The Consultation Letters of Dr William Cullen (1710-1790) at the Royal College of Physicians of Edinburgh
[ID:59] From: Dr William Cullen (Professor Cullen) / To: Dr Hugh / Regarding: Mrs Perkins (Patient), Mr Knox (Patient) / 29 May 1769 / (Outgoing)
Reply to Dr Hugh 'For Mrs Perkins'
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- Normalized Text
- Diplomatic Text
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Facsimile
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Metadata
Field | Data |
---|---|
DOC ID | 59 |
RCPE Catalogue Number | CUL/1/1/1/54 |
Main Language | English |
Document Direction | Outgoing |
Date | 29 May 1769 |
Annotation | None |
Type | Scribal copy ( includes Casebook Entry) |
Enclosure(s) | No enclosure(s) |
Autopsy | No |
Recipe | No |
Regimen | No |
Letter of Introduction | No |
Case Note | No |
Summary | Reply to Dr Hugh 'For Mrs Perkins' |
Manuscript Incomplete? | No |
Evidence of Commercial Posting | No |
Case
Cases that this document belongs to:
Case ID | Description | Num Docs |
---|---|---|
[Case ID:269] |
Case of Mrs Perkins who is pregnant; Cullen fears that her uterine system and nerves are weakened and advises on regimen. |
1 |
[Case ID:2458] |
Case of Mr Knox, a patient of Dr Hugh. |
1 |
People linked to this document
Person ID | Role in document | Person |
---|---|---|
[PERS ID:1] | Author | Dr William Cullen (Professor Cullen) |
[PERS ID:1131] | Addressee | Dr Hugh |
[PERS ID:57] | Patient | Mrs Perkins |
[PERS ID:350] | Patient | Mr Knox |
[PERS ID:1131] | Patient's Physician / Surgeon / Apothecary | Dr Hugh |
[PERS ID:1] | Patient's Physician / Surgeon / Apothecary | Dr William Cullen (Professor Cullen) |
[PERS ID:706] | Other Physician / Surgeon | Dr Gregory |
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 |
Normalized Text
For Mrs Perkins
I have again & again considered with great attention
your full and exact account of Mrs Perkins, & am sorry to observe in the
first place that we have a weak shattered constitution to work upon.
But it is no worse than when you met with it & I truly admire the jud¬
gement skill & discretion with which you have hitherto managed
it. If it was not still in your hands I should have little expectation
from any thing I could advise for still must be left to your discre¬
tion to direct according to the circumstances for the time present.
However for a person in whom you take so much concern I shall
advise as well as I possibly can. I think it is a general laxity we
[Page 2]
have to struggle with both in the simple solid & in the nervous System &
most considerably of all in the uterine vessels. I shall think it very un¬
lucky for Mrs Perkins to fall with child again as that as best must greatly
overstretch the weak vessels & I think you may give some directions on this
subject that may be useful but they are not very proper for a letter.
To strengthen the whole system I know nothing more proper or
indeed more safe than Cold Bathing & applied as I shall say it may be
applied to the weakliest person. We have got here in to the use of a bath¬
ing machine in which we find great conveniency. It is contrived to let
fall a shower of water upon the head & shoulders, & I think it does as much
as any Immersion. The particular advantage of it is this, that the quantity of
water employed es small & therefore can be made of what temperature you
please. For example I begin with four English Gallons taken from a
well of a more uniform temperature than any river & to these four Gallons
of Cold water I add half a Gallon of boiling water. This the weakest person
may bear & every day or every second day I with draw half a pint of the
boiling water so that in eight bathings I bring them to the natural cold &
then I gradually increase the quantity of water till it is perhaps ten Gallons.
Tho you have no machine you may easily imitate this practice by sitting the
patient in a proper tub to recieve the water that runs down while you pour
it, as above tempered as above from a Bucket or other such vessel upon the head
& shoulders. In this way I think there can be no hesitation about giving Mrs
Perkins the cold Bath & not only for the whole summer but as it may be prac¬
tised in her bed chamber, after she is once accustomed to it it may be conti¬
nued for the year round.
With this bathing I shall think it very necessary to join exercise. All
bodily Exercise may do harm & she should not even walk but in the gentlest
manner, upon a level only, & never long at one time. But every kind of Ges¬
tation will do service if it is not rough violent nor pushed to fatigue.
All such Gestation pushes {illeg} to the surface than to the Internal vessels
& I find they rather diminish & take of all internal determinations, only
this is to be observed that in such weakened systems as the present, it is proper
to avoid all kinds of Exercise at the time of Menstruation.
[Page 3]
Cold Bathing & Exercise are the Strengtheners I depend upon & in the
present case I think Chalybeates are a very ambiguous remedy.
The only shape in which I could admit them is that of a mineral water
& if there is any light one in your patient's Neighbourhood she might take
a glass or two of it every forenoon.
The Bark is a strengthener better adapted to Mrs Perkins & it ap¬
pears that she has recieved much benefit by it. While she is liable to re¬
turns of Fever whether of more short duration in the shape of Weeds or E¬
phemer{illeg}↑a↑ or of the more lingering kind you mention I shall think in
either case the Bark necessary as soon as a proper interval occurs but I am
much inclined to confine the Bark to these occasions alone when it is to
be employed in pretty large quantities & for a short time only & I dont like
any habitual use of it as a strengthener for the habit both diminishes
its efficacy at other times & from some experience I am persuaded that the
long continued use of it destroys the tone of the stomach & of the whole sys¬
tem
In case ↑of the↑ return of floodings, if without fever I shall always
think Opiates not only safe but necessary. And tho some frequency of
pulse should attend it, if it came on with no horripilation & was not there¬
fore to be considered as a formed fever it would not restrain me from
the moderate use of Opiates. But where fever is more evidently formed
the use of these is at least hazardous or may readily prove hurtful.
But I hope this difficulty shall not occur to you you as I am to propose a
Medecine which is the best suited that I know of to moderate Uterine
Excretion whether red or white & at the same time to take of any fever thst
may accompany them. I dont know how far the use of Tartar Emetic in
all sorts of fever have yet reached your corner but however that may bear
I find that tho the use of it is very general the proper use of it is not com¬
mon. I shall let you know what my experience has taught me. I make
a solution of two grains of Tartar Emetic in Aqua Rosar ℥iij ſs Syrup Caryophill ʒv so that I have a quarter grain in the ℥ſs or spoonfull.
This solution I employ at the times of accession where these are distinctly
[Page 4]
distinctly marked but in continued fevers where they are not I give the
solution about eight o clock of the Evening. At that hour I give a spoonfull &
every half hour after give another till some degree of Nausea & sickness
comes on when I stop for that night. In different persons the sickness comes
on sooner or later but for the first trial I never go beyond the fourth dose
for it often goes downwards & operates sometimes smartly by stool. It is
proper therefore to try the Constitution before you push the Medecine for
it is worth observing that it is with advantage that the Tartar operates [a?]
little by stool & you may always make it do so by giving the doses at lon¬
ger intervals & the faster you give it the more certainly it operates on
the stomach. It sometimes vomits & there is never any harm in it
producing some reaching but unless the sickness & reachings are violent
I do not encourage vomiting by giving warm water for I find
it has better effects if they can bear the sickness without vomiting.
This is the management in cases of Fever which it will sometimes suddenly
[discuss?] but this not often & you are only to expect to obtain remissions under
which the fever proceeds easily & safely to its period. Sometimes the remissions
{illeg} ↑are so considerable as↑ to admit of Bark which gives a certain cure. Thus I hope it may operate
in the lingering feverish fits that Mrs Perkins has been lately liable to & I have
now farther to observe that the Tartar Emetic has often proved usefull both
in preventing & removing Uterine Hemorrhages & Fluor Albus given in
the same manner as above mentioned but as it is to be longer continued it
may be given in smaller doses or repeated only [ad initium levionis?] nausea.
Given in this way it does not restrain from the use of the cold bath. In chro¬
nic cases I give it sometimes in the morning as well as the Evening. In
the mornings as smaller dose will occasion sickness than in the Evening
but in the case of cold Bathing, for which the morning is the best time, I do not
give the Tartar till after the Bathing. These directions for the use of the Tar¬
tar Emetic may possibly be superfluous but I do not grudge to bestow a little
writing upon you & I can assure you the Tartar is an important remedy
& I hope you shall find the benefit of it both in Mrs Perkins case & many others.
With regards to her I have nothing farther to say but that Camphire seems a
[Page 5]
proper medecine for her especially when by fever you are secluded from opi¬
ates but I doubt if any [fœtid?] medecines are fit for her as I think they are
all too stimulant & favouring Haemorrhagy & when Nervous symptoms
appear, as it will generally be without fever, I would prefer Opiates to
{illeg}↑every↑ other remedy.
You have said nothing about the present state of Mrs Perkins
Belly. Tho it has been formerly in a lax state from the use of whey & yet in
another place you say it is naturally costive & I suspect it may be so at
present but there is nothing worse for her & the best & safest means of
obviating it is by Flores Sulphuris to which if you add one half their
weight of finely powdered Cream of Tartar you will have a powder of which
a tea-spoonfull, more or less, mixed with a little simple syrup & taken in
{illeg} ↑the↑ morning more or less frequently as occasion requires, will keep the
belly regular without their irritation which {illeg} Aloes Rhubarb & other
purgatives are reliable to give.
You make no remark upon Mrs Perkins diet or how you propose
to order it. Allow one to say that tho a purely vegetable diet might be impro¬
per yet her Animal food ought to be both sparing & light. She should
take none at supper & at dinner it should be but a part of her meal filling
up therest with vegetable food particularly the grain and farinaceous
kind. If Mrs Perkins can digest Milk I should think it very proper for her,
& I shall think a diet of milk and grain more likely than Animal food
to make her more plump than she is at present.
I give you now
what occurs to me upon farther information or upon any remarks
you please to make, or doubts you shall please to propose I shall say
farther. Before this letter I have had none from you since you sent me
the case of Mr Knox & I was a good deal disappointed in never hearing more of
that Gentleman & in your not ever acknowledging the receipt of my
letter on that subject. I shall be obliged to you for acknowledging the re¬
ceipt of this which I must not conclude without giving you some ac¬
count of myself.
My practise & teaching go on as usual that is with as
much success as I can expect. I suppose you know that three years ago I
[Page 6]
changed the Chemistry for the Institution & next year I make another change
being to teach the Colle↑d↑ge of Practice. Hereafter Dr Gregory & I are to teach the Insti¬
tutions and Practice alternately so that each of us in the course of two years
are to teach a compleat system. 1 This is very agreable to the students who may
have a complete & consistent system from one master & may if they please
have the compleat system from two Masters. The number of our students rather
increases but we shall hardly have any more agreable than some we have had
before & among which I have always reckoned you and I beg you will believe
me to be always with great regard and affection
Dr Hugh Your most obedient
servant
Notes:
1: Cullen's first appointment at Edinburgh College (University), in 1755 was to share the chair of Chemistry with Andrew Plummer. Cullen became sole professor of Chemistry upon Plummer's death in 1756. When John Rutherford resigned the chair of the practice of physic in 1766 Cullen hoped to succeed, but the chair went to Rutherford's candidate John Gregory. Cullen was disappointed but reluctantly accepted the chair of the theory of medicine which became vacant on the death of Robert Whytt later that year. In an unusual act of collegiality, Gregory and Cullen, responding to the petitions of faculty and students, agreed to give alternate lectures in the theory and in the practice of medicine. Upon Gregory's sudden death in 1773 Cullen became sole occupant of the more prestigious chair in the practice of medicine.
Diplomatic Text
For Mrs Perkins
I have again & again considered with great attention
your full and exact account of Mrs Perkins, & am sorry to observe in the
first place that we have a weak shattered constitution to work upon.
But it is no worse than when you met with it & I truly admire the jud¬
gement skill & discretion with which you have hitherto managed
it. If it was not still in your hands I should have little expectation
from any thing I could advise for still must be left to your discre¬
tion to direct according to the circumstances for the time present.
However for a person in whom you take so much concern I shall
advise as well as I possibly can. I think it is a general laxity we
[Page 2]
have to struggle with both in the simple solid & in the nervous System &
most considerably of all in the uterine vessels. I shall think it very un¬
lucky for Mrs Perkins to fall with child again as that as best must greatly
overstretch the weak vessels & I think you may give some directions on this
subject that may be useful but they are not very proper for a letter.
To strengthen the whole system I know nothing more proper or
indeed more safe than Cold Bathing & applied as I shall say it may be
applied to the weakliest person. We have got here in to the use of a bath¬
ing machine in which we find great conveniency. It is contrived to let
fall a shower of water upon the head & shoulders, & I think it does as much
as any Immersion. The particular advantage of it is this, that the quantity of
water employed es small & therefore can be made of what temperature you
please. For example I begin with four English Gallons taken from a
well of a more uniform temperature than any river & to these four Gallons
of Cold water I add half a Gallon of boiling water. This the weakest person
may bear & every day or every second day I with draw half a pint of the
boiling water so that in eight bathings I bring them to the natural cold &
then I gradually increase the quantity of water till it is perhaps ten Gallons.
Tho you have no machine you may easily imitate this practice by sitting the
patient in a proper tub to recieve the water that runs down while you pour
it, as above tempered as above from a Bucket or other such vessel upon the head
& shoulders. In this way I think there can be no hesitation about giving Mrs
Perkins the cold Bath & not only for the whole summer but as it may be prac¬
tised in her bed chamber, after she is once accustomed to it it may be conti¬
nued for the year round.
With this bathing I shall think it very necessary to join exercise. All
bodily Exercise may do harm & she should not even walk but in the gentlest
manner, upon a level only, & never long at one time. But every kind of Ges¬
tation will do service if it is not rough violent nor pushed to fatigue.
All such Gestation pushes {illeg} to the surface than to the Internal vessels
& I find they rather diminish & take of all internal determinations, only
this is to be observed that in such weakened systems as the present, it is proper
to avoid all kinds of Exercise at the time of Menstruation.
[Page 3]
Cold Bathing & Exercise are the Strengtheners I depend upon & in the
present case I think Chalybeates are a very ambiguous remedy.
The only shape in which I could admit them is that of a mineral water
& if there is any light one in your patient's Neighbourhood she might take
a glass or two of it every forenoon.
The Bark is a strengthener better adapted to Mrs Perkins & it ap¬
pears that she has recieved much benefit by it. While she is liable to re¬
turns of Fever whether of more short duration in the shape of Weeds or E¬
phemer{illeg}↑a↑ or of the more lingering kind you mention I shall think in
either case the Bark necessary as soon as a proper interval occurs but I am
much inclined to confine the Bark to these occasions alone when it is to
be employed in pretty large quantities & for a short time only & I dont like
any habitual use of it as a strengthener for the habit both diminishes
its efficacy at other times & from some experience I am persuaded that the
long continued use of it destroys the tone of the stomach & of the whole sys¬
tem
In case ↑of the↑ return of floodings, if without fever I shall always
think Opiates not only safe but necessary. And tho some frequency of
pulse should attend it, if it came on with no horripilation & was not there¬
fore to be considered as a formed fever it would not restrain me from
the moderate use of Opiates. But where fever is more evidently formed
the use of these is at least hazardous or may readily prove hurtful.
But I hope this difficulty shall not occur to you you as I am to propose a
Medecine which is the best suited that I know of to moderate Uterine
Excretion whether red or white & at the same time to take of any fever thst
may accompany them. I dont know how far the use of Tartar Emetic in
all sorts of fever have yet reached your corner but however that may bear
I find that tho the use of it is very general the proper use of it is not com¬
mon. I shall let you know what my experience has taught me. I make
a solution of two grains of Tartar Emetic in Aq. Rosar. ℥iij ſs Syr. Ca¬
ryophill ʒv so that I have a quarter grain in the ℥ſs or spoonfull.
This solution I employ at the times of accession where these are distinctly
[Page 4]
distinctly marked but in continued fevers where they are not I give the
solution about eight o clock of the Evening. At that hour I give a spoonfull &
every half hour after give another till some degree of Nausea & sickness
comes on when I stop for that night. In different persons the sickness comes
on sooner or later but for the first trial I never go beyond the fourth dose
for it often goes downwards & operates sometimes smartly by stool. It is
proper therefore to try the Constitution before you push the Medecine for
it is worth observing that it is with advantage that the Tartar operates [a?]
little by stool & you may always make it do so by giving the doses at lon¬
ger intervals & the faster you give it the more certainly it operates on
the stomach. It sometimes vomits & there is never any harm in it
producing some reaching but unless the sickness & reachings are violent
I do not encourage vomiting by giving warm water for I find
it has better effects if they can bear the sickness without vomiting.
This is the management in cases of Fever which it will sometimes suddenly
[discuss?] but this not often & you are only to expect to obtain remissions under
which the fever proceeds easily & safely to its period. Sometimes the remissions
{illeg} ↑are so considerable as↑ to admit of Bark which gives a certain cure. Thus I hope it may operate
in the lingering feverish fits that Mrs Perkins has been lately liable to & I have
now farther to observe that the Tartar Emetic has often proved usefull both
in preventing & removing Uterine Hemorrhages & Fluor Albus given in
the same manner as above mentioned but as it is to be longer continued it
may be given in smaller doses or repeated only [ad initium levionis?] nausea.
Given in this way it does not restrain from the use of the cold bath. In chro¬
nic cases I give it sometimes in the morning as well as the Evening. In
the mornings as smaller dose will occasion sickness than in the Evening
but in the case of cold Bathing, for which the morning is the best time, I do not
give the Tartar till after the Bathing. These directions for the use of the Tar¬
tar Emetic may possibly be superfluous but I do not grudge to bestow a little
writing upon you & I can assure you the Tartar is an important remedy
& I hope you shall find the benefit of it both in Mrs Perkins case & many others.
With regards to her I have nothing farther to say but that Camphire seems a
[Page 5]
proper medecine for her especially when by fever you are secluded from opi¬
ates but I doubt if any [fœtid?] medecines are fit for her as I think they are
all too stimulant & favouring Haemorrhagy & when Nervous symptoms
appear, as it will generally be without fever, I would prefer Opiates to
{illeg}↑every↑ other remedy.
You have said nothing about the present state of Mrs Perkins
Belly. Tho it has been formerly in a lax state from the use of whey & yet in
another place you say it is naturally costive & I suspect it may be so at
present but there is nothing worse for her & the best & safest means of
obviating it is by Flores Sulphuris to which if you add one half their
weight of finely powdered Cream of Tartar you will have a powder of which
a tea-spoonfull, more or less, mixed with a little simple syrup & taken in
{illeg} ↑the↑ morning more or less frequently as occasion requires, will keep the
belly regular without their irritation which {illeg} Aloes Rhubarb & other
purgatives are reliable to give.
You make no remark upon Mrs Perkins diet or how you propose
to order it. Allow one to say that tho a purely vegetable diet might be impro¬
per yet her Animal food ought to be both sparing & light. She should
take none at supper & at dinner it should be but a part of her meal filling
up therest with vegetable food particularly the grain and farinaceous
kind. If Mrs Perkins can digest Milk I should think it very proper for her,
& I shall think a diet of milk and grain more likely than Animal food
to make her more plump than she is at present.
I give you now
what occurs to me upon farther information or upon any remarks
you please to make, or doubts you shall please to propose I shall say
farther. Before this letter I have had none from you since you sent me
the case of Mr Knox & I was a good deal disappointed in never hearing more of
that Gentleman & in your not ever acknowledging the receipt of my
letter on that subject. I shall be obliged to you for acknowledging the re¬
ceipt of this which I must not conclude without giving you some ac¬
count of myself.
My practise & teaching go on as usual that is with as
much success as I can expect. I suppose you know that three years ago I
[Page 6]
changed the Chemistry for the Institution & next year I make another change
being to teach the Colle↑d↑ge of Practice. Hereafter Dr Gregory & I are to teach the Insti¬
tutions and Practice alternately so that each of us in the course of two years
are to teach a compleat system. 1 This is very agreable to the students who may
have a complete & consistent system from one master & may if they please
have the compleat system from two Masters. The number of our students rather
increases but we shall hardly have any more agreable than some we have had
before & among which I have always reckoned you and I beg you will believe
me to be always with great regard and affection
Dr Hugh Your most obedient
servant
Notes:
1: Cullen's first appointment at Edinburgh College (University), in 1755 was to share the chair of Chemistry with Andrew Plummer. Cullen became sole professor of Chemistry upon Plummer's death in 1756. When John Rutherford resigned the chair of the practice of physic in 1766 Cullen hoped to succeed, but the chair went to Rutherford's candidate John Gregory. Cullen was disappointed but reluctantly accepted the chair of the theory of medicine which became vacant on the death of Robert Whytt later that year. In an unusual act of collegiality, Gregory and Cullen, responding to the petitions of faculty and students, agreed to give alternate lectures in the theory and in the practice of medicine. Upon Gregory's sudden death in 1773 Cullen became sole occupant of the more prestigious chair in the practice of medicine.
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