Cullen

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

 

[ID:3808] From: Dr William Cullen (Professor Cullen) / To: Anonymous / Regarding: Miss Stevenson (Patient) / 5 May 1776 / (Outgoing)

Reply, addressed to an unidentified practitioner, 'For Miss Stevenson'. Cullen enters into an unusual degree of speculation concerning the likely cause of a possible internal abcess, and cites post-mortem findings of other cases. He is also careful to state that his advice is to be shown to the patient's brother rather than her father.

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Metadata

FieldData
DOC ID 3808
RCPE Catalogue Number CUL/1/1/7/29
Main Language English
Document Direction Outgoing
Date5 May 1776
Annotation None
TypeScribal copy ( includes Casebook Entry)
Enclosure(s) No enclosure(s)
Autopsy No
Recipe No
Regimen No
Letter of Introduction No
Case Note No
Summary Reply, addressed to an unidentified practitioner, 'For Miss Stevenson'. Cullen enters into an unusual degree of speculation concerning the likely cause of a possible internal abcess, and cites post-mortem findings of other cases. He is also careful to state that his advice is to be shown to the patient's brother rather than her father.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:829]
Case of Miss Stevenson who is suspected of having an internal abscess.
1


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:3649]Addressee
[PERS ID:2097]PatientMiss Stevenson
[PERS ID:3649]Patient's Physician / Surgeon / Apothecary
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:2099]Patient's Relative / Spouse / FriendMr Stevenson (Senior) (Steventon)
[PERS ID:2098]Patient's Relative / Spouse / FriendMr Stevenson (Junior) (Steventon)

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

Normalized Text

[Page 1]
For Miss Stevenson


I am still of opinion that my former judgement was
well founded. The principal affection was then evidently
Spasmodic. I thought at the same time there might be a
topical Affection which gave the irritation but there were no
Symptomes which pointed out the nature of it: & particularly there
were no marks of Suppuration going on. Whatever might
be the nature of the topical Affection I could not think of any
remedy suited to it, & therefore the only measures I could
propose were such as might obviate the effects. Such was
the state of my opinion formerly & I still think it was
well founded, but what has happened since obliges me to
take another view of the case. As Mr Stevenson his self



[Page 2]

has never seen any matter rejected which he could clearly judge
to be purulent, there can be no certainty of its being so, but
the circumstances of the first vomiting in the night of the 10th past
& the relief which has since followed makes the opinion of the
breaking of an abcess the most probable that can be entertained;
& the absence of any previous symptoms of Suppuration
do not absolutely reject the Supposition. For we have
very often upon dissection found Abcesses in the Liver,
Pancreas & spleen when there had been no previous
indications of them, & there have been instances of these
Abcesses penetrating into the Stomach. Previously to these
Suppurations there must have been some Inflam↑mm↑ation
however obscure, Which always forms adhesions to any
neighbouring part, which afterwards the matter of the Abcess erodes
but as it is in a slow manner, it is without any remarkable
Symptoms. If I might indulge a conjecture I would explain
the whole of the case in this manner. The bruise from the
fall had affected the Spleen & had produced an Inflamma¬
tion
& abcess which has at length penetrated into the Stomach.
The whole series of symptoms might I think be explain¬
ed on this footing but such explanation is neither
interesting enough nor convenient to be entered in to at
present, especially as there may be too much of conjecture
in the supposition of Suppuration upon which we proceed. ---
I must still own there may be some fallacy in that
Supposition but it appears at present the most probable
we can make & therefore it is upon that only that I can
offer any opinion about the proper management. In
all cases of internal Suppuration I know nothing that
can be materially of Service, & all that I think we can do


[Page 3]

is to avoid irritation. & to guard the blood against the
effects of a purulent Absorption, by a milk diet. Upon
this plan I cannot approve of either the vomiting or
purging which Mr Sevenson has practised. Laxatives
may be necessary but purging is not, & vomiting may
certainly be very hurtful. I believe the vegetable diet he
employs may be very proper, but I would chuse to make
it chiefly ↑of↑ farinacea & milk. With respect to the last it is
to be observed that in the case of any suppuration in the
Stomach cows milk is ready to form too firm a
Coagulum & therefore the Asses milk is properly preferred;
but as that is not always to be had, the Cows milk may
be employed, if it be diluted with an equal part of water gruel
or barley water & the mixture very well sweetened with sugar
or honey. Let this be understood to be written for Mr Stevenson
the Son rather than the Father. ------------


Edinburgh May 5th.
1776
William Cullen.

Diplomatic Text

[Page 1]
For Miss Stevenson


I am still of opinion that my former judgement was
well founded. The principal affection was then evidently
Spasmodic. I thought at the same time there might be a
topical Affection wc gave ye irritation but there were no
Symptomes wc pointed out ye nature of it: & particularly there
were no marks of Suppuration going on. Whatever might
be ye nature of ye topical Affecn. I could not think of any
remedy suited to it, & therefore ye only measures I could
propose were such as might obviate ye effects. Such was
ye state of my opinion formerly & I still think it was
well founded, but what has happened since obliges me to
take another view of ye case. As Mr Stevenson his self



[Page 2]

has never seen any matter rejected wc he could clearly judge
to be purulent, there can be no certainty of its being so, but
ye circumstances of ye first vomiting in ye night of the 10th past
& ye relief wc has since followed makes ye opinion of ye
breaking of an abcess ye most probable yt can be entertained;
& ye absence of any previous symptoms of Suppuration
do not absolutely reject ye Supposition. For we have
very often upon dissection found Abcesses in ye Liver,
Pancreas & spleen when there had been no previous
indications of them, & there have been instances of these
Abcesses penetrating into ye Stomach. Previously to these
Suppurations there must have been some Inflam↑mm↑ation
however obscure, Wc. always forms adhesions to any
neighbouring part, wc afterwards ye matter of ye Abcess erodes
but as it is in a slow manner, it is without any remarkable
Symptoms. If I might indulge a conjecture I would explain
ye whole of ye case in this manner. The bruise from ye
fall had affectd ye Spleen & had produced an Inflamma¬
tion
& abcess wc has at length penetrated into ye Stomach.
The whole series of symptoms might I think be explain¬
ed on this footing but such explanation is neither
interesting enough nor convenient to be entered in to at
present, especially as there may be too much of conjecture
in ye supposition of Suppuration upon wc we proceed. ---
I must still own there may be some fallacy in that
Supposition but it appears at present ye most probable
we can make & therefore it is upon that only that I can
offer any opinion about ye proper management. In
all cases of internal Suppuration I know nothing that
can be materially of Service, & all that I think we can do


[Page 3]

is to avoid irritation. & to guard ye blood against ye
effects of a purulent Absorption, by a milk diet. Upon
this plan I cannot approve of either ye vomiting or
purging wc Mr Sevenson has practised. Laxatives
may be necessary but purging is not, & vomiting may
certainly be very hurtful. I believe ye vegetable diet he
employs may be very proper, but I would chuse to make
it chiefly ↑of↑ farinacea & milk. With respect to ye last it is
to be observed that in ye case of any suppuration in ye
Stomach cows milk is ready to form too firm a
Coagulum & therefore ye Asses milk is properly preferred;
but as that is not always to be had, the Cows milk may
be employed, if it be diluted wt an equal part of water gruel
or barley water & ye mixture very well sweetened wt sugar
or honey. Let this be understood to be written for Mr Stevenson
ye Son rather than the Father. ------------


Edin'r. May 5th.
1776
William Cullen.

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