Cullen

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

 

[ID:690] From: Dr William Cullen (Professor Cullen) / To: Mr William Ingham / Regarding: Miss Barbara Peareth (Pearith) (Patient) / 24 December 1782 / (Outgoing)

Reply, 'Mr Ingham Concerning Miss Peariths': 'you will not expect that I can do much for your patient and indeed I do not expect to do more than to palliate a little'.

Facsimile

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Metadata

FieldData
DOC ID 690
RCPE Catalogue Number CUL/1/1/15/177
Main Language English
Document Direction Outgoing
Date24 December 1782
Annotation None
TypeMachine copy
Enclosure(s) No enclosure(s)
Autopsy No
Recipe Yes
Regimen No
Letter of Introduction No
Case Note No
Summary Reply, 'Mr Ingham Concerning Miss Peariths': 'you will not expect that I can do much for your patient and indeed I do not expect to do more than to palliate a little'.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:53]
Case of Miss Barbara Peareth who is thought to have an internal abdominal tumour.
13


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:82]AddresseeMr William Ingham
[PERS ID:662]PatientMiss Barbara Peareth (Pearith)
[PERS ID:82]Patient's Physician / Surgeon / ApothecaryMr William Ingham
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:81]Patient's Physician / Surgeon / ApothecaryMr Richard Lambert

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 Newcastle upon Tyne North-East England Europe inferred

Normalized Text

[Page 1]

Mr Ingham Concerning Miss Peariths

Edinburgh 24th December 1782.

Dear Sir


I am favoured with yours concerning
Miss Barbara Pearith and sorry to say that I must join
with you in thinking the symptoms truly alarming.


There can be no doubt now that the schirrosity which has
subsisted so long, is as Mr Lambert and I judged formerly, strictly
connected with the Liver or perhaps a part of it. Tho the humour
externally is not evidently increased it must have extended itself
internally and now ↑certainly↑ compresses the biliary ducts, and tho there
are no external symptoms of a suppuration, nor any certain
evidence of it going on internally, yet the pain felt on pressure
with the frequent recurrence of feverishness, give me a strong
suspicion of it, and I have no doubt but that the whole of
the disease will end in a hectic State.


In this view of things you will not expect that I can do
much for your patient and indeed I do not expect to do more
than to palliate a little and even while the irritability of the
stomach remains, the palliation will be difficult. To get the
stomach to admit of both medicine and food I would have you



[Page 2]

to employ opiates both largely and very frequently, tho without
either the patient or her friends knowing much of the matter.
The only interruption in this course ↑you↑ will be liable to, will
be from the costiveness which the opiates induce, but the keep¬
ping the intestines to their due course is otherwise necessary
for the disease and therefore what laxatives the Stomach will
bear must be very constantly employed. I have prescribed be¬
low a Soap pill which when taken in sufficient quantity, com¬
monly keep the belly open but I doubt much if Miss Barbara
will be able to take the quantity necessary for that purpose and
therefore I expect you will find it necessary to employ some other
laxative. Calcined Magnesia from half a dram to a dram
once or twice a day may possibly answer, or if it does not the
oleum ricini may perhaps be admitted and to make it more
allowed and also more effectual add to it a fourth part of the
Tinct. Senn. composit. of our Dispensatory or perhaps the same
proportion of our Tinct. Jalap. When these Tinctures are
well shaken together with the Oil, immediately before exhibition the
warmth of the spirituous Tincture will not be perceived. If


[Page 3]

neither of these medicines answer you may have recourse to
our compound powder of Jalop which when properly triturated
you will find to be a tolerably mild medicine. I mention these
several medicines both that you may find the necessary laxative
and that you may sometimes vary it. These however with
the Opiates and the Aperient Pills ordered below are the only
medicines I would propose at present. For her diet I believe you
must be confined to broths, ↑&↑ Jellies, with Some of the more nourishing
farinacea as Sago & Jalep, though if her Stomach will bear a
little of the lighter kinds of animal food I should not think it un¬
proper. In drink I don't expect expect She will bear any fermented
or spirituous liquor and I would not advise them. Her drink there¬
fore must be of plainest & mildest kind, Boiled water with a toast in
it, Thin water gruel, Barley water, Weak Bohea Tea or Cocoa Tea
Wishing you heartily Success & with Compliments to the family
I am with great regard Dear Sir Your most obedient Servant --


William Cullen
For Miss Barbara Pearith

Take one drachm of electuary of rhubarb Powder, two drachms of Spanish Soap and a sufficient quantity of Simple Syrup in order to let there be made a mass to be divided into pills of five grains each. Label as Aperient Pills, two, three or four to be taken twice a day, washing them down with a small cupfull of the following.

Take one drachm of english gentian Root and half a drachm of orange Peel. Pour over the crushed ingredients one pound of boiling water. Let it digest for six hours, add one ounce of Tincture of bitters and then strain using the paper. Label as Aperient Infusion


W.C.

Diplomatic Text

[Page 1]

Mr Ingham C Miss Peariths

Edin.r 24th Decr. 1782.

Dear Sir


I am favoured with yours concerning
Miss Barbara Pearith and sorry to say that I must join
with you in thinking the symptoms truly alarming.


There can be no doubt now that the schirrosity which has
subsisted so long, is as Mr Lambert and I judged formerly, strictly
connected with the Liver or perhaps a part of it. Tho the humour
externally is not evidently increased it must have extended itself
internally and now ↑certainly↑ compresses the biliary ducts, and tho there
are no external symptoms of a suppuration, nor any certain
evidence of it going on internally, yet the pain felt on pressure
with the frequent recurrence of feverishness, give me a strong
suspicion of it, and I have no doubt but that the whole of
the disease will end in a hectic State.


In this view of things you will not expect that I can do
much for your patient and indeed I do not expect to do more
than to palliate a little and even while the irritability of the
stomach remains, the palliation will be difficult. To get the
stomach to admit of both medicine and food I would have you



[Page 2]

to employ opiates both largely and very frequently, tho without
either the patient or her friends knowing much of the matter.
The only interruption in this course ↑you↑ will be liable to, will
be from the costiveness which the opiates induce, but the keep¬
ping the intestines to their due course is otherwise necessary
for the disease and therefore what laxatives the Stomach will
bear must be very constantly employed. I have prescribed be¬
low a Soap pill which when taken in sufficient quantity, com¬
monly keep the belly open but I doubt much if Miss Barbara
will be able to take the quantity necessary for that purpose and
therefore I expect you will find it necessary to employ some other
laxative. Calcined Magnesia from half a dram to a dram
once or twice a day may possibly answer, or if it does not the
oleum ricini may perhaps be admitted and to make it more
allowed and also more effectual add to it a fourth part of the
Tinct. Senn. composit. of our Dispensatory or perhaps the same
proportion of our Tinct. Jalap. When these Tinctures are
well shaken together with the Oil, immediately before exhibition the
warmth of the spirituous Tincture will not be perceived. If


[Page 3]

neither of these medicines answer you may have recourse to
our compound powder of Jalop which when properly triturated
you will find to be a tolerably mild medicine. I mention these
several medicines both that you may find the necessary laxative
and that you may sometimes vary it. These however with
the Opiates and the Aperient Pills ordered below are the only
medicines I would propose at present. For her diet I believe you
must be confined to broths, ↑&↑ Jellies, with Some of the more nourishing
farinacea as Sago & Jalep, though if her Stomach will bear a
little of the lighter kinds of animal food I should not think it un¬
proper. In drink I don't expect expect She will bear any fermented
or spirituous liquor and I would not advise them. Her drink there¬
fore must be of plainest & mildest kind, Boiled water wth a toast in
it, Thin water gruel, Barley water, Weak Bohea Tea or Cocoa Tea
Wishing you heartily Success & with Compliments to the family
I am with great regard Dear Sir Your most obedient Servant --


William Cullen
For Miss Barbara Pearith


Pulv. rhei. elect. ʒj Sapon. Hispan. ʒij
Syr. Simpl. q. s. ut f. massa dividend in pil. Sing. gr. v. Sig. Aperient Pills two
three or four to be taken twice day, washing them down with a small cupfull of the
following.


Rad. gentian. ʒj Cort. aurant. ʒfs Contusis affunde Aq. fervent. ℔j
Digere horas Sex et adde Tinct. amar. ℥j et denique per chartam cola Signa
Aperient Infusion


W.C.

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