Cullen

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

 

[ID:4280] From: Dr William Cullen (Professor Cullen) / To: Dr Thomas Stephen / Regarding: Miss Isabella Shaw (Bell Shaw) (Patient) / 20 July 1778 / (Outgoing)

Reply to Dr Thomas Stephen in Elgin concerning 'Miss Bell Shaw' who has a constricted oesophagus. Cullen thinks it likely to prove fatal, but advises using larger doses of cicuta.

Facsimile

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[Page 2]


 
 

Metadata

FieldData
DOC ID 4280
RCPE Catalogue Number CUL/1/1/11/18
Main Language English
Document Direction Outgoing
Date20 July 1778
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 to Dr Thomas Stephen in Elgin concerning 'Miss Bell Shaw' who has a constricted oesophagus. Cullen thinks it likely to prove fatal, but advises using larger doses of cicuta.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:1039]
Case of Miss Bell Shaw who has a constricted oesophagus, and strained herself nursing her dying father.
2


People linked to this document

Person IDRole in documentPerson
[PERS ID:1]AuthorDr William Cullen (Professor Cullen)
[PERS ID:820]AddresseeDr Thomas Stephen
[PERS ID:2203]PatientMiss Isabella Shaw (Bell Shaw)
[PERS ID:820]Patient's Physician / Surgeon / ApothecaryDr Thomas Stephen
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)

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 Elgin East Highlands Scotland Europe inferred

Normalized Text

[Page 1]
Miss Bell Shaw.


Her former nervous complaints I consider as out of the
question & altho they were not I could add nothing to
your judicious treatment. I shall therefore only speak of
that present distressing & dangerous ailment, the pain¬
ful stricture of the OEsophagus. I attempt to explain
the nature of it (to myself) in this way. Under her
efforts to support her father- the Diaphragm was
thrown into violent contractions & in one of these the
œsophagus where it pierces the diaphragm was squeezed
hurt violently; this appeared from the sensation fol¬
lowed by the throwing ↑up↑ of blood . Whether these be
a tumor formed I cant say but in either case there
is probably a construction rendering the passage
of the food difficult. Every dilation of the




[Page 2]


part must give pain & it is possible that the
pain arising upon matters being pushed thro may de¬
pend partly upon the spasmodic effects of the
neighbouring portions of the œsophagus, in pushing the
matters thro the constricted part. How far the
connected fibres of the diaphragm may be affected
& have a share in the pheenomenons I cannot posi¬
tively decide but suspect somewhat of that kind.


Whatever judgement we make however will influence little
our practice. But in no view can I form a favorable prognostic.
I have personally known several & read of others all turned out
incureable, fatal. But however desperate, to be attempted.
As in this case schirrosity is suspicious, you have done right in
giving Cicuta, but your dose has not been carried far & you
should go increasing till you produce sensible effects. The
thirst is not a consequence of the use of the Cicuta-, but of the af¬
fection of the œsophagus; as is common in allmost all such.
Go on then till you produce sensible effects - 40 grains in a
day -- If she takes this without sensible effect your Cicuta
is bad try a better parcel: only in beginning the new parcel
begin by small doses as before. If it produce sensible effects
but not on the disease try Belladonna but this a still more
ticklish remedy do not try it till the Cicuta is despaired of
while the disease continues very urgent I shall give you directions
for the use of it then. In the mean time nourish as well as you
can by throwing in the most easily swallowed things. but while
the difficulty & pain continue or increase you may relieve
by a broth glyster once or twice a day.

W. C.
Edinburgh July. 20. 1778.

Diplomatic Text

[Page 1]
Miss Bell Shaw.


Her former nervous complaints I consider as out of the
question & altho they were not I could add nothing to
your judicious treatment. I shall therefore only speak of
that present distressing & dangerous ailment, the pain¬
ful stricture of the OEsophagus. I attempt to explain
the nature of it (to myself) in this way. Under her
efforts to support her father- the Diaphragm was
thrown into violent contractions & in one of these the
œsophagus where it pierces the diaphr. was squeezed
hurt violently; this appeared from the sensation fol¬
lowed by the throwing ↑up↑ of blood . Whether these be
a tumor formed I cant say but in either case there
is probably a construction rendering the passage
of the food difficult. Every dilation of the




[Page 2]


part must give pain & it is possible that the
pain arising upon matters being pushed thro may de¬
pend partly upon the spasmodic effects of the
neighbouring portions of the œsophagus, in pushing the
matters thro the constricted part. How far the
connected fibres of the diaphragm may be affected
& have a share in the pheenomenons I cannot posi¬
tively decide but suspect somewhat of that kind.


Whatever judgement we make however will influence little
our practice. But in no view can I form a favorable prognostic.
I have personally known several & read of others all turned out
incureable, fatal. But however desperate, to be attempted.
As in this case schirrosity is suspicious, you have done right in
giving Cicuta, but your dose has not been carried far & you
should go increasing till you produce sensible effects. The
thirst is not a conseq. of the use of the Cicuta-, but of the af¬
fection of the œsophagus; as is common in allmost all such.
Go on then till you produce sensible effects - 40 grains in a
day -- If she takes this without sensible effect your Cicuta
is bad try a better parcel: only in beginning the new parcel
begin by small doses as before. If it produce sensible effects
but not on the disease try Belladonna but this a still more
ticklish remedy do not try it till the Cicuta is despaired of
while the disease continues very urgent I shall give you directions
for the use of it then. In the mean time nourish as well as you
can by throwing in the most easily swallowed things. but while
the difficulty & pain continue or increase you may relieve
by a broth glyster once or twice a day.

W. C.
Edr. July. 20. 1778.

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