Cullen

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

 

[ID:1135] From: Reverend Joshua Parry (of Cirencester) / To: Dr William Cullen (Professor Cullen) / Regarding: Mr Holder (Patient) / 17 March 1775 / (Incoming)

Letter from Joshua Parry, giving answers to Cullen's queries about Mr Holder.

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Metadata

FieldData
DOC ID 1135
RCPE Catalogue Number CUL/1/2/236
Main Language English
Document Direction Incoming
Date17 March 1775
Annotation None
TypeAuthorial original
Enclosure(s) No enclosure(s)
Autopsy No
Recipe No
Regimen No
Letter of Introduction No
Case Note No
Summary Letter from Joshua Parry, giving answers to Cullen's queries about Mr Holder.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:623]
Case of Mr Holder who is bilious after having had jaundice.
1


People linked to this document

Person IDRole in documentPerson
[PERS ID:1427]AuthorReverend Joshua Parry (of Cirencester)
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:1428]PatientMr Holder
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:1430]Other Physician / SurgeonDr John Wall
[PERS ID:1429]Other Physician / SurgeonMr Cheston
[PERS ID:1427]Patient's Relative / Spouse / FriendReverend Joshua Parry (of Cirencester)

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing Cirencester South-West England Europe certain
Destination of Letter Edinburgh Edinburgh and East Scotland Europe inferred
Mentioned / Other Gloucester South-West England Europe certain
Mentioned / Other Worcester Midlands England Europe certain

Normalized Text

[Page 1]
Cirencester, March 17, 1775.


Mr Holder desires you to present his most respect¬
ful Compliments to Dr Cullen, & best Thanks for his
kind & studious Attention to his Case; sending him now
the following farther Account of it, taken by one in
Writing from his own Mouth.

Answers to the Doctor's Queries:


To Qu.1. Mr Holder from his Infancy to the Age
of 21, was one of the healthiest persons living, & one
of the most temperate. Near 22, he was seized with
a very violent Jaundice, which lasted 6 Weeks, &
was cured by the Expulsion of a very large Gall¬
stone
. From that Time he became extremely subject
to great Secretions of Bile, attended with violent
Pains in the Bowels & Stomach, & with Vomitings &
Purgings; which Symptoms frequently recurred, & were
not to be removed but by Laudanum. From the
Age of 24 to that of 42, at which he is now ar¬
rived, he hath been rather of a convivial Disposition,
though not what is commonly deemed intemperate.
By constant & violent Exercise on Horseback, & the
habitual Use of a rough, generous Cider, he supposes
the bilious Tendency of his Constitution to have been
considerably check'd. And yet, on the other Side, having
been usually exposed, during the last-mentioned peri¬
od, to all Changes of Weather, while carrying on a ve¬
ry extensive Country-Business as surgeon & Apothe¬
cary, he became very subject to Catarrhs, though not
of long duration. -- For the last 3 Months he hath
been much indisposed with bilious Complaints, which
so prevailed as to threaten, tho' they only threatened,
a complete Jaundice; the Serum of his Blood being deeply
tinged with Bile. Ever since his Confinement he hath been
afflicted with bitter Eructations, & with bilious Vomitings



[Page 2]

& Purgings; which seemed to himself, independantly
of the Pain in his Thorax, greatly to weaken him, & to
occasion an extreme Inappetence & Abhorrence of
Food
. Nevertheless at Times he eats with pleasure
a Meal of Fish, which he appears to digest as well
as ever he did in his Life.


Qu. 2. As to the Cause of the Disorders, i.e. of the
Pain & Dyspnœa, the Patient can form no Conjecture.
He remembers their Commencement to have been about
4 Years ago.


To Qu. 3 he hath nothing to answer, except that
the Fits are much longer going off than formerly.


With regard to Qu. 4, he says, that he can inspire
& expire
without any Excitation of pain, or the
least Inconvenience.


Qu. 5. See the Conclusion of the Answer to Qu. 1.


Qu. 6. He hath voided no Gall-Stone since the
first. As to Appearances of Jaundice, see Answer
to Qu. 1.


Qu. 7. The Numbness he hath experienced incessantly
for about 3 Months; except only that Sinapisms for
a very short Time produced some Sensation in, &
blister'd the Feet. But at present plaisters of Bur¬
gundy-Pitch
& Euphorbium have no sensible
Effect.


Qu. 8. The pain is only from Motion, such as Cough¬
ing
, Sneezing, & every Declination from an horizontal
Posture. Of course the Patient now constantly keeps
his Bed.


Qu. 9. The Pain seems, & always has seemed to be,
as nearly as possible, to (in) the Middle of the Sternum.


Parry of Cirencester
about
Mr Holder, March.
1775.




[Page 3]
March 18
.

Miscellaneous particulars, without
Arrangement, just as recollected.


The Patient perhaps remarked to the Doctor in the
former Account of his Case, that about 6 Weeks ago he
caught a violent Cold by Riding through a deep
Flood, which occasioned an extreme Hoarseness; but
that his Voice has been restored to him for some
Time.


Water Drinking for 5 months, preceding the 3
Months of his violent Disorder, apparently weakened
the Powers of his Heart, & bereaved him of Flesh &
Strength. - He does not appear to have had a Fe
ver
. - He was extremely weakened when by a small
Loss of Blood when his Cold was ↑at↑ the worst.


The Gushing Noise below his Ear (now of late in his
Ear) he hath probably remarked in the former Case.


Mr Cheston, an eminent Surgeon at Glo'ster, was
confident on studying his Case, & even brought over
Dr Wall of Worcester to his Opinion, that the Disorder
was a Polypus in the Heart; the Symptoms being
precisely similar to those of a Patient who died in the
Glo'ster Infirmary, &, being opened, appeared to have
a fleshy Excrescence, or Polypus, interwoven with the
Columnæ of the Heart.


His Cough seems sometimes to arise from a Nausea,
at other Times the Nausea from the Cough.


He was accustomed for a great while to be worse eve¬
ry other Day: He is now so every other Night. To prove,
as he thinks, how much Spasm is concerned, he remarks,
he can sleep very soundly on the well Night in any
Posture that is horizontal; but on the bad Night, the
Motion of his Heart is so languid (when instead of the
strong gushing, he perceives a faint ↑hissing↑ sound) that his utmost
care is requisite to continue it's Motion, by keeping strictly



[Page 4]

to the horizontal posture.


On Wednesday the 15th instant, his bilious Disorder being
extremely bad, he took pulverized Columbo-Root, 3 (↑10↑) Grains,
& 3 Grains of aromatic Species every Hour, which reliev'd
his Stomach, & by Thursday Night seemed to have totally
settled it, & to give his Disorder a Turn downward; & he
now continues it in a double Dose, every three Hours, as
it gives him great Comfort in his Stomach & Bowels,
& seems to strengthen his Heart.


{illeg} He has began taking the Æther, which seems
good of it's Kind, yesterday; has taken 6 Doses, & his Legs,
with regard to the Numbness, seem to be amazingly mend¬
ed. The Sensibility of his Hands had been in some Measure
restored before. It remarkably (I mean the Æther) filled
him with Wind. He had not been out of Bed for 4 Days
till to Day, when he bore getting up better than many
Efforts of the same Kind before. He took [a?] Dose of
Æther immediately before, & another immediately after
quitting his Bed; the Motion of his Heart being at once
exceedingly quick and languid. On his taking the very first
Dose of it, in a too small Draught of Water, he found
such an apparent Bursting (or something like Bursting)
in the place where the Pain was, that he was terrified;
but he thinks the Situation of the Pain to have been
much lower ever since, even as low as the Cartilago
ensiformis
; & he has hardly since been free from pain, e¬
specially on Talking.


I am sensible that in this Case there are some Ob¬
scurities, & perhaps some little Inconsistences; but, the
Patient being very languid, I could not demand of him
so many Explanations as I could have wished. Dr
Cullen's penetration will enable him to see through the
whole. Though not of the Faculty, I think I have
exprest exactly the Ideas communicated by the patient,
which he himself allowed me to have done.

Joshua Parry
.


It may be added, that Mr Holder has suffered long
and intense uneasiness from some of his closest family
connections.

Diplomatic Text

[Page 1]
Cirencester, March 17, 1775.


Mr Holder desires you to present his most respect¬
ful Compliments to Dr Cullen, & best Thanks for his
kind & studious Attention to his Case; sending him now
the following farther Account of it, taken by one in
Writing from his own Mouth.

Answers to the Doctor's Queries:


To Qu.1. Mr Holder from his Infancy to the Age
of 21, was one of the healthiest persons living, & one
of the most temperate. Near 22, he was seized with
a very violent Jaundice, which lasted 6 Weeks, &
was cured by the Expulsion of a very large Gall¬
stone
. From that Time he became extremely subject
to great Secretions of Bile, attended with violent
Pains in the Bowels & Stomach, & with Vomitings &
Purgings; which Symptoms frequently recurred, & were
not to be removed but by Laudanum. From the
Age of 24 to that of 42, at which he is now ar¬
rived, he hath been rather of a convivial Disposition,
though not what is commonly deemed intemperate.
By constant & violent Exercise on Horseback, & the
habitual Use of a rough, generous Cider, he supposes
the bilious Tendency of his Constitution to have been
considerably check'd. And yet, on the other Side, having
been usually exposed, during the last-mentioned peri¬
od, to all Changes of Weather, while carrying on a ve¬
ry extensive Country-Business as surgeon & Apothe¬
cary, he became very subject to Catarrhs, though not
of long duration. -- For the last 3 Months he hath
been much indisposed with bilious Complaints, which
so prevailed as to threaten, tho' they only threatened,
a complete Jaundice; the Serum of his Blood being deeply
tinged with Bile. Ever since his Confinement he hath been
afflicted with bitter Eructations, & with bilious Vomitings



[Page 2]

& Purgings; which seemed to himself, independantly
of the Pain in his Thorax, greatly to weaken him, & to
occasion an extreme Inappetence & Abhorrence of
Food
. Nevertheless at Times he eats with pleasure
a Meal of Fish, which he appears to digest as well
as ever he did in his Life.


Qu. 2. As to the Cause of the Disorders, i.e. of the
Pain & Dyspnœa, the Patient can form no Conjecture.
He remembers their Commencement to have been about
4 Years ago.


To Qu. 3 he hath nothing to answer, except that
the Fits are much longer going off than formerly.


With regard to Qu. 4, he says, that he can inspire
& expire
without any Excitation of pain, or the
least Inconvenience.


Qu. 5. See the Conclusion of the Answer to Qu. 1.


Qu. 6. He hath voided no Gall-Stone since the
first. As to Appearances of Jaundice, see Answer
to Qu. 1.


Qu. 7. The Numbness he hath experienced incessantly
for about 3 Months; except only that Sinapisms for
a very short Time produced some Sensation in, &
blister'd the Feet. But at present plaisters of Bur¬
gundy-Pitch
& Euphorbium have no sensible
Effect.


Qu. 8. The pain is only from Motion, such as Cough¬
ing
, Sneezing, & every Declination from an horizontal
Posture. Of course the Patient now constantly keeps
his Bed.


Qu. 9. The Pain seems, & always has seemed to be,
as nearly as possible, to (in) the Middle of the Sternum.


Parry of Cirencester
about
Mr Holder, March.
1775.




[Page 3]
March 18
.

Miscellaneous particulars, without
Arrangement, just as recollected.


The Patient perhaps remarked to the Doctor in the
former Account of his Case, that abt 6 Weeks ago he
caught a violent Cold by Riding through a deep
Flood, which occasioned an extreme Hoarseness; but
that his Voice has been restored to him for some
Time.


Water Drinking for 5 months, preceding the 3
Months of his violent Disorder, apparently weakened
the Powers of his Heart, & bereaved him of Flesh &
Strength. - He does not appear to have had a Fe
ver
. - He was extremely weakened when by a small
Loss of Blood when his Cold was ↑at↑ the worst.


The Gushing Noise below his Ear (now of late in his
Ear) he hath probably remarked in the former Case.


Mr Cheston, an eminent Surgeon at Glo'ster, was
confident on studying his Case, & even brought over
Dr Wall of Worcester to his Opinion, that the Disorder
was a Polypus in the Heart; the Symptoms being
precisely similar to those of a Patient who died in the
Glo'ster Infirmary, &, being opened, appeared to have
a fleshy Excrescence, or Polypus, interwoven with the
Columnæ of the Heart.


His Cough seems sometimes to arise from a Nausea,
at other Times the Nausea from the Cough.


He was accustomed for a great while to be worse eve¬
ry other Day: He is now so every other Night. To prove,
as he thinks, how much Spasm is concerned, he remarks,
he can sleep very soundly on the well Night in any
Posture that is horizontal; but on the bad Night, the
Motion of his Heart is so languid (when instead of the
strong gushing, he perceives a faint ↑hissing↑ sound) that his utmost
care is requisite to continue it's Motion, by keeping strictly



[Page 4]

to the horizontal posture.


On Wednesday the 15th instant, his bilious Disorder being
extremely bad, he took pulverized Columbo-Root, 3 (↑10↑) Grains,
& 3 Grains of aromatic Species every Hour, which reliev'd
his Stomach, & by Thursday Night seemed to have totally
settled it, & to give his Disorder a Turn downward; & he
now continues it in a double Dose, every three Hours, as
it gives him great Comfort in his Stomach & Bowels,
& seems to strengthen his Heart.


{illeg} He has began taking the Æther, which seems
good of it's Kind, yesterday; has taken 6 Doses, & his Legs,
with regard to the Numbness, seem to be amazingly mend¬
ed. The Sensibility of his Hands had been in some Measure
restored before. It remarkably (I mean the Æther) filled
him with Wind. He had not been out of Bed for 4 Days
till to Day, when he bore getting up better than many
Efforts of the same Kind before. He took [a?] Dose of
Æther immediately before, & another immediately after
quitting his Bed; the Motion of his Heart being at once
exceedingly quick and languid. On his taking the very first
Dose of it, in a too small Draught of Water, he found
such an apparent Bursting (or something like Bursting)
in the place where the Pain was, that he was terrified;
but he thinks the Situation of the Pain to have been
much lower ever since, even as low as the Cartilago
ensiformis
; & he has hardly since been free from pain, e¬
specially on Talking.


I am sensible that in this Case there are some Ob¬
scurities, & perhaps some little Inconsistences; but, the
Patient being very languid, I could not demand of him
so many Explanations as I could have wished. Dr
Cullen's penetration will enable him to see through the
whole. Though not of the Faculty, I think I have
exprest exactly the Ideas communicated by the patient,
which he himself allowed me to have done.

Joshua Parry
.


It may be added, that Mr Holder has suffered long
and intense uneasiness from some of his closest family
connections.

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