Cullen

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

 

[ID:873] From: Dr William Cullen (Professor Cullen) / To: [ADDRESSEE UNKNOWN] / Regarding: Mr N Halkerston (Patient) / February 1774 / (Outgoing)

Reply, giving detailed directions for Mr Halkerston in the form of a loose, corrected draft in Cullen's own hand. Cullen believes that 'the foundation of all his complaints both formerly and more evidently now is a weakness and mobility of his Nervous system'. The polished version of this response would have been supplied around the time Haggerston consulted Cullen in person as indicated in the other letter linked to this case.

Facsimile

There are 8 images for this document.

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[Page 2]


 

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Metadata

FieldData
DOC ID 873
RCPE Catalogue Number CUL/1/2/139
Main Language English
Document Direction Outgoing
DateFebruary 1774
Annotation None
TypeAuthorial original
Enclosure(s) No enclosure(s)
Autopsy No
Recipe No
Regimen Yes
Letter of Introduction No
Case Note No
Summary Reply, giving detailed directions for Mr Halkerston in the form of a loose, corrected draft in Cullen's own hand. Cullen believes that 'the foundation of all his complaints both formerly and more evidently now is a weakness and mobility of his Nervous system'. The polished version of this response would have been supplied around the time Haggerston consulted Cullen in person as indicated in the other letter linked to this case.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:22]
Case of Mr Halkerson, diagnosed with a 'weakness of his Nervous System'.
2


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:392]PatientMr N Halkerston
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr 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
Therapeutic Recommendation Spain Europe certain
Therapeutic Recommendation North of France France Europe certain
Therapeutic Recommendation South of France France Europe certain
Therapeutic Recommendation South of Spain Spain Europe certain
Mentioned / Other Britain Europe certain
Mentioned / Other Scotland Europe certain

Normalized Text

[Page 1]
For Mr Halkerston


Having now and formerly considered ↑both↑ the
former history and present State of Mr Halkerstons
complaints I own it would be difficult to account
for the various appearances and revolutions which
have happened in his constitution. ↑[Not?]↑ but upon the
whole I am of opinion, that the foundation of all
his complaints both formerly and more evidently now
is a weakness and mobility of his Nervous System
which is liable to every variety of derangement and
↑ready to give ↑the appearance of↑a general Cachexy In particular the alimentary ↑Canal↑ is liable to suffer,
weakness is ready to appear and Spasms to happen
in every part of it. From imperfect digestion and
assimilation acrimony is likely to prevail and both (↑not only↑)
from this source of imperfect assimilation but also from
the Stagnations which weakness gives occasion to and



[Page 2]

from the various fluids which are poured into the
↑long↑ Intestinal canal a general and various acrimony is
likely to fall upon it and particularly by irritating the
rectum to produce an hemorrhoidal afflux


This is my Idea of Mr Halkerstons State of
body. It is a State however which as depending upon
original and constitutional faults and as having
now Subsisted for a long time must now be difficult
to mend but I hope that a proper management
may do ↑a↑ great deal to all obviate consequences
and alleviate his distress and in Short to amke
life pass on ↑Still↑ to a great length with tolerable ease
and comfort.


For this purpose the fundamental measure
would be to restore Some Strength to the Nervous Sys¬
tem
but I believe it is not to be done now by Medicine
and Some of the medicines which might be employed



[Page 3]

are in hazard (↑danger↑) of giving disturbance by the astriction and
infarctions they are liable to produce in a moveable System
{illeg} The only roborant that I think could be Safely employed
is a light Chalybeate water taken for sometime in mode¬
rate quantity. Of Such waters there are many in every
Country of Europe. Those of Tunbridge are not more power¬
full than many others but as they are in a good Climate
and much resorted to they amy answer ↑many purposes↑ better than some others.


Instead of remedies for strengthening his constitu¬
tion Mr Halkerston must employ & depend upon
the effects of gentle exercise very frequently used
and in no way more properly than in easy jour¬
nies. It is probable also that he might be the better
for a cold bath of a very moderate kind. The
cold applied being never under 70 degrees of Fah¬
renheit's Thermometer & rather a little warmer
or of such a temperature as may be produced by a
mixture of one part boiling water with four parts of



[Page 4]

Spring water which is commonly of fifty de¬
grees. The best ↑& safest↑ way of applying this will be by
washing the body all over it with it by a large
spunge dipt in to it. every morning.


Besides using strengthening means Mr H
must avoid every debilitating cause & such is
a cold & damp climate. In this Respect Scotland (↑In the respect every part of Britain ↑)
is extremely bad ↑for him↑ in winter & not good enough
for him even in Summer because it is liable
to more frequent and sudden changes than the Air
↑of the↑ Continent. ↑In Winter↑ The South of France might answer
pretty well but the South of Spain is still
much better in winter & somewhere to the
North of France would be best in Summer
tho I believe with some little care to avoid the
mid day heats he might bear the Summer of
Spain very well & especially if he could continue
During Summer to retire to a mountainous si¬
tuation.
it is all damned nonsense 1




[Page 5]


These measures respect his general
habit but a great deal of care must be directed
by him ti the management of his alimentary
canal
. His Stomach must be accomodated
with such mild & bland nourishment as it
can most easily digest. So long as it agrees
with milk there is nothing more proper for
him & this with bread or the dry grains such
as Rice or Barley will make a diet which will
be one of the most secure & at the same
time ↑will↑ support him in as much strength as
his constitution admits of. If the Milk at any
time proves of more difficult digestion it will
be mended by water gruel or a decoction of
Rice and Barley mixed in an equal part with
it & the whole well sweetened with Sugar or
Honey. This will be especially necessary with
↑Cows or↑ Goats mild but will hardly be necessary with



[Page 6]

that of Asses.


Besides Milk & Grain it is probable that
in a warm climate Mr H. will bear some milk
& quite ripe fruit but he must be very cautious
in taking these very freely as they may very
possibly prove tooo cold for his bowels


Mr H. knows very well that it is absolutely
necessary for him to have regular & easy stools
to prevent all stagnation & consequent acrimony
So long as this can be obtained by Sugar or
Honey mixed with his milk it is the most
desireable means & if it should fail it is pro¬
bable that a moderate use of ripe fruit will
answer the purpose; but if this also still fails
or proves inconvenient he must have recourse
to medicines for the choice of which I



[Page 7]

must leave him to his own experience


In spite of all we can do by the mildness
of diet & avoiding all stagnation in the bowels
to prevent acrimony it is to be feared
that some may prevail & for preventing it
I know know nothing more probable than
the dose of Seltzer water taken from the 9th of
an ↑English↑ Pint to a Quart english every day.
When this water can be had from the natural
Springs it is to be prefered but in any
place it may be imitated by disolving from
ten to twenty grains of a pure salt of Tartar
in a pint of water & impregnating the same
water {illeg} the fixed (↑by a proper apparatus↑) wih a quantity of fixed
air taken from chalk.


I Should have said above that no thing
contributes more to support appetite & di¬
gestion tho & to prevent all the ba (↑any load from↑) falling



[Page 8]

upon the bowels, than supporting the exter
perspiration of the skin by a warm climate
& gentle exercise.


Mr. H. seems to have been relieved from
some of his complaints by the bleeding of Piles
but I cannot think there is any fullness in
his constitution to require any large eva¬
cuation this way & therefore tho I would
take no measures to stop it when nature
seems to point this way but neither would
I solicit or encourage it & therefore would I
avoid if possible Aloetic Purges. Tho I say I
would not encourage this evacuation yet I must
own that when the Piles are much swelled &
strangled it may be necessary to relieve them by
leeches.

Notes:

1: This inexplicable annotation appears as if it was added by Cullen in the same ink as the main draft, but possibly not. It could simply be an irritable outburst while testing a quill.

Diplomatic Text

[Page 1]
For Mr Halkerston


Having now and formerly considered ↑both↑ the
former history and present State of Mr Halkerstons
complaints I own it would be difficult to account
for the various appearances and revolutions which
have happened in his constitution. ↑[Not?]↑ but upon the
whole I am of opinion, that the foundation of all
his complaints both formerly and more evidently now
is a weakness and mobility of his Nervous System
which is liable to every variety of derangement and
↑ready to give ↑the appearance of↑a general Cachexy In particular the alimentary ↑Canal↑ is liable to suffer,
weakness is ready to appear and Spasms to happen
in every part of it. From imperfect digestion and
assimilation acrimony is likely to prevail and both (↑not only↑)
from this source of imperfect assimilation but also from
the Stagnations which weakness gives occasion to and



[Page 2]

from the various fluids which are poured into the
↑long↑ Intestinal canal a general and various acrimony is
likely to fall upon it and particularly by irritating the
rectum to produce an hemorrhoidal afflux


This is my Idea of Mr Halkerstons State of
body. It is a State however which as depending upon
original and constitutional faults and as having
now Subsisted for a long time must now be difficult
to mend but I hope that a proper management
may do ↑a↑ great deal to all obviate consequences
and alleviate his distress and in Short to amke
life pass on ↑Still↑ to a great length with tolerable ease
and comfort.


For this purpose the fundamental measure
would be to restore Some Strength to the Nervous Sys¬
tem
but I believe it is not to be done now by Medicine
and Some of the medicines which might be employed



[Page 3]

are in hazard (↑danger↑) of giving disturbance by the astriction and
infarctions they are liable to produce in a moveable System
{illeg} The only roborant that I think could be Safely employed
is a light Chalybeate water taken for sometime in mode¬
rate quantity. Of Such waters there are many in every
Country of Europe. Those of Tunbridge are not more power¬
full than many others but as they are in a good Climate
and much resorted to they amy answer ↑many purposes↑ better than some others.


Instead of remedies for strengthening his constitu¬
tion Mr Halkerston must employ & depend upon
the effects of gentle exercise very frequently used
and in no way more properly than in easy jour¬
nies. It is probable also that he might be the better
for a cold bath of a very moderate kind. The
cold applied being never under 70 degrees of Fah¬
renheit's Thermometer & rather a little warmer
or of such a temperature as may be produced by a
mixture of one part boiling water with four parts of



[Page 4]

Spring water which is commonly of fifty de¬
grees. The best ↑& safest↑ way of applying this will be by
washing the body all over it with it by a large
spunge dipt in to it. every morning.


Besides using strengthening means Mr H
must avoid every debilitating cause & such is
a cold & damp climate. In this Respect Scotland (↑In ye respect every part of Britain ↑)
is extremely bad ↑for him↑ in winter & not good enough
for him even in Summer because it is liable
to more frequent and sudden changes than the Air
↑of the↑ Continent. ↑In Winter↑ The South of France might answer
pretty well but the South of Spain is still
much better in winter & somewhere to the
North of France would be best in Summer
tho I believe with some little care to avoid the
mid day heats he might bear the Summer of
Spain very well & especially if he could continue
During Summer to retire to a mountainous si¬
tuation.
it is all damned nonsense 1




[Page 5]


These measures respect his general
habit but a great deal of care must be directed
by him ti the management of his alimentary
canal
. His Stomach must be accomodated
with such mild & bland nourishment as it
can most easily digest. So long as it agrees
with milk there is nothing more proper for
him & this with bread or the dry grains such
as Rice or Barley will make a diet which will
be one of the most secure & at the same
time ↑will↑ support him in as much strength as
his constitution admits of. If the Milk at any
time proves of more difficult digestion it will
be mended by water gruel or a decoction of
Rice and Barley mixed in an equal part with
it & the whole well sweetened with Sugar or
Honey. This will be especially necessary with
↑Cows or↑ Goats mild but will hardly be necessary with



[Page 6]

that of Asses.


Besides Milk & Grain it is probable that
in a warm climate Mr H. will bear some milk
& quite ripe fruit but he must be very cautious
in taking these very freely as they may very
possibly prove tooo cold for his bowels


Mr H. knows very well that it is absolutely
necessary for him to have regular & easy stools
to prevent all stagnation & consequent acrimony
So long as this can be obtained by Sugar or
Honey mixed with his milk it is the most
desireable means & if it should fail it is pro¬
bable that a moderate use of ripe fruit will
answer the purpose; but if this also still fails
or proves inconvenient he must have recourse
to medicines for the choice of which I



[Page 7]

must leave him to his own experience


In spite of all we can do by the mildness
of diet & avoiding all stagnation in the bowels
to prevent acrimony it is to be feared
that some may prevail & for preventing it
I know know nothing more probable than
the dose of Seltzer water taken from ye 9th of
an ↑English↑ Pint to a Quart english every day.
When this water can be had from the natural
Springs it is to be prefered but in any
place it may be imitated by disolving from
ten to twenty grains of a pure salt of Tartar
in a pint of water & impregnating ye same
water {illeg} the fixed (↑by a proper apparatus↑) wih a quanty of fixed
air taken from chalk.


I Should have said above that no thing
contributes more to support appetite & di¬
gestion tho & to prevent all the ba (↑any load from↑) falling



[Page 8]

upon the bowels, than supporting the exter
perspiration of the skin by a warm climate
& gentle exercise.


Mr. H. seems to have been relieved from
some of his compts by the bleeding of Piles
but I cannot think there is any fullness in
his constitution to require any large eva¬
cuation this way & therefore tho I would
take no measures to stop it when nature
seems to point this way but neither would
I solicit or encourage it & therefore would I
avoid if possible Aloetic Purges. Tho I say I
would not encourage this evacuation yet I must
own that when the Piles are much swelled &
strangled it may be necessary to relieve ym by
leeches.

Notes:

1: This inexplicable annotation appears as if it was added by Cullen in the same ink as the main draft, but possibly not. It could simply be an irritable outburst while testing a quill.

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