Cullen

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

 

[ID:2523] From: Dr William Cullen (Professor Cullen) / To: Dr William Baylies / Regarding: Baron Friedrich Anton von Heynitz (Patient) / September 1784 / (Outgoing)

Draft of a reply by Cullen concerning the case of Mr Heynitz. In three different hands, one of which is Cullen's and the other two presumably Cullen's scribes.

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Metadata

FieldData
DOC ID 2523
RCPE Catalogue Number CUL/1/2/1574
Main Language English
Document Direction Outgoing
DateSeptember 1784
Annotation None
TypeUnattributed
Enclosure(s) No enclosure(s)
Autopsy No
Recipe No
Regimen Yes
Letter of Introduction No
Case Note No
Summary Draft of a reply by Cullen concerning the case of Mr Heynitz. In three different hands, one of which is Cullen's and the other two presumably Cullen's scribes.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:1714]
Case of Baron Heynitz in Berlin, who is advised on his gout.
5


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:3840]AddresseeDr William Baylies
[PERS ID:5460]PatientBaron Friedrich Anton von Heynitz
[PERS ID:5465]Patient's Physician / Surgeon / ApothecaryDr Paul Gottlieb Werlhof
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:3840]Patient's Physician / Surgeon / ApothecaryDr William Baylies
[PERS ID:1218]Other Physician / SurgeonDr Johann Justus de Berger

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 Secretary of State's office, Cleveland Row London London and South-East England Europe inferred
Mentioned / Other Sweden Europe certain
Mentioned / Other Bad Freienwalde Brandenburg Germany Europe certain
Mentioned / Other Berlin Germany Germany Europe certain
Mentioned / Other Buxton Midlands England Europe certain

Normalized Text

[Page 1]
Dear Sir


I hold it ↑as↑ the highest honour to be Consulted
by you whose parts and knowledge I esteem so much
that I should have applied to them whenever I could
have had an opportunity of doing it. As however you
have ↑now↑ do me this (↑e↑) honour ↑of consulting me for Mr Heynitz↑ I shall certainly do
my utmost in giving you my opinion and advice
for Mr. Heynitz (↑him↑). I must however begin by
saying that such a series of ailments has cost me
↑required↑ a great deal of attention and study and after all
I find the Case very difficult and especially
from hence (↑this↑) that it has baffled the many most
judicious and promising remedies that you
have already employed and ↑therefore↑ though I must give
an opinion ↑I must own that↑ it is not with all the confidence
that I could wish.


After much thinking my opinion (↑what appears to me most probable↑) is that




[Page 2]


Mr. Heynitz disease is ↑very much↑ a Case of Gout. and From
1747 to 1755 it showed ↑& several times since it has shewn↑ a tendency to take its proper
form but since that time (↑for the most part↑) it has appeared in a very
Anomalous state but In 1782 ↑however↑ it appeared in a
shape that is quite consistent with ↑and a common consequence of↑ the primary
disease, that is, an attack upon the kidneys
attended wtih the peculiar symptoms of a Catarrhus
Vesicæ
which I have known so often to attend
not only Nephritic but simply Gouty complaints.
The complaints he has often had in his stomach
I consider as a symptom of Gouty diathesis and
I think there is this clear proof of it, that
while the affection of the kidneys continued
his stomach complaints and others were consi¬
derably relieved and ↑only↑ returned again when the
determination to the kidneys had ceased. ↑[N. L.?]↑ It
would be difficult and very tedious for me to
offer an explanation of the various symptoms
which have occurred as depending upon the




[Page 3]


general cause I have assigned; B (↑b↑)ut I think
I could do it if you could also (↑would↑) allow me to take in¬
↑to the account↑ some circumstances which have concurred to modify
his symptoms (↑the various appearances of the disease.↑), That which I would especially
take notice of, is, a certain plethoric habit which
from his infancy has made him prone to Hemorr¬
hagies
. Unless I had been upon the spot (↑present at the time↑) I cannot
↑now positively↑ determine whether the bleedings Practised by
the late Dr. Werllhoff whom I have always
esteemed very much were not too much; but I
am persuaded that the bleedings both spontaneous
and artificial ↑which have often occurred↑ have hurt his Constitution ↑and↑ have
been very unfavourable to the ↑proper↑ course of the
Gout
., but Be that ↑however↑ as it will (↑may↑) I am equally (↑very clear and↑)
positive that a person who has been often
affected with the loss of blood may therefore
certainly require a repetition ↑of bloodletting and that those
bleedings you lately practised were extremely
proper. and (↑The↑) Vertiginous affections and pains (stiffness)




[Page 4]


about his neck which still continue; ↑to trouble him↑ show that there
is still some disposition to a plethoric state in the
vessels
of the head and the relief he has had by
Piles or artificial bleedings from the fundament
show sufficiently the nature of these (↑such↑) complaints.
[Start of margin text]N. L.[End of margin text] The Startings and spasmodic complaints which
he has been so much troubled with I know to be
a symptom of Gouty diathesis and I have often
met with them as such. I hold Warm bathing
to be unfavourable both to these and to his
Hæmorrhagic tendency and do not expect that
either the aluminous or Chalybeate impregnation
of the Freyenwald water will obviate the effects
of their (↑its↑) heat and humidity but I hope those
symptoms we speak of shall be rendered easier
by the medicines and regimen I am now to pre¬
scribe. ↑N. L. I hope I have said enough on the pathology of the disease and↑
↑shall now proceed to offer some advice for the conduct of it. In this↑


I proceed upon the supposition of the whole
of the ailments being dependent upon a Gouty




[Page 5]


diathesis and for preserving the tone of the stomach
and determining as much as possible to the extreme
parts I would chiefly rely upon the use of Gum
Guaiacum
. I dont however like the use of it in
and Spirituous tinctures of which (I have seen
since it came into frequent use) several instances
of their bad effects and am very glad to find
the Swedish Physician de Berger agreeing
with me in this matter. See the Neue abhandlungen
of the Stockholm Society. ↑pag. 69 & 70↑ As he does ↑so↑ I employ
the Gum↑rubbed to a powder with a little fine that is a hard sugar and then↑ diffused in a watery liquor by means
of Mucilage of Gum Arabic, or, when a small
quantity is only to be made at once it may
be better done
by ↑what is still better↑ the yolk of Egg. Of such a
solution I give from ten to twenty grains
every night and morning, more or less as
it affects the bowels which he (↑it↑) should keep
to regular stools without purging. In




[Page 6]


some persons however the doses I mention do not
readily operate upon the bowels or answer the
purpose I mention but in such cases I do not
increase the dose of the Guaiac but seek for
another laxative to obviate or remove the costiveness
which is always very hurtful in such cases,


When I enter upon such cases as I con¬
ceive the present to be I advise the Guaiac to
be taken every night and morning for two ↑or three↑ weeks
but then (↑afterwards↑) I lay it aside and resume it only
for a few days ↑together↑ when the state of his (↑the↑) stomach and
bowels ↑seem to require it↑ or his (↑the↑) startings and what you call his
Rheumatic pains
are unusually troublesome.
In cases like the present when Nephritic
complaints
alternate with the Gouty I some¬
times employ the Guaiacum for the former
and especially where the Guaiacum readily
answers the purpose of a laxative but where
it does not it sometimes proves too heating




[Page 7]


and does not agree well with the Nephritic state
of the disease.


Besides the use of the Guaiacum in the
manner I have mentioned I have no other ge¬
neral remedy to propose for Mr. Heynitz and
the only other advices I have to offer relate to his
regimen and ↑to↑ the palliation of symptoms which
may occasionally occurr.


With respect to regimen it seems to have
been formerly very properly ordered and I
shall only touch a few particulars.


1. ↑I would advise↑ The use of Animal food at dinner but
with great moderation and the taking none
at supper or of the very lightest kinds.


2 Avoiding acescent and flatulent vegetables
and ↑admitting↑ almost only the farinaceous kind.


3 Abstaining from Tea and Coffee


4 The being much in the fresh air but taking




[Page 8]


great care to avoid cold particularly of the feet and legs


5 As often as the weather and business will any
ways allow being in gentle exercise in the open
air. If he walks it should never be to the
degree of being either heating or fatiguing and
going on horseback or in a Carriage will be of
more service.


6 Speaking very loud or very fast may be ↑very↑ hurtful
but the moderate exercise of the voice I take
to be very wholesome to the lungs, the stomach
and the whole System.


7 Great moderation in applying to business
and never continuing it long at one time.


8 The taking daily a small quantity of some strong
bodied wine but never so much as to prove heating
and carefully avoiding weak bodied wines, such as
I take the Rhenish and other German wines to b
generally to be. Some Hungarian Wines may
be very proper but if the French or spanish
and Portuguese




[Page 9]


wines are used at Berlin I take the two latter
to be much safer than the former. I hold Malt
liquors of all kinds to be improper.


9 The use of the flesh brush may be a proper
remedy and I have no objection to its being
applied to the Back and between the shoulders
but I would particularly recommend it to be
applied every morning from the haunches
downwards
and particularly to the feet and legs


10 Going to bed early at night will be always
a proper measure and if he can sleep in the
morning I would not complain of his lying
long abed.


Though (↑As↑) he has formerly been so liable
to Hemorrhagy that might seem to indicate
a cool diet ↑but↑ I am of opinion that his advanced
in life renders that (↑it↑) less necessary and the
general notion I have of his disease makes




[Page 10]


me think a low diet would be ↑very↑ improper.


With respect to the palliation of symptoms
I must leave it very much to your good Judgement
which seems already ↑to have↑ been often successfully
applied. I shall only therefore give you a few
hints on this Subject (↑article↑)


Upon the subject of Bloodletting I have
given my opinion above and have only to say
now that it may be still necessary but I would
have it practised only when the necessity is
very evident.


When any Nephritic symptoms shall
come on Diluents and Demulcents ↑and Laxatives may be
very useful but the Uva Ursi is the remedy
I would especially depend upon. ↑N. l.↑ In the same
case of Nephritic symptoms, Opiates may
be very necessary and if they can be employed
without inducing Costiveness I am of opinion
that in the case of many Anomalous symptoms




[Page 11]


it is the (↑they are↑) palliative. I should think the best suited
to Mr. Heynitz.


I find it difficult to determine how far
Warm bathing is fit in this case. They seem
formerly to have been of service to him but I
doubt very much of their proving so now and am
pretty clear that only tepid baths should be
employed. Our Baths at Buxton which have
so often been of service in the case of irregular
Gout
do not exceed the temperature of 82 in
Farenheit thermometer and I would not have
Mr. Heynitz use any that should go beyond
90. I cannot supppose that the Aluminous
and Chalybeate impregnation of the Fr↑e↑yen¬
wald waters will do any thing to obviate the
effects of their heat and humidity.


2. I have now given you my opinion
and Advice in this Case ↑with great freedom↑ but I am very diffident
of its bearing your judgement and I am very




[Page 12]


ready to submitt every part of it to such correc¬
tion as your excellent judgement and more
intimate acquaintance with the Case may suggest.


1. In this advice Mr Heynitz may complain that I have
not mentioned any remedies particularly adapted to his ver¬
tigo
or startings but it is because I cannot expect to relieve
these but by a general amendment of his whole system. I shall
only say that if the vertiginous complaints should be at any
time unusually troublesome I would endeavour to relieve
them by some leeches applied to the temples.


Upon every occasion I shall be very
proud of your correspondence and shall be very glad
of having any thing ↑to↑ communicate from this that
may be worthy of your notice and should have been
willing to have attempted something in that way
now but the above letter has taken every moment
I could possibly afford at present. If Mr. Heynitz
case shall require any further correspondence
I shall be very punctual in answering you
and at any rate I will take it as a particular
favour of you will tell me how you like the advice
I have given.

I am &c.

Diplomatic Text

[Page 1]
Dear Sir


I hold it ↑as↑ the highest honour to be Consulted
by you whose parts and knowledge I esteem so much
that I should have applied to them whenever I could
have had an opportunity of doing it. As however you
have ↑now↑ do me this (↑e↑) honour ↑of consulting me for Mr Heynitz↑ I shall certainly do
my utmost in giving you my opinion and advice
for Mr. Heynitz (↑him↑). I must however begin by
saying that such a series of ailments has cost me
↑required↑ a great deal of attention and study and after all
I find the Case very difficult and especially
from hence (↑this↑) that it has baffled the many most
judicious and promising remedies that you
have already employed and ↑therefore↑ though I must give
an opinion ↑I must own that↑ it is not with all the confidence
that I could wish.


After much thinking my opinion (↑what appears to me most probable↑) is that




[Page 2]


Mr. Heynitz disease is ↑very much↑ a Case of Gout. and From
1747 to 1755 it showed ↑& several times since it has shewn↑ a tendency to take its proper
form but since that time (↑for the most part↑) it has appeared in a very
Anomalous state but In 1782 ↑however↑ it appeared in a
shape that is quite consistent with ↑and a common consequence of↑ the primary
disease, that is, an attack upon the kidneys
attended wtih the peculiar symptoms of a Catarrhus
Vesicæ
which I have known so often to attend
not only Nephritic but simply Gouty complaints.
The complaints he has often had in his stomach
I consider as a symptom of Gouty diathesis and
I think there is this clear proof of it, that
while the affection of the kidneys continued
his stomach complaints and others were consi¬
derably relieved and ↑only↑ returned again when the
determination to the kidneys had ceased. ↑[N. L.?]↑ It
would be difficult and very tedious for me to
offer an explanation of the various symptoms
which have occurred as depending upon the




[Page 3]


general cause I have assigned; B (↑b↑)ut I think
I could do it if you could also (↑would↑) allow me to take in¬
↑to the account↑ some circumstances which have concurred to modify
his symptoms (↑the various appearances of the disease.↑), That which I would especially
take notice of, is, a certain plethoric habit which
from his infancy has made him prone to Hemorr¬
hagies
. Unless I had been upon the spot (↑present at the time↑) I cannot
↑now positively↑ determine whether the bleedings Practised by
the late Dr. Werllhoff whom I have always
esteemed very much were not too much; but I
am persuaded that the bleedings both spontaneous
and artificial ↑which have often occurred↑ have hurt his Constitution ↑and↑ have
been very unfavourable to the ↑proper↑ course of the
Gout
., but Be that ↑however↑ as it will (↑may↑) I am equally (↑very clear and↑)
positive that a person who has been often
affected with the loss of blood may therefore
certainly require a repetition ↑of bloodletting and that those
bleedings you lately practised were extremely
proper. and (↑The↑) Vertiginous affections and pains (stiffness)




[Page 4]


about his neck which still continue; ↑to trouble him↑ show that there
is still some disposition to a plethoric state in the
vessels
of the head and the relief he has had by
Piles or artificial bleedings from the fundament
show sufficiently the nature of these (↑such↑) complaints.
[Start of margin text]N. L.[End of margin text] The Startings and spasmodic complaints which
he has been so much troubled with I know to be
a symptom of Gouty diathesis and I have often
met with them as such. I hold Warm bathing
to be unfavourable both to these and to his
Hæmorrhagic tendency and do not expect that
either the aluminous or Chalybeate impregnation
of the Freyenwald water will obviate the effects
of their (↑its↑) heat and humidity but I hope those
symptoms we speak of shall be rendered easier
by the medicines and regimen I am now to pre¬
scribe. ↑N. L. I hope I have said enough on the pathology of the disease and↑
↑shall now proceed to offer some advice for the conduct of it. In this↑


I proceed upon the supposition of the whole
of the ailments being dependent upon a Gouty




[Page 5]


diathesis and for preserving the tone of the stomach
and determining as much as possible to the extreme
parts I would chiefly rely upon the use of Gum
Guaiacum
. I dont however like the use of it in
and Spirituous tinctures of which (I have seen
since it came into frequent use) several instances
of their bad effects and am very glad to find
the Swedish Physician de Berger agreeing
with me in this matter. See the Neue abhandlungen
of the Stockholm Society. ↑pag. 69 & 70↑ As he does ↑so↑ I employ
the Gum↑rubbed to a powder with a little fine that is a hard sugar and then↑ diffused in a watery liquor by means
of Mucilage of Gum Arabic, or, when a small
quantity is only to be made at once it may
be better done
by ↑what is still better↑ the yolk of Egg. Of such a
solution I give from ten to twenty grains
every night and morning, more or less as
it affects the bowels which he (↑it↑) should keep
to regular stools without purging. In




[Page 6]


some persons however the doses I mention do not
readily operate upon the bowels or answer the
purpose I mention but in such cases I do not
increase the dose of the Guaiac but seek for
another laxative to obviate or remove the costiveness
which is always very hurtful in such cases,


When I enter upon such cases as I con¬
ceive the present to be I advise the Guaiac to
be taken every night and morning for two ↑or three↑ weeks
but then (↑afterwards↑) I lay it aside and resume it only
for a few days ↑together↑ when the state of his (↑the↑) stomach and
bowels ↑seem to require it↑ or his (↑the↑) startings and what you call his
Rheumatic pains
are unusually troublesome.
In cases like the present when Nephritic
complaints
alternate with the Gouty I some¬
times employ the Guaiacum for the former
and especially where the Guaiacum readily
answers the purpose of a laxative but where
it does not it sometimes proves too heating




[Page 7]


and does not agree well with the Nephritic state
of the disease.


Besides the use of the Guaiacum in the
manner I have mentioned I have no other ge¬
neral remedy to propose for Mr. Heynitz and
the only other advices I have to offer relate to his
regimen and ↑to↑ the palliation of symptoms which
may occasionally occurr.


With respect to regimen it seems to have
been formerly very properly ordered and I
shall only touch a few particulars.


1. ↑I would advise↑ The use of Animal food at dinner but
with great moderation and the taking none
at supper or of the very lightest kinds.


2 Avoiding acescent and flatulent vegetables
and ↑admitting↑ almost only the farinaceous kind.


3 Abstaining from Tea and Coffee


4 The being much in the fresh air but taking




[Page 8]


great care to avoid cold particularly of the feet and legs


5 As often as the weather and business will any
ways allow being in gentle exercise in the open
air. If he walks it should never be to the
degree of being either heating or fatiguing and
going on horseback or in a Carriage will be of
more service.


6 Speaking very loud or very fast may be ↑very↑ hurtful
but the moderate exercise of the voice I take
to be very wholesome to the lungs, the stomach
and the whole System.


7 Great moderation in applying to business
and never continuing it long at one time.


8 The taking daily a small quantity of some strong
bodied wine but never so much as to prove heating
and carefully avoiding weak bodied wines, such as
I take the Rhenish and other German wines to b
generally to be. Some Hungarian Wines may
be very proper but if the French or spanish
and Portuguese




[Page 9]


wines are used at Berlin I take the two latter
to be much safer than the former. I hold Malt
liquors of all kinds to be improper.


9 The use of the flesh brush may be a proper
remedy and I have no objection to its being
applied to the Back and between the shoulders
but I would particularly recommend it to be
applied every morning from the haunches
downwards
and particularly to the feet and legs


10 Going to bed early at night will be always
a proper measure and if he can sleep in the
morning I would not complain of his lying
long abed.


Though (↑As↑) he has formerly been so liable
to Hemorrhagy that might seem to indicate
a cool diet ↑but↑ I am of opinion that his advanced
in life renders that (↑it↑) less necessary and the
general notion I have of his disease makes




[Page 10]


me think a low diet would be ↑very↑ improper.


With respect to the palliation of symptoms
I must leave it very much to your good Judgement
which seems already ↑to have↑ been often successfully
applied. I shall only therefore give you a few
hints on this Subject (↑article↑)


Upon the subject of Bloodletting I have
given my opinion above and have only to say
now that it may be still necessary but I would
have it practised only when the necessity is
very evident.


When any Nephritic symptoms shall
come on Diluents and Demulcents ↑and Laxatives may be
very useful but the Uva Ursi is the remedy
I would especially depend upon. ↑N. l.↑ In the same
case of Nephritic symptoms, Opiates may
be very necessary and if they can be employed
without inducing Costiveness I am of opinion
that in the case of many Anomalous symptoms




[Page 11]


it is the (↑they are↑) palliative. I should think the best suited
to Mr. Heynitz.


I find it difficult to determine how far
Warm bathing is fit in this case. They seem
formerly to have been of service to him but I
doubt very much of their proving so now and am
pretty clear that only tepid baths should be
employed. Our Baths at Buxton which have
so often been of service in the case of irregular
Gout
do not exceed the temperature of 82 in
Farenheit thermometer and I would not have
Mr. Heynitz use any that should go beyond
90. I cannot supppose that the Aluminous
and Chalybeate impregnation of the Fr↑e↑yen¬
wald waters will do any thing to obviate the
effects of their heat and humidity.


2. I have now given you my opinion
and Advice in this Case ↑with great freedom↑ but I am very diffident
of its bearing your judgement and I am very




[Page 12]


ready to submitt every part of it to such correc¬
tion as your excellent judgement and more
intimate acquaintance with the Case may suggest.


1. In this advice Mr Heynitz may complain that I have
not mentioned any remedies particularly adapted to his ver¬
tigo
or startings but it is because I cannot expect to relieve
these but by a general amendment of his whole system. I shall
only say that if the vertiginous complaints should be at any
time unusually troublesome I would endeavour to relieve
them by some leeches applied to the temples.


Upon every occasion I shall be very
proud of your correspondence and shall be very glad
of having any thing ↑to↑ communicate from this that
may be worthy of your notice and should have been
willing to have attempted something in that way
now but the above letter has taken every moment
I could possibly afford at present. If Mr. Heynitz
case shall require any further correspondence
I shall be very punctual in answering you
and at any rate I will take it as a particular
favour of you will tell me how you like the advice
I have given.

I am &c.

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