pain abate proportionally as the matter dis¬
charged, So that it was not till some weeks that the swelling & pain
subsided, but the orifice keeped open, & does to this day, a little matter
drairing from it, of no bad quality, yet sometimes it gives him
pain. --- A forthnight or three weeks after it was opened he
[recruited?] some strength & could walk once across the room, & would
take some food. And during his Confinement the Cough keeped

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more moderate than it had been for a long time before. The swelling
& pain near the Anus now gone, altho the orifice keeped open; the Cough
Comparatively easy, his Appetite recruiting, & his Spirits much relieved
gave him flattering hopes that this fit of illness would procure him
health afterwards. --- But this interval was of short duration,
for in less than a forthnight he was attacked in a nights time with
a considerable degree of feverishness, a short troublesome dry Cough,
oppression of Breathing, a sickness & loathing of food, his digestion
worse than ever, & sleep had forsaken him. On being thus seized
he sent to me. I had not seen him from November last; we are separated
above thirty miles of bad road, with sea & land between us, & my
Business is confined to a certain district round this small Town.
I saw him the 4th. January last when he was truly in a distressed
Situation. --- He was so weak he would not sit up in the Bed
without fainting, a considerable degree of hectic Fever, loathing
of all kinds of food, his stomach exceedingly oppressed, sickness &
flatulency; His Breathing oppressed frequently, so that when it
came on, whether day or night, or whatever weather, the Doors and
windows behoved to be opened, frequent heat & cold fits, & often severe
sweating but at no stated periods, nor did it last long, no stool but
what was procured with Glysters, and withall a distressing Cough

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often dry, & when he did expectorate, it was a tuff glutinous
Phlegm more like that from Tubercles than from the Suppurations
he formerly had. The Cough seems to be deeper seated in the Lungs
than before. He could ascribe this change to no cause excepting he
had catched cold unwantly from keeping the windows open at times.
The sore at the anus keeped open but did not now pain him. -- I
should have observed that for some time before the swelling came
on near the Anus he had been a good deal distressed with a scor¬
butic itchy Eruption over his Body, which went off during
his Confinement without any application directly to that
complaint. -- But to return. On finding him in the above
described situation, altho the relief of the Cough was very pressing
yet I would not prescribe the medicines commonly called Pec¬
toral, his Stomach could not bear them. I began by endeavour¬
ing to relieve his Stomach & by all means to assist digestion.
At the same time advising such things for the Cough as did
not contradict the other Intention. --- During this last illness
he had been frequently too long costive, which generally
brought on gripes & some loose stools, which in his weakened
state was unfavorable, I therefore gave him glysters every
second day at least, which brought away the fœces & pre¬

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prevented what food he might take from lodging too long
in his Bowels, & as he was often troubled with acidity in
his Stomach, he got magnesia alba, & some of the lighter Sto¬
machics, such as Peppermint water, Elixir of Vitriol & weak
Spirit of Vitriol. These means relieved his Stomach considerably
assisted by the lightest food that would be got, & his Cough was no
way hurt by them. His most distressing complaint now was want
of sleep in the night time. He often never shut his Eyes the whole
night, & when he did, he did not slumber above ten minutes at a
time. I gave him thirty gutts of Laudanum repeated nights; but
without procuring sleep. The only time he had any thing like
Sleep, near in the afternoons; Above four or five he would begin
& dose, & with intervals, would sometimes dose to ten, but as mid¬
night approached all desire to sleep left him, nor would he feel
the least inclination, till sometimes six oClock in the morning, &
then it was only short unrefreshing Slumbers. The want of Sleep
distressed him, & he became very impatient. I apprehended the want
of Sleep might in some measure be owing to too great an irritability
of the System; He was therefore Blistered, got pills of Asafœtida
with Powder of Valerian, & the Emulsio camphorata, But they were

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given very sparingly for fear of hurting his Cough & heating
him. I would not perceive they did either, & he thought himself
bettered by them. He slumbered more after using them, but to
this day he does not get regular Sleep in the night time, His
time of Slumbering continued to be in the afternoons & after supper,
sometimes till one in the morning, but none after that. When in his
Best health little sleep served him ↑but then it was sound.↑ During the use of the nervous
Medicines he would not want the Laudanum, for altho it
did not procure Sleep, yet it made him almost quite easie
through the night. His Stomach would often be swelled & op¬
pressed before taking the Laudanum, & he had not swallowed it
half an hour, till he became easy & composed, & continued so
all night. I could not discover any matter mixed with the
Phlegm he spit while I stayed with him, which was sixteen
days. His drinks were water grewel, Cow milk whey of which
he is very fond, artificial Asses milk & Butter milk. I would not
venture to give him laxatives internally, I mean by the mouth.
He is not easily acted on by laxatives, & I was afraid that large
Evacuations by Stool would reduce his Strength. -- I would willingly

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have tryed him with a vomit while I was with him, but he was
so weak he could not sit up in the bed to take it, besides he had
frequently a difficulty & oppression of Breathing, that might have
come on in the time of the vomit, for the time of its attack was by
no means certain or regular, but more commonly when there was
food or drink on his Stomach. In his Best health when he took
a vomit it strained him very much. I mentioned among other
directions I left with him, that if a reaching to vomit should at any
time come on, it should be encouraged by drinking Camomile Tea.
I am informed he has tryed it once but without finding his Sto¬
mach relieved by it. --- I believe his Stomach & Bowels have long ↑been↑
(years I think) in a weak state; the Complaints in them, & the diffi¬
culty & oppression in his Breathing have for a long time back given
him more distress than he has had from the Cough. They continue
still to distress him more. I had a letter three days ago wrote by
his orders in which he tells me he is much in the state I have described
above. Since I left him his Complaints have abated at times & he
has been in the hopes ↑of↑ their leaving him, but in a few days he has
been as often disappointed. His Complaints have recurred. The
more he has been able to bear ↑since I left him↑ is, to be carried sometimes to the fire &
laid on a Couch, he has never attempted to walk to it. His strength &

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Flesh are greatly reduced. --- In short his Complaints now are the
same as I have described already vizt. a severe Cough; for the most
part some degree of Feverishness, oppression & sickness of his Stomach
at times, difficulty & oppression of Breathing frequently, uncommon
slowness of digestion; Sometimes some desire for food, & sometimes little
of it. I have long before now advised him to wear flannel next his
Skin, but he never would be prevailed on to use it, untill January
last that I was with him. He now wears it. He has found very
little pain in his Side or Breast since this last fit of illness---
Whenever he was near me & had the Cough severely I generally
Bled him. I have often done it, & his Blood was always thick &
very sizy, before he left this in October last I bled him & the
Blood was the same. When I saw him last he was too much re¬
duced to bear Blooding, nor had he any inflammatory Symptoms.
Last week in attempting to subscrive his Name which he has not
done for some months, the glare of the paper & fixing his Eyes stead
fastly on it, had much an Effect on his Eyes as occasioned strangely
& he became considerably feverish. These Symptoms continued all night,
but begun to take off next day & in three or four days they were
almost all gone

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March 25th. Since writing the foregoing pages I had a letter
from Mr. B. Scott, who is, in place of being stronger, considerably weaker.
So that without some great change soon in his favourr he cannot hold
it long. This puts me in mind of disiring you to read the following
Paragraph to Doctor Cullen when you give in the Representatives of
Mr. Scotts Case to him. I am doubtfull as I told you before that I
had not been full enough from my want of time. Tell him or
read to him as follows ---- "That for several years back Mr.
" Scotts Blood has been very sizy & was so the last time I bled him,
" That as often as I had an opportunity of seeing him when distressed with
" a Cough or pain at his Side I Bled him, recommended the cooling and
" anaphlogistic Regimen to him. But that on finding relief from
" the Blooding he generally neglected all attention to his Regimen,
" & followed what best suited his taste, which was by no means the
" Diet his Complaints required. --- His Stomach always agreed best
" with solids. He has all his lifetime been very temperate in drinking
" any strong Liquors, & for many years back peculiarly so. He has
" got after the suppurations broke in his Lungs, the Tar Pills, & at other
" times the Ammoniac Pills & [Lax.?] ammoniacum. This Case his Sto¬
" mach would not beat the last time I saw him" ---- I have no more
to add but many blessings from us all -- These are 11 sail of Greenland¬
ers in, no disturbance yet ² -- No Race horse yet ³ ---