Cullen

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

 

[ID:1719] Case Note / Regarding: Mr K. (Patient) / 7 August 1779 / (Incoming)

Unsigned case note (originally enclosed with Doc: 1718), by Timothy Kirby, describing the case of Mr. K., a married man aged 30, who is said to have inherited his parents' 'gouty diathesis'. His case history goes back to 1764, when he was a student at an academy in Dublin, and includes time in Glasgow in 1766. He has a wide range of ailments, including respiratory and bilious symptoms, listlessness and seminal effusions. He has tried a range of medicines and plaisters, and taken the waters at Bath. He has consulted other physicians in England: Delacour, Warren and Jebb.

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Metadata

FieldData
DOC ID 1719
RCPE Catalogue Number CUL/1/2/806
Main Language English
Document Direction Incoming
Date7 August 1779
Annotation None
TypeAuthorial original
Enclosure(s) Enclosure(s) present
Autopsy No
Recipe No
Regimen No
Letter of Introduction No
Case Note No
Summary Unsigned case note (originally enclosed with Doc: 1718), by Timothy Kirby, describing the case of Mr. K., a married man aged 30, who is said to have inherited his parents' 'gouty diathesis'. His case history goes back to 1764, when he was a student at an academy in Dublin, and includes time in Glasgow in 1766. He has a wide range of ailments, including respiratory and bilious symptoms, listlessness and seminal effusions. He has tried a range of medicines and plaisters, and taken the waters at Bath. He has consulted other physicians in England: Delacour, Warren and Jebb.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:1193]
Case of the anonymised 'Mr K.' in Ireland, who is languorous from a very long-standing weakness, probably rooted in the gout and for which a regimen and cold shower bath is advised.
3


People linked to this document

Person IDRole in documentPerson
[PERS ID:3134]AuthorDr Timothy Kirby (Kirkby)
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:3135]PatientMr K.
[PERS ID:3134]Patient's Physician / Surgeon / ApothecaryDr Timothy Kirby (Kirkby)
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:3174]Patient's Physician / Surgeon / ApothecaryDr Philip De La Cour (Philippe Delacour)
[PERS ID:137]Patient's Physician / Surgeon / ApothecarySir Richard Jebb
[PERS ID:531]Patient's Physician / Surgeon / ApothecaryDr Richard? Warren
[PERS ID:925]Other Physician / SurgeonDr Herman Boerhaave
[PERS ID:3131]Patient's Relative / Spouse / FriendMrs K.
[PERS ID:3134]Patient's Relative / Spouse / FriendDr Timothy Kirby (Kirkby)

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing Tallow South Ireland Ireland Europe certain
Destination of Letter Edinburgh Edinburgh and East Scotland Europe certain
Mentioned / Other Bath South-West England Europe certain
Mentioned / Other Dublin Mid Ireland Ireland Europe certain
Mentioned / Other Glasgow Glasgow and West Scotland Europe certain
Mentioned / Other London London and South-East England Europe certain

Normalized Text

[Page 1]
Mr. K––––s Case ––


Mr K ag'd about 30 is of a spare
habit of body – inherits the gouty dia¬
thesis
from both of his parent – & seems
to be of that temperament describ'd
by Boerhaave under the title of bilious temperament. 1 The first commence¬
ment of his ill health was in the year
64 – and the most obvious source ↑of↑ it was an
obstinate intermittent
, which seiz'd him
while at school at an academy in Dub¬
lin – A dry cough attended with some
pain of the right sidea remarkable sal¬
lowness of complexion
loss of appetite
& emaciation were the sequels of it. He
pass'd the winter of the year 66 in Glasgow,
where he had a severe Angina. The cough
& pain of his side still subsisted, & he
was subject to frequent complaints of his sto¬
mach
& head – which were usually appeas'd



[Page 2]

or terminated by more or less of a vomit¬
ing of
bilious matter. His appetite – di¬
gestion & spirits were now much impair¬
ed
, & he was most commonly costive.
Some aperients & deobstruent medicines
were prescrib'd for him here & he was
recommended exercise on horseback &
change of air. I had no opportunity of
seeing him again 'till the year 74 in Dub¬
lin – whither the encrease of his former
complaints (from which he never experi¬
enced a total freedom) with the addition
of some others – such as universal debi¬
lity
tremors, languors & wandering
pains of his body & limbs determin'd
him to goe for the sake of consulting the
physicians of eminence. I did not learn
precisely what their ideas were of the na¬
ture of his ailments, but concluded
from the medicines employ'd by 'em (which
were chiefly of the tonic & antispasmodic
class) that they consider'd 'em as prin¬


[Page 3]

cipally depending on a universally weak
& irritable state of
the nervous system.
Be this as it may, very little permanent
change was wrought by 'em, & in about
a year and a half after I was applied to, &
found his already discrib'd complaints
aggravated by the addition of an almost
incessant involuntary seminal effu¬
sion, accompanied with vast debility
sense of lassitude, pain & weakness of the
small of the back
, & very frequently also,
with [dead?] pain, torpor, & sense of weight
& coldness in the back of the head. He
complain'd much at times of stricture
& pain extending from his right side
across his stomach. These affections
did not preserve any uniform tenour –
but became at times as considerable
as to oblige him to keep to bed for a day
or two – during which time he was to¬
tally enervated
, & destitute of appetite
& spirits, had flying pains all over &


[Page 4]

thro' him, and an insuperable listless¬
ness, and aversion from every exertion
whatsoever of mind & body
– Mr K:
led usually an active life, & very rarely
committed excesses of any kind – except
in point of violent exercise on horseback
being exceedingly given to fox hunting.
My treatment of him was in general
address'd to the obviating the universal
debility, & atonia of his nervous system
& the particular one of his stomach & di¬
gestive organs – while in the meantime
particular attention was paid to the
special relax'd & irritable state of
his
seminal organs
, and as some suspicion
occurr'd that his liver & biliary passa¬
ges
were somewhat obstructed – I occa¬
sionally directed such medicines as
are reputed to act in removing obstruct¬
ions of these organs
, and may at the
same time keep his belly is a proper¬
ly soluble state. With a view to ac¬


[Page 5]

complish the first of these ends he took
from time to time various forms of the
Bark
with bitters, & astringents, & also
several medicines of the nervous: seda¬
tive
& antispasmodic kind – such as
Æther, Castor, Valerian, Musk, Paregoric Elixir join'd with the Composite Castor Tincture
& Volatile Fœtid Spirit and the fœtid gums –
which for the last purpose were combi¬
ned with soap, Aloes Socotorin. Rhu¬
barb
, Gum. Ammon.Ammoniac &c – To assist to¬
wards the same end, He tried a plaister
of
the Volatile Epithem & then one compos'd
of equal parts of the Plaister of
Ammonia with Mercury & the Gum Plaister to the
pain'd side
Fomentations & Embroca¬
tions were also employ'd – For the semi¬
nal weakness
particularly, he took
the bark in substance with allum
& Steel Salts, and on the presumption
of it's great astringency, I was willing
to give the Tincture of Kino Gum from the Edinburgh Pharmacopœia 3 a tryal, but it disagreeing with
his stomach, he was oblig'd to discont¬
inue it before any judment of it's ef¬
ficacy cou'd be form'd – Gentle exercise
cold bathing, a light nutritive & resto¬
rative
regimen, the use of Spa water &
red wine accompanied this course, &
he was enjoin'd a total abstinence from
tea & all relaxants, & sedatives. Such
as much intercourse with his wife –
laborious & fatiguing exercises of body
& mind, soft beds, warm & crowded
rooms &c – Finding at length that his
complaints were little dispos'd to give
way to these & other means employ'd at
different times for his relief, & suspect¬
ing partly from his hæreditary predis¬
position, but especially from my ob¬
serving latterally that the affections of
his head & stomach alternated with
those of his limbs – that a latent gou¬
ty seminium
may have some share


[Page 7]

in the production of his complaints, I
concurr'd with his friends in advising
him a trip to Bath – He accordingly
passed the greatest part of the last sum¬
mer there, & drank the waters under the
direction of a physician. For some
time after he commenc'd their use, he
experienc'd some good effects, especially
an improvement of his appetite – digesti¬
on & spirits – but latterally they disa¬
greed with him much. He consulted
during his stay in England – Doctor De
la Cour of Bath, and Doctors Jebb &
Warren of London, who order'd some
medicines, principally of the tonic &
stomachick kind for him – and advi¬
sed him to use saltwater bathing.
He has try'd the latter for some weeks
past, but not regularly or constant¬
ly – and he is now taking by my direct¬
tions, some pills compos'd of Extract of Peruvian Bark Extract of Gentian, Olibanum


[Page 8]

Turkey Rhubarb & Steel Salts for
his gleet – But I do not hear that with
this – or ↑his↑ other complaints are material¬
ly affected by either ––

August 7th – 1779 ––––

Notes:

1: A precise reference in the published works of the leading Dutch academic physician Herman Boerhaave (1688-1738), has not been traced, but he discussed biliousness in his influential lectures.

2: See Pharmacopoeia Collegii Regii Medicorum Edinburgensis (Edinburgh: 1774), pp.78-9.

3: See Pharmacopoeia Collegii Regii Medicorum Edinburgensis (Edinburgh: 1774), pp.78-9.

Diplomatic Text

[Page 1]
Mr. K––––s Case ––


Mr K ag'd about 30 is of a spare
habit of body – inherits the gouty dia¬
thesis
from both of his parent – & seems
to be of that temperament describ'd
by Boerhaave under the title of tem¬
peries biliosa
. 1 The first commence¬
ment of his ill health was in ye. year
64 – and ye. most obvious source ↑of↑ it was an
obstinate intermittent
, which seiz'd him
while at school at an academy in Dub¬
lin – A dry cough attended with some
pain of ye. right sidea remarkable sal¬
lowness of complexion
loss of appetite
& emaciation were ye. sequels of it. He
pass'd ye. winter of ye. year 66 in Glasgow,
where he had a severe Angina. The cough
& pain of his side still subsisted, & he
was subject to frequent complts. of his sto¬
mach
& head – wch. were usually appeas'd



[Page 2]

or terminated by more or less of a vomit¬
ing of
bilious matter. His appetite – di¬
gestion & spirits were now much impair¬
ed
, & he was most commonly costive.
Some aperients & deobstruent medicines
were prescrib'd for him here & he was
recommended exercise on horseback &
change of air. I had no opportunity of
seeing him again 'till ye. year 74 in Dub¬
lin – whither the encrease of his former
complaints (from which he never experi¬
enced a total freedom) with ye. addition
of some others – such as universal debi¬
lity
tremors, languors & wandering
pains of his body & limbs determin'd
him to goe for ye. sake of consulting ye.
physicians of eminence. I did not learn
precisely what their ideas were of ye. na¬
ture of his ailments, but concluded
from ye. medicines employ'd by 'em (wch.
were chiefly of ye. tonic & antispasmodic
class) that they consider'd 'em as prin¬


[Page 3]

cipally depending on a universally weak
& irritable state of
ye. nervous system.
Be this as it may, very little permant.
change was wrought by 'em, & in about
a year and a half after I was applied to, &
found his already discrib'd complaints
aggravated by ye. addition of an almost
incessant involuntary seminal effu¬
sion, accompanied with vast debility
sense of lassitude, pain & weakness of ye.
small of ye. back
, & very frequently also,
with [dead?] pain, torpor, & sense of weight
& coldness in ye. back of ye. head. He
complain'd much at times of stricture
& pain extending from his right side
across his stomach. These affections
did not preserve any uniform tenour –
but became at times as considerable
as to oblige him to keep to bed for a day
or two – during which time he was to¬
tally enervated
, & destitute of appetite
& spirits, had flying pains all over &


[Page 4]

thro' him, and an insuperable listless¬
ness, and aversion from every exertion
whatsoever of mind & body
– Mr K:
led usually an active life, & very rarely
committed excesses of any kind – except
in point of violent exercise on horseback
being exceedingly given to fox hunting.
My treatment of him was in general
address'd to ye. obviating the universal
debility, & atonia of his nervous system
& ye. particular one of his stomach & di¬
gestive organs – while in ye. meantime
particular attention was paid to the
special relax'd & irritable state of
his
seminal organs
, and as some suspicion
occurr'd that his liver & biliary passa¬
ges
were somewhat obstructed – I occa¬
sionally directed such medicines as
are reputed to act in removing obstruct¬
ions of these organs
, and may at the
same time keep his belly is a proper¬
ly soluble state. With a view to ac¬


[Page 5]

complish ye. first of these ends he took
from time to time various forms of ye.
Cortex
with bitters, & astringents, & also
several medicines of ye. nervous: seda¬
tive
& antispasmodic kind – such as
Æther, Castor, Valerian, Musk, Elix¬
ir paregor.
join'd with the Tinct. Castor. c.
& Spir. vol. fœtid. and ye. fœtid gums –
which for ye. last purpose were combi¬
ned with soap, Aloes Socotorin. Rhu¬
barb
, Gum. Ammon.Ammoniac &c – To assist to¬
wards ye. same end, He tried a plaister
of
ye. Epithem. vol. & then one compos'd
of p.a. ye. Emplastr. ex
Ammon. cum
Mercur. & ye. Emplastr. gummos. to ye.
pain'd side
Fomentations & Embroca¬
tions were also employ'd – For ye. semi¬
nal weakness
particularly, he took
the bark in substance with allum
& Sal. Mart., and on ye. presumption
of it's great astringency, I was willing
to give ye. Tinctur. e gummi Kino Ph:


[Page 6]

Edinb.
2 a tryal, but it disagreeing wth.
his stomach, he was oblig'd to discont¬
inue it before any judment of it's ef¬
ficacy cou'd be form'd – Gentle exercise
cold bathing, a light nutritive & resto¬
rative
regimen, ye. use of Spa water &
red wine accompanied this course, &
he was enjoin'd a total abstinence from
tea & all relaxants, & sedatives. Such
as much intercourse with his wife –
laborious & fatiguing exercises of body
& mind, soft beds, warm & crowded
rooms &c – Finding at length that his
complaints were little dispos'd to give
way to these & other means employ'd at
different times for his relief, & suspect¬
ing partly from his hæreditary predis¬
position, but especially from my ob¬
serving latterally yt. ye. affections of
his head & stomach alternated with
those of his limbs – that a latent gou¬
ty seminium
may have some share


[Page 7]

in ye. production of his complaints, I
concurr'd with his friends in advising
him a trip to Bath – He accordingly
passed ye. greatest part of ye. last sum¬
mer there, & drank ye. waters under the
direction of a physician. For some
time after he commenc'd their use, he
experienc'd some good effects, especially
an improvemt. of his appetite – digesti¬
on & spirits – but latterally they disa¬
greed with him much. He consulted
during his stay in England – Doct. De
la Cour of Bath, and Doctors Jebb &
Warren of London, who order'd some
medicines, principally of ye. tonic &
stomachick kind for him – and advi¬
sed him to use saltwater bathing.
He has try'd ye. latter for some weeks
past, but not regularly or constant¬
ly – and he is now taking by my direct¬
tions, some pills compos'd of Extract.
Cort. Peruv.
–––– Gentian, Olibanum


[Page 8]

Rhabarb. Turcic. & Sal. Mart. for
his gleet – But I do not hear yt. with
this – or ↑his↑ other complaints are material¬
ly affected by either ––

August 7th – 1779 ––––

Notes:

1: A precise reference in the published works of the leading Dutch academic physician Herman Boerhaave (1688-1738), has not been traced, but he discussed biliousness in his influential lectures.

2: See Pharmacopoeia Collegii Regii Medicorum Edinburgensis (Edinburgh: 1774), pp.78-9.

3: See Pharmacopoeia Collegii Regii Medicorum Edinburgensis (Edinburgh: 1774), pp.78-9.

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