Cullen

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

 

[ID:2174] From: Dr Alexander Taylor (Sanders) / To: Dr William Cullen (Professor Cullen) / Regarding: Mr James Orr (Patient), Mr William Orr ((later) of Ingliston, then Ralston) (Patient), Reverend James Hamilton (of Paisley) (Patient), Mr Davidson (Davieson) (Patient) / 16 March 1782 / (Incoming)

Letter from Alexander Taylor, concerning the cases of the brothers James and William Orr. James has pain in the side, and has been coughing up bloody pus: 'I see it mentioned in your Practice that abcesses of the liver are sometimes expectorated but I do not understand this'. William's eyes are improving. He reports on the post-mortem dissection of the minister, Mr Hamilton. He also notes that 'After you left Paisley I found you had not been paid your fee', and discussed this with the Hamiltons and with Cullen's old friend Rev. Davidson of Inchinnan, whose father Cullen had attended.

Facsimile

There are 8 images for this document.

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Metadata

FieldData
DOC ID 2174
RCPE Catalogue Number CUL/1/2/1247
Main Language English
Document Direction Incoming
Date16 March 1782
Annotation None
TypeAuthorial original
Enclosure(s) No enclosure(s)
Autopsy Yes
Recipe No
Regimen No
Letter of Introduction No
Case Note No
Summary Letter from Alexander Taylor, concerning the cases of the brothers James and William Orr. James has pain in the side, and has been coughing up bloody pus: 'I see it mentioned in your Practice that abcesses of the liver are sometimes expectorated but I do not understand this'. William's eyes are improving. He reports on the post-mortem dissection of the minister, Mr Hamilton. He also notes that 'After you left Paisley I found you had not been paid your fee', and discussed this with the Hamiltons and with Cullen's old friend Rev. Davidson of Inchinnan, whose father Cullen had attended.
Manuscript Incomplete? No
Evidence of Commercial Posting Yes

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:553]
Case of James Orr who has a venereal infection in 1778, but by 1782 has abdominal complaints and various bodily pains which Cullen eventually attributes to a disordered liver.
13
[Case ID:554]
Case of William Orr who has an eye condition.
13
[Case ID:1452]
Case of the Revd. James Hamilton, minister in Paisley, who suffers from swollen and ulcerated legs. The case proves terminal and a post-mortem is performed by local surgeon Alexander ["Sanders"] Taylor.
7
[Case ID:2134]
Case of Mr Davidson, previously treated by Cullen without a fee.
1


People linked to this document

Person IDRole in documentPerson
[PERS ID:207]AuthorDr Alexander Taylor (Sanders)
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:210]PatientMr James Orr
[PERS ID:2696]PatientMr Davidson (Davieson)
[PERS ID:211]PatientMr William Orr ((later) of Ingliston, then Ralston)
[PERS ID:2236]PatientReverend James Hamilton (of Paisley)
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:207]Patient's Physician / Surgeon / ApothecaryDr Alexander Taylor (Sanders)
[PERS ID:211]Patient's Relative / Spouse / FriendMr William Orr ((later) of Ingliston, then Ralston)
[PERS ID:804]Patient's Relative / Spouse / FriendMrs Elizabeth Hamilton
[PERS ID:2695]Patient's Relative / Spouse / FriendMiss Hamilton
[PERS ID:210]Patient's Relative / Spouse / FriendMr James Orr
[PERS ID:2696]Patient's Relative / Spouse / FriendMr Davidson (Davieson)
[PERS ID:1055]OtherReverend Archibald Davidson (Davieson; of Inchinnan)

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing Paisley Glasgow and West Scotland Europe certain
Destination of Letter Cullen's House / Mint Close Edinburgh Edinburgh and East Scotland Europe certain
Mentioned / Other Inchinnan Glasgow and West Scotland Europe certain
Mentioned / Other Paisley Glasgow and West Scotland Europe certain
Place of Handstamp Paisley Glasgow and West Scotland Europe certain

Normalized Text

[Page 1]
Sir


Nothing new has
happened to Mr. Orr excepting a
Pain in his left shoulder and Hy¬
pochondrium
which some days
ago came at the same time ––
the pain in the side soon went off
but that of the shoulder still re¬
mains –– the pain of his right side
had mounted higher and fixed half
way betwixt the right nipple and
lower end of the sternum; but this
likewise has almost entirely gone off
and the only pains which remain are



[Page 2]

those of his shoulders which within
these two last days have also become
more mild; but change of posture al¬
ways renders them more uneasy; yet
such increase of uneasiness soon goes off
nor does he observe that one Position more
than another makes any difference in
this respect not even lying on his left
side
nor standing upright –– some de¬
gree of appetite continues and his thirst
is not considerable
and he has had no
shiverings
nor Coldness – but notwithstanding
all these favourable appearances I
doubt him much for his pulse continues
quick as ever (100) and is rather stronger

and he gets little sleep, not more at any
time than 3 hours in the 24
, and no
rest excepting what is procured by an
Anodyne; and after every little sleep he


[Page 3]

sweats a little –– your aperient was
given and repeated in a larger quantity
but without purging and brought
on a return of the flatulence and un¬
easiness of stomach so that I have
been obliged to keep his belly open
with Clysters –– his Urine often de¬
posites a Copious Sediment; but there
is no appearances of Jaundice; and
I believe in such Disease there
is none to be expected the inflammation
being confined to the arterial ramifica¬
tions
in the liver and affecting neither
the secretion nor transmission of the
bile
–– his belly is soft and free
of either general or particular swelling
neither does moderate swelling (↑pressure↑) give
him Pain or uneasiness ––


His Brother's eyes still continue



[Page 4]

getting gradually better and he is
able now to look longer at one object
without glimmering –– the adnata of
the right under Eye-lid
still continues
a very little inflamed –– the iris in it's
motion appears to me to vary the
Pupil
too little – however small the
light and however carelessly he may
look or however distant the object to
which he directs his eye the pupil
never dilates sufficiently; and does
not this point out a remainder of mor¬
bid sensibility
? But I am perfectly
perswaded from what you point out
that the seat of the disease is in the
elevating muscles
of the eyes and eye
lids
– does their weakness proceed from
inflammation and does such inflam¬
mation still exist
? ––––




[Page 5]


On Thursday morning last Mr
Hamilton died – upon opening him,
for there was a necessity to evacuate
the water which was in amazing
quantity, I found the liver much
diminished but without any marks
of ulceration
– it was rough and
hard as if par-boiled but not so
hard as to deserve the name of
schirrous
–– [at?] In the entrance of
the Cystic duct
from the I found
a small hard subtance which was
black and rough and of the size
of a Pea
and I saw nothing else
remarkable –––– After you
left Paisley I found you had
not been paid your fee and



[Page 6]

spoke of it to Mr. and Mrs. and
Miss Hamilton and also to your
old acquaintance Mr. Davieson
of Inshinnan –– but was given
to understand that you would ex¬
pect nor take nothing and that you
had formerly attended his father
and had never taken a farthing;
so I found it was use and won't 1
and could urged the matter no far¬
ther – but the demands upon ↑the generosity of↑ me¬
dical people are unconscionable
and it is not without indignation
I meet with them –– I am sir

Your most humble servant
Alexr. Taylor
Paisley 16 March 1782.



[Page 7]


I have ↑been↑ this moment called to Mr.
Orr in a hurry –– he is coughing up
(not Vomiting) pus mixed with
a little blood, at least the Pus
is of a reddish colour
–– this is the
first time he has had any cough and
all along the deepest inspiration ne¬
ver affected the Pains not even
smart sneezing
–– I see it men[tioned]
in your Practice that abcesses of the
liver
are sometimes expectorated;
but I do not understand this: there
must surely in such cases be an
adhesion of the lungs to the diaphragm
and a perforation of the diaphragm
and lungs likewise –– can this dis¬
ease have been all this while in
his lungs?




[Page 8]


Dr. William Cullen
Professor of Physic
Edinburgh


Mr Taylor
Concerning
Messrs Orrs.
March. 1782
V. XIII p. 330 &ca

Notes:

1: Legal expression meaning 'the established custom'.

Diplomatic Text

[Page 1]
Sir


Nothing new has
happened to Mr. Orr excepting a
Pain in his left shoulder and Hy¬
pochondrium
which some days
ago came at the same time ––
the pain in the side soon went off
but that of the shoulder still re¬
mains –– the pain of his right side
had mounted higher and fixed half
way betwixt the right nipple and
lower end of the sternum; but this
likewise has almost entirely gone off
and the only pains which remain are



[Page 2]

those of his shoulders which within
these two last days have also become
more mild; but change of posture al¬
ways renders them more uneasy; yet
such increase of uneasiness soon goes off
nor does he observe that one Position more
than another makes any difference in
this respect not even lying on his left
side
nor standing upright –– some de¬
gree of appetite continues and his thirst
is not considerable
and he has had no
shiverings
nor Coldness – but notwithstanding
all these favourable appearances I
doubt him much for his pulse continues
quick as ever (100) and is rather stronger

and he gets little sleep, not more at any
time than 3 hours in the 24
, and no
rest excepting what is procured by an
Anodyne; and after every little sleep he


[Page 3]

sweats a little –– your aperient was
given and repeated in a larger quantity
but without purging and brought
on a return of the flatulence and un¬
easiness of stomach so that I have
been obliged to keep his belly open
with Clysters –– his Urine often de¬
posites a Copious Sediment; but there
is no appearances of Jaundice; and
I believe in such Disease there
is none to be expected the inflammation
being confined to the arterial ramifica¬
tions
in the liver and affecting neither
the secretion nor transmission of the
bile
–– his belly is soft and free
of either general or particular swelling
neither does moderate swelling (↑pressure↑) give
him Pain or uneasiness ––


His Brother's eyes still continue



[Page 4]

getting gradually better and he is
able now to look longer at one object
without glimmering –– the adnata of
the right under Eye-lid
still continues
a very little inflamed –– the iris in it's
motion appears to me to vary the
Pupil
too little – however small the
light and however carelessly he may
look or however distant the object to
which he directs his eye the pupil
never dilates sufficiently; and does
not this point out a remainder of mor¬
bid sensibility
? But I am perfectly
perswaded from what you point out
that the seat of the disease is in the
elevating muscles
of the eyes and eye
lids
– does their weakness proceed from
inflammation and does such inflam¬
mation still exist
? ––––




[Page 5]


On Thursday morning last Mr
Hamilton died – upon opening him,
for there was a necessity to evacuate
the water which was in amazing
quantity, I found the liver much
diminished but without any marks
of ulceration
– it was rough and
hard as if par-boiled but not so
hard as to deserve the name of
schirrous
–– [at?] In the entrance of
the Cystic duct
from the I found
a small hard subtance which was
black and rough and of the size
of a Pea
and I saw nothing else
remarkable –––– After you
left Paisley I found you had
not been paid your fee and



[Page 6]

spoke of it to Mr. and Mrs. and
Miss Hamilton and also to your
old acquaintance Mr. Davieson
of Inshinnan –– but was given
to understand that you would ex¬
pect nor take nothing and that you
had formerly attended his father
and had never taken a farthing;
so I found it was use and won't 1
and could urged the matter no far¬
ther – but the demands upon ↑the generosity of↑ me¬
dical people are unconscionable
and it is not without indignation
I meet with them –– I am sir

Your most humble servant
Alexr. Taylor
Paisley 16 March 1782.



[Page 7]


I have ↑been↑ this moment called to Mr.
Orr in a hurry –– he is coughing up
(not Vomiting) pus mixed with
a little blood, at least the Pus
is of a reddish colour
–– this is the
first time he has had any cough and
all along the deepest inspiration ne¬
ver affected the Pains not even
smart sneezing
–– I see it men[tioned]
in your Practice that abcesses of the
liver
are sometimes expectorated;
but I do not understand this: there
must surely in such cases be an
adhesion of the lungs to the diaphragm
and a perforation of the diaphragm
and lungs likewise –– can this dis¬
ease have been all this while in
his lungs?




[Page 8]


Dr. William Cullen
Professor of Physic
Edinr.


Mr Taylor
C
Messrs Orrs.
March. 1782
V. XIII p. 330 &ca

Notes:

1: Legal expression meaning 'the established custom'.

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