Cullen

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

 

[ID:291] From: Dr William Cullen (Professor Cullen) / To: Dr Alexander Taylor (Sanders) / Regarding: Mr James Orr (Patient), Mr William Orr ((later) of Ingliston, then Ralston) (Patient), Reverend James Hamilton (of Paisley) (Patient) / 19 March 1782 / (Outgoing)

Reply to Alexander Taylor concerning directions for James Orr, and the absence of jaundice: 'there can be no doubt that an abcess has existed somewhere but whether in the liver or lungs is not easily determined and the discussion is not fit for my time or this letter'. He also refers briefly to James' brother William Orr's eye condition. Cullen also mentions Taylor's recent report on the post-mortem examination of the body of their mutual patient, the Rev. James Hamilton.

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Metadata

FieldData
DOC ID 291
RCPE Catalogue Number CUL/1/1/14/180
Main Language English
Document Direction Outgoing
Date19 March 1782
Annotation None
TypeMachine copy
Enclosure(s) No enclosure(s)
Autopsy No
Recipe Yes
Regimen No
Letter of Introduction No
Case Note No
Summary Reply to Alexander Taylor concerning directions for James Orr, and the absence of jaundice: 'there can be no doubt that an abcess has existed somewhere but whether in the liver or lungs is not easily determined and the discussion is not fit for my time or this letter'. He also refers briefly to James' brother William Orr's eye condition. Cullen also mentions Taylor's recent report on the post-mortem examination of the body of their mutual patient, the Rev. James Hamilton.
Manuscript Incomplete? No
Evidence of Commercial Posting No

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


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:207]AddresseeDr Alexander Taylor (Sanders)
[PERS ID:211]PatientMr William Orr ((later) of Ingliston, then Ralston)
[PERS ID:2236]PatientReverend James Hamilton (of Paisley)
[PERS ID:210]PatientMr James Orr
[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:210]Patient's Relative / Spouse / FriendMr James Orr
[PERS ID:211]Patient's Relative / Spouse / FriendMr William Orr ((later) of Ingliston, then Ralston)

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 Paisley Glasgow and West Scotland Europe inferred

Normalized Text

[Page 1]
Mr Taylor Concerning Messrs Orrs
Dear Sir


I need not take any notice of the first part
of your letter relating to James Orr as what you say in your
postscript must now engross our attention. From what you say there
there can be no doubt that an abcess has existed somewhere but
whether in ↑the↑ liver or lungs is not easily determined and the discussion
is not fit for my time or this letter and I don't think it necessary as
our measures must be ↑the↑ same whether it is in the one place or in
the other. The healing of the ulcer formed must be the work of
nature, more than of medicine but I shall tell you for your com¬
fort and that of your patient that I have known nature do the
business very compleatly both in cases of the liver and of the lungs.
All that we can do is to avoid irritation and to put the blood
in as good condition as we can by a diet of milk and farinacea
alone. If cough proves troublesome you must employ some de¬
mulcents mucilaginous or sweet
and if especially troublesome
in the night time some opiates will be unavoidable. Whether
from the use of these or from other cause if costiveness come on



[Page 2]

it must be removed by glysters or what gentle laxatives are
found to agree with his stomach. To favour the digestion and
healing of the ulcer let him use the antiseptic and balsamic pills
prescribed below. Many practitioners at present have a good opi¬
nion of these but I do not trust to them so much as to give
large doses of them. This is all I have to ↑say of↑ James Orr but I
shall expect to hear from you again concerning him very soon.


With respect to Mr Wm Orr I hope his eyes are recovering
and that we have no reason to make any change in our present
plan. I am still perswaded that the disease is very much in
the muscles of the ball, but the retina is singularly connected
with every part of the organ and it is impressions made upon
that which excite and direct the motions of the every part and
the present rigidity of the pupil I impute to its having been
long in the habit of a contracted state


I am obliged to you for your account of the dissection
of ↑the↑ Minister. 1 I think you are nice in admitting schirrosity for
I think every shrinking of the viscera may be considered as such.
The parboiled appearance was owing to its being long soaked in



[Page 3]

serum.


We may have been mistaken with respect to
the seat of Mr J. Orrs disease but supposing it to have been
in the liver you are perfectly right in accounting for the absence
of Jaundice for I hold it certain that it is never the interruption
of the secretion but that of the excretion only, which occasions
Jaundice. The small calculus which you found in the cystic
duct
of Mr Hamilton had not fallen far enough ↑down↑ to occasion
Jaundice but it renders it probable that there had been
formerly larger concretions there which had occasioned
the former jaundice. I am always with great regard

Dear Sir your most obedient servant ––––
William Cullen
For Mr James Orr

Take ½ a drachm each of Balsam of Tolu and best Myrrh, a drachm of White Sugar and 3 drachms of Liquorice Extract. Having cut the Extract into very small pieces, pour over enough very hot water to soften it and crush it into a pulp, to which add the rest, rubbed into a fine powder, and with enough water to make into a mass to be divided into pills of 5 grains each. Label: Balsamic Pills two to be taken every night and one every morning

W.C.
19th March 1782.

Notes:

1: Cullen is replying to a letter form taylor, dated 16 March 1782, in which the surgeon had included an account of his post-mortem examination of their mutual patient, the Revd. James Hamilton, who had died on 14 March (see Document ID:2174).

Diplomatic Text

[Page 1]
Mr Taylor C. Messrs Orrs
Dear Sir


I need not take any notice of the first part
of your letter relating to James Orr as what you say in your
postscript must now engross our attention. From what you say there
there can be no doubt that an abcess has existed somewhere but
whether in ↑the↑ liver or lungs is not easily determined and the discussion
is not fit for my time or this letter and I don't think it necessary as
our measures must be ↑the↑ same whether it is in the one place or in
the other. The healing of the ulcer formed must be the work of
nature, more than of medicine but I shall tell you for your com¬
fort and that of your patient that I have known nature do the
business very compleatly both in cases of the liver and of the lungs.
All that we can do is to avoid irritation and to put the blood
in as good condition as we can by a diet of milk and farinacea
alone. If cough proves troublesome you must employ some de¬
mulcents mucilaginous or sweet
and if especially troublesome
in the night time some opiates will be unavoidable. Whether
from the use of these or from other cause if costiveness come on



[Page 2]

it must be removed by glysters or what gentle laxatives are
found to agree with his stomach. To favour the digestion and
healing of the ulcer let him use the antiseptic and balsamic pills
prescribed below. Many practitioners at present have a good opi¬
nion of these but I do not trust to them so much as to give
large doses of them. This is all I have to ↑say of↑ James Orr but I
shall expect to hear from you again concerning him very soon.


With respect to Mr Wm Orr I hope his eyes are recovering
and that we have no reason to make any change in our present
plan. I am still perswaded that the disease is very much in
the muscles of the ball, but the retina is singularly connected
with every part of the organ and it is impressions made upon
that which excite and direct the motions of the every part and
the present rigidity of the pupil I impute to its having been
long in the habit of a contracted state


I am obliged to you for your account of the dissection
of ↑the↑ Minister. 1 I think you are nice in admitting schirrosity for
I think every shrinking of the viscera may be considered as such.
The parboiled appearance was owing to its being long soaked in



[Page 3]

serum.


We may have been mistaken with respect to
the seat of Mr J. Orrs disease but supposing it to have been
in the liver you are perfectly right in accounting for the absence
of Jaundice for I hold it certain that it is never the interruption
of the secretion but that of the excretion only, which occasions
Jaundice. The small calculus which you found in the cystic
duct
of Mr Hamilton had not fallen far enough ↑down↑ to occasion
Jaundice but it renders it probable that there had been
formerly larger concretions there which had occasioned
the former jaundice. I am always with great regard

Dr Sir your most obedient servant ––––
William Cullen
For Mr James Orr


Balsam. Tolutan. Myrrh. opt @ ʒſs
Sacchar. alb. ʒj Extract. Glycyrrh. ʒiij
Extracto in frustula conciso affunde aquæ ferventis q. s. ut mollescat et in
pulpam contundatur cui adde cætera in pulverem tenuem trita et cum
aquæ q. s. fiat massa dividenda in pil. sing. gr. V.
Signa Balsamic Pills two to be taken every night and one every
morning

W.C.
19th March 1782.

Notes:

1: Cullen is replying to a letter form taylor, dated 16 March 1782, in which the surgeon had included an account of his post-mortem examination of their mutual patient, the Revd. James Hamilton, who had died on 14 March (see Document ID:2174).

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