Cullen

The Consultation Letters of Dr William Cullen (1710-1790) at the Royal College of Physicians of Edinburgh

 

[ID:407] From: Dr William Cullen (Professor Cullen) / To: Bishop John Oswald (of Raphoe) / Regarding: Mrs Ann Oswald (of Raphoe) (Patient) / 18 September 1768 / (Outgoing)

Lengthy reply 'For Mrs Oswald', addressed to 'My Lord', detailing the management of a course of mercurial treatment requiring a period of confinement to her rooms and keeping to a strict regimen. From a follow-up letter the patient can be identified as Ann, wife of John Oswald, Bishop of Raphoe to to whom we can assume the present letter is also addressed.

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Metadata

FieldData
DOC ID 407
RCPE Catalogue Number CUL/1/1/2/28
Main Language English
Document Direction Outgoing
Date18 September 1768
Annotation None
TypeScribal copy ( includes Casebook Entry)
Enclosure(s) No enclosure(s)
Autopsy No
Recipe Yes
Regimen No
Letter of Introduction No
Case Note No
Summary Lengthy reply 'For Mrs Oswald', addressed to 'My Lord', detailing the management of a course of mercurial treatment requiring a period of confinement to her rooms and keeping to a strict regimen. From a follow-up letter the patient can be identified as Ann, wife of John Oswald, Bishop of Raphoe to to whom we can assume the present letter is also addressed.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:230]
Case of Mrs Ann Oswald who is to undergo a mercurial treatment.
2


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:2061]AddresseeBishop John Oswald (of Raphoe)
[PERS ID:56]PatientMrs Ann Oswald (of Raphoe)
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:2061]Patient's Relative / Spouse / FriendBishop John Oswald (of Raphoe)

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing Cullen's House / Mint Close Edinburgh Edinburgh and East Scotland Europe certain
Destination of Letter Raphoe North Ireland Ireland Europe inferred

Normalized Text

[Page 1]
For Mrs Oswald
My Lord


I have now recollected all the circumstan¬
ces of Mrs Oswalds Constitution & complaints as fully as I can
& have to propose the following measurs.


She will be pleased as soon as convenient to enter on
a Course of the mercurial {illeg} Solution Ordered
below which I have found to Answer better than any other form
of that medicine - The dose to begin with is twenty four
drops which almost contains an eight part of a grain of Mercury


This is to be taken in two table spoonfulls of distilled water
also ordered below. Let these two spoonfulls of the drops be
poured into a tea Cup, & this put into a Bason of Warm water
till the dose is a little warmed.


This dose is to be taken three times a day that is in the
morning before Breakfast, an hour before dinner & again
at going to bed. If the morning dose is disagreable it may be
let alone & a dose may be taken an hour or two before
Supper in place of it


These Doses are to be continued in the same manner
for four of five days that some judgement may be fo↑r↑med
of their effects as I shall say presently but if in five days they
shew no sensible effects the doses are to be increased ↑to↑ thirty
six drops & some days after on the same conditions to
forty eight


It is expected that these drops will Operate chiefly by
perspiration & sweat & if the last appears evident the doses
are enough but if it does not the doses may be increased by
degrees unless other effects in the bowels or in the mouth appear
at the same time - If the doses give a very manifest increase



[Page 2]

of urine it will be equally a proof that the doses are enough
& need not be in↑c↑reased for some time - If the medicine
takes to the bowels & shews a disposition to purge; this is
the least desireable effect of it & must be avoided. The means
are 1. by taking the doses at longer Intervals as I proposed
in the first place or 2. by taking only two doses a day till the
medicine has found its way into the blood or 3 by taking with
the Evening dose twenty or twenty five drops of Laudunum
which will probably be only necessary for two or three times
It must be noted that if the medicine can not be easily
prevented from Running of by the Belly it will either
not answer the Purpose of clearing the blood by the skin which
is the Chief Intention as it will render the Course much longer
& too tedious


The most common effect of the Medicine when it
does not go by the skin is to go to the mouth. It may do both
together & if the effects on the mouth are moderated it will give
no Intermission (↑ruption↑) to the Course tho it may limit the Doses.
If therefore after four or five days any taint is percieved in
the breath
, any Copper tasted in the mouth & much more still
if any soreness is felt in the Gums or uneasiness in chewing,
the doses must be omitted one, two, or three of them or all
them according to the degree of these effects. - If attention
is given to observe the first taint of the breath it will be
enough to Omit the morning Dose only & next day as the
taint increases to Omit the Noon or afternoon dose unless
it still increases to with other effits for a third day it will
not be necessary to Omit the bedtime dose. I shall think



[Page 3]

if very disagreeable to keep up a little taint in the breath
for the whole Course & if at the same time ay sweating goes
on there will be little fear of the symptoms rising fast in the
mouth however it is proper to proceed with caution & nevere to
push the symptoms in the mouth but to keep to the lowest
quantity that effects the breath & whenever that increases
especially with other symptoms there, let doses be Omitted in
part or in the whole till these symptoms diminish but as soon
as that happens let them be repeated Again this is nes necessary
to render the Course both more effectual & shorter -


The length of the Course is not to be determined before trial
It should certainly be so long as to clear the skin very entirely
unless that proves so tedious as either to make us dispair of it
or to exhaust Mrs Oswalds patience or that some circumstances
or accidents render it improper to be continued. The last I do
not forsee with any such probability as to make me mention
mere possibilities. I hope no such thing shall happen but that
the Course shall go on easily & speedily answer the purpose


I do not however expect that any thing shall happen that
less than six weeks or two months will do the business
& if it shall happen that the head & every part of the skin
is cleared sooner I would not advise trusting to that but that
if the Course with any tolerable ease it should at any rate
be continued for two months.


I have now to add the Regimen I think necessary to render
the Course both safe & effectual.


The Bedchamber ought to be large rather than small
& such as Can be kept moderately warm without much
fire liable to no draughs or Sifling 1 Airs as we call them



[Page 4]
It ought to have to a constant fire & therefore will never
need a large one. Mrs Oswald should never sit in sight of
the fire or so as to be heated by it. If the medicine does never
more than heat taint her breath she is not to be confined to
this bedchamber - but for the most part of the day may go into
another that is on the same floor & communicates with it
without her being obliged to go into any Stair case Lobby or
passage in passing from the one to the other - This Draw¬
ing Room should have the same conditions as the bedchamber
& she may pass at pleasure from the one to the other
except it shall happen that her mouth becomes sore &
swelled & she is disposed to spit & in this Case she must
keep to the bedchamber till these symptoms are gone of
When she quiets either of these three Rooms they may
be rubbed & swept & even the windows set up for a few
minutes ↑but↑ they must never be washed or wetted


In dress Mrs Oswald should take to one she can commit
conveniently keep to during the whole course for changes of
any kind would be hazardous. If her chambers are managed
as I have directed she will need no additional Covers only
let her put feet & legs & her neck & shoulders to be kept well
& uniformly covered let the Carpet be always under her feet
& let a cloath be hung from the bottom of the chair to the floor
that no cold air may come from behind upon her heels
& legs & if she sits between a bed & the fire let a cloath be
hung down from the bedstead to the floor to prevent all
draught from under the bed if the medicine does not affect



[Page 5]

her mouth or if it only affects her breath she will need no
covering about her Chops but if the symptoms in her mouth
shall at any time be more considerable it will be very
proper to tye up her throat & chops from Ear to Ear with
flannel.


During this Course it will be very necessary for Mrs Oswald
to live low for unless the medicine & diet together take down
her body a good deal I shall not expect much good from it.
Let her begin for a week {illeg} ↑or↑ ten days before she takes
the medicine to take down her diet by taking meat only
a day & then to let her take only of the lighter kinds let
her take that also more sparingly & fill up her meal with
pudding for Roots & greens must be taken very cautiously
& seldom. After entering upon the Course I would have her
observe this low diet ↑still↑ more exactly, I do not desire her
to give up meat entirely but if two or three days of the week
are entirely meagre days it will be the better & if it should
happen that the Mercury goes more to the mouth than we
desire with heat swelling & spitting it will be absolutely
then necessary {illeg} to abstain from all meat &
at other times you will understand it ought to be in propor¬
tions every day she may have a Bason of broth made
of chicken or other lean mean but not very strong - At
Breakfast she may take tea as usual with dry toast as
a very little butter upon it. Her supper should be always
some kind of milk meat.


For drink it will be proper for her to take it plenti¬
fully her tea twice a day will be very proper a dish of



[Page 6]

of Coffee she may take sometimes but for common
it is not so fit if the medcine works easily she may
some times take chocolate for breakfast or supper
but not Very strong. If she chuses to drink between
meals, Water gruel, Barley, water, Milk with two
parts of Water or if the medicine shows no tendency
to purge, fresh Cow milk whey may [all?] if (↑or↑) either of them
be employed she may take them at pleasure & eveery
dose of the Drops ought to be washed dow with a pretty
good draught of one kind or another. I need hardly
say that she ought to take nothing Cold but it is by no means
necessary that her drink be very warm. The draught
with the bed time dose of Drops may be larger & warmer
than other & if she sweats a little & drink in the night
time her drink may then also be a little warmer during the
whole of the Course I would have all kind of strong drink
avoided I would even put no wine into her gruel or other
drink & small beer is very improper this change however
of Mrs Oswalds manner of living must not be made all at
once but as for some days before she begins her Course
I have desired her to take down her eating so she must hold by
her drinking lessening it by degrees so that against
she has taken the Medicine four of fife five days her
strong may be none at all. I have no


I have now only to add that if there can be with



[Page 7]

conveniency for it, it will be proper for Mrs Oswald to
have a warm bath the day before she begines her Course &
again the second da day or third day after. The Water must
be no more than blood warm and she may remain in it for
about fifteen or twenty minutes when she comes out of it
she must be all dried & dressed as Usual. The best time for it
is about six or seven in the Evening and she should keep
to her bedchamber for the rest of the Evening


I have yet forgot to speak of the management of sweating
which may occurr. If it proves at time considerable or
if that appears to be the tendency of the Medicine I would have
her have flannel next her skin and if she can possible
bear to ly in Blankets with bed linnen for the sweating
in linnen is exposed to many accidents. However I would
not wish to take the the sweating to be considerable and
I would not employ [the?] means to increase it. If it comes sponta¬
neously it must have it's Course, and it may be dangerous to
check it but when it is disposed to be free I would not
{illeg} (↑a↑) encourage it either by the bed cloathes or
warm drinks, by confining the hands or pinning the bed
cloaths very close above her neck of what sleep sweat
comes on in the time of sleep without much heat may
be of service but there is a sweat that comes in the
morning after waking is of less service is not ↑to↑ be long
encouraged & may even be stopt towards the forenoon with safety


I have proceeded above upon the supposition that Mrs. O.
wears no hair in her head if she does I would have it
entirely cut out for with any sweating it would be troublesome
and Coming is altogether inadmissable




[Page 8]
For Mrs Oswald

Take two ounces of Rose Water, one drachm of corrosive sublimate of Mercury, and two drachms of crude Salts of ammonia. Dissolve and sieve through paper. Label: Mercurial solution, twenty-four drops for a dose.

Take two pints of spring water distilled in glass vessels and three ounces of Syrup of Balsam. Label: Distilled Water to be taken with the drops, two or three tablespoonfulls for a dose.

Edinburgh September 18 1768
W C

Notes:

1: Rare derivation from 'Siffle' meaning 'to blow with a sibilant sound; to whistle, hiss' (OED).

Diplomatic Text

[Page 1]
For Mrs Oswald
My Lord


I have now recollected all the circumstan¬
ces of Mrs Oswalds Constitution & complaints as fully as I can
& have to propose the following measurs.


She will be pleased as soon as convenient to enter on
a Course of the mercurial {illeg} Solution Ordered
below which I have found to Answer better than any other form
of that medicine - The dose to begin with is twenty four
drops which almost contains an eight part of a grain of Mercury


This is to be taken in two table spoonfulls of distilled water
also ordered below. Let these two spoonfulls of the drops be
poured into a tea Cup, & this put into a Bason of Warm water
till the dose is a little warmed.


This dose is to be taken three times a day that is in the
morning before Breakfast, an hour before dinner & again
at going to bed. If the morning dose is disagreable it may be
let alone & a dose may be taken an hour or two before
Supper in place of it


These Doses are to be continued in the same manner
for four of five days that some judgement may be fo↑r↑med
of their effects as I shall say presently but if in five days they
shew no sensible effects the doses are to be increased ↑to↑ thirty
six drops & some days after on the same conditions to
forty eight


It is expected that these drops will Operate chiefly by
perspiration & sweat & if the last appears evident the doses
are enough but if it does not the doses may be increased by
degrees unless other effects in the bowels or in the mouth appear
at the same time - If the doses give a very manifest increase



[Page 2]

of urine it will be equally a proof that the doses are enough
& need not be in↑c↑reased for some time - If the medicine
takes to the bowels & shews a disposition to purge; this is
the least desireable effect of it & must be avoided. The means
are 1. by taking the doses at longer Intervals as I proposed
in the first place or 2. by taking only two doses a day till the
medicine has found its way into the blood or 3 by taking with
the Evening dose twenty or twenty five drops of Laudunum
which will probably be only necessary for two or three times
It must be noted that if the medicine can not be easily
prevented from Running of by the Belly it will either
not answer the Purpose of clearing the blood by the skin whc
is the Chief Intention as it will render the Course much longer
& too tedious


The most common effect of the Medicine when it
does not go by the skin is to go to the mouth. It may do both
together & if the effects on the mouth are moderated it will give
no Intermission (↑ruption↑) to the Course tho it may limit the Doses.
If therefore after four or five days any taint is percieved in
the breath
, any Copper tasted in the mouth & much more still
if any soreness is felt in the Gums or uneasiness in chewing,
the doses must be omitted one, two, or three of them or all
them according to the degree of these effects. - If attention
is given to observe the first taint of the breath it will be
enough to Omit the morning Dose only & next day as the
taint increases to Omit the Noon or afternoon dose unless
it still increases to with other effits for a third day it will
not be necessary to Omit the bedtime dose. I shall think



[Page 3]

if very disagreeable to keep up a little taint in the breath
for the whole Course & if at the same time ay sweating goes
on there will be little fear of the symptoms rising fast in the
mouth however it is proper to proceed with caution & nevere to
push the symptoms in the mouth but to keep to the lowest
quantity that effects the breath & whenever that increases
especially with other symptoms there, let doses be Omitted in
part or in the whole till these symptoms diminish but as soon
as that happens let them be repeated Again this is nes necessary
to render the Course both more effectual & shorter -


The length of the Course is not to be determined before trial
It should certainly be so long as to clear the skin very entirely
unless that proves so tedious as either to make us dispair of it
or to exhaust Mrs Oswalds patience or that some circumstances
or accidents render it improper to be continued. The last I do
not forsee with any such probability as to make me mention
mere possibilities. I hope no such thing shall happen but that
the Course shall go on easily & speedily answer the purpose


I do not however expect that any thing shall happen that
less than six weeks or two months will do the business
& if it shall happen that the head & every part of the skin
is cleared sooner I would not advise trusting to that but that
if the Course with any tolerable ease it should at any rate
be continued for two months.


I have now to add the Regimen I think necessary to render
the Course both safe & effectual.


The Bedchamber ought to be large rather than small
& such as Can be kept moderately warm without much
fire liable to no draughs or Sifling 1 Airs as we call them



[Page 4]
It ought to have to a constant fire & therefore will never
need a large one. Mrs Oswald should never sit in sight of
the fire or so as to be heated by it. If the medicine does never
more than heat taint her breath she is not to be confined to
this bedchamber - but for the most part of the day may go into
another that is on the same floor & communicates with it
without her being obliged to go into any Stair case Lobby or
passage in passing from the one to the other - This Draw¬
ing Room should have the same conditions as the bedchamber
& she may pass at pleasure from the one to the other
except it shall happen that her mouth becomes sore &
swelled & she is disposed to spit & in this Case she must
keep to the bedchamber till these symptoms are gone of
When she quiets either of these three Rooms they may
be rubbed & swept & even the windows set up for a few
minutes ↑but↑ they must never be washed or wetted


In dress Mrs Oswald should take to one she can commit
conveniently keep to during the whole course for changes of
any kind would be hazardous. If her chambers are managed
as I have directed she will need no additional Covers only
let her put feet & legs & her neck & shoulders to be kept well
& uniformly covered let the Carpet be always under her feet
& let a cloath be hung from the bottom of the chair to the floor
that no cold air may come from behind upon her heels
& legs & if she sits between a bed & the fire let a cloath be
hung down from the bedstead to the floor to prevent all
draught from under the bed if the medicine does not affect



[Page 5]

her mouth or if it only affects her breath she will need no
covering about her Chops but if the symptoms in her mouth
shall at any time be more considerable it will be very
proper to tye up her throat & chops from Ear to Ear with
flannel.


During this Course it will be very necessary for Mrs Oswald
to live low for unless the medicine & diet together take down
her body a good deal I shall not expect much good from it.
Let her begin for a week {illeg} ↑or↑ ten days before she takes
the medicine to take down her diet by taking meat only
a day & then to let her take only of the lighter kinds let
her take that also more sparingly & fill up her meal with
pudding for Roots & greens must be taken very cautiously
& seldom. After entering upon the Course I would have her
observe this low diet ↑still↑ more exactly, I do not desire her
to give up meat entirely but if two or three days of the week
are entirely meagre days it will be the better & if it should
happen that the Mercury goes more to the mouth than we
desire with heat swelling & spitting it will be absolutely
then necessary {illeg} to abstain from all meat &
at other times you will understand it ought to be in propor¬
tions every day she may have a Bason of broth made
of chicken or other lean mean but not very strong - At
Breakfast she may take tea as usual with dry toast as
a very little butter upon it. Her supper should be always
some kind of milk meat.


For drink it will be proper for her to take it plenti¬
fully her tea twice a day will be very proper a dish of



[Page 6]

of Coffee she may take sometimes but for common
it is not so fit if the medcine works easily she may
some times take chocolate for breakfast or supper
but not Very strong. If she chuses to drink between
meals, Water gruel, Barley, water, Milk with two
parts of Water or if the medicine shows no tendency
to purge, fresh Cow milk whey may [all?] if (↑or↑) either of them
be employed she may take them at pleasure & eveery
dose of the Drops ought to be washed dow with a pretty
good draught of one kind or another. I need hardly
say that she ought to take nothing Cold but it is by no means
necessary that her drink be very warm. The draught
with the bed time dose of Drops may be larger & warmer
than other & if she sweats a little & drink in the night
time her drink may then also be a little warmer during the
whole of the Course I would have all kind of strong drink
avoided I would even put no wine into her gruel or other
drink & small beer is very improper this change however
of Mrs Oswalds manner of living must not be made all at
once but as for some days before she begins her Course
I have desired her to take down her eating so she must hold by
her drinking lessening it by degrees so that against
she has taken the Medicine four of fife five days her
strong may be none at all. I have no


I have now only to add that if there can be with



[Page 7]

conveniency for it, it will be proper for Mrs Oswald to
have a warm bath the day before she begines her Course &
again the second da day or third day after. The Water must
be no more than blood warm and she may remain in it for
about fifteen or twenty minutes when she comes out of it
she must be all dried & dressed as Usual. The best time for it
is about six or seven in the Evening and she should keep
to her bedchamber for the rest of the Evening


I have yet forgot to speak of the management of sweating
which may occurr. If it proves at time considerable or
if that appears to be the tendency of the Medicine I would have
her have flannel next her skin and if she can possible
bear to ly in Blankets with bed linnen for the sweating
in linnen is exposed to many accidents. However I would
not wish to take the the sweating to be considerable and
I would not employ [the?] means to increase it. If it comes sponta¬
neously it must have it's Course, and it may be dangerous to
check it but when it is disposed to be free I would not
{illeg} (↑a↑) encourage it either by the bed cloathes or
warm drinks, by confining the hands or pinning the bed
cloaths very close above her neck of what sleep sweat
comes on in the time of sleep without much heat may
be of service but there is a sweat that comes in the
morning after waking is of less service is not ↑to↑ be long
encouraged & may even be stopt towards the forenoon with safety


I have proceeded above upon the supposition that Mrs. O.
wears no hair in her head if she does I would have it
entirely cut out for with any sweating it would be troublesome
and Coming is altogether inadmissable




[Page 8]
For Mrs Oswald


Aq. Rosar. ℥ij
Merc. sublimat. corr. ʒj
Sal. ammoniac crud. ʒij
Solve & per chartam cola.
Signa Mercurial solution twenty four Drops for
a dose


℞ Aq. font. ex vasis vitreis distillat. lb ij
Syr. Balsam ℥iij
ℳ Signa Distilled Water to be taken
with the drops two or three table spoonfulls
for a dose

Edr. Sept. 18 1768
W C

Notes:

1: Rare derivation from 'Siffle' meaning 'to blow with a sibilant sound; to whistle, hiss' (OED).

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