Cullen

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

 

[ID:826] From: T Shiels / To: Dr William Cullen (Professor Cullen) / Regarding: T Shiels (Patient), Mr Knox (Patient), Mrs Knox (Patient) / 30 June 1772 / (Incoming)

Letter from [T.?] Shiels in Dublin, concerning the cases of his friends Mr and Mrs Knox. Mrs Knox suffers from headaches. Mr Knox has been treated with Selters water by somebody else against fits of the gout but still has problems, turning yelloow. Shiels also mentions that he is himself in poor health and announces to give an account of it in 2 or 3 parts.

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Metadata

FieldData
DOC ID 826
RCPE Catalogue Number CUL/1/2/93
Main Language English
Document Direction Incoming
Date30 June 1772
Annotation None
TypeAuthorial original
Enclosure(s) No enclosure(s)
Autopsy No
Recipe No
Regimen No
Letter of Introduction No
Case Note No
Summary Letter from [T.?] Shiels in Dublin, concerning the cases of his friends Mr and Mrs Knox. Mrs Knox suffers from headaches. Mr Knox has been treated with Selters water by somebody else against fits of the gout but still has problems, turning yelloow. Shiels also mentions that he is himself in poor health and announces to give an account of it in 2 or 3 parts.
Manuscript Incomplete? Yes
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:168]
Case of Mr Knox who has an inflamed liver.
3
[Case ID:169]
Case of Mrs Knox who has stomach pains.
2
[Case ID:1340]
Case of T. Shiells, medical practitioner in Ireland, who has developed severe headaches after catching fever while attending patients.
2


People linked to this document

Person IDRole in documentPerson
[PERS ID:349]Author T Shiels
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:350]PatientMr Knox
[PERS ID:351]PatientMrs Knox
[PERS ID:349]Patient T Shiels
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:349]Patient's Physician / Surgeon / Apothecary T Shiels

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing Dublin Mid Ireland Ireland Europe certain
Destination of Letter Edinburgh Edinburgh and East Scotland Europe inferred

Normalized Text

[Page 1]
Dublin June 30th. 1772
Dear Sir


I have been lately called upon to see Mr. Knox
Who has been for some months past in a very bad state of health, and as I would
which that He shou'd have all the assitance in the power of Medicine to bestow
I again address myselfe to you about him as the Person the best qualified
to ↑do↑ him all possible Justice and from a conviction that your regard for me
will lead you to pay the greatest attention to the case of a Gentleman
Who had ever been my warmest and best Friend.


Having in my former State of his case described his habit of Body, Age etc.
it will be unecessary to recaptitulate those circumstances here, I shall
therefore confine my account to the changes He underwent, since the receipt.
of your directions for him in 1767: After his recovery from the Inflammation
in his Liver, I put him on a course of Strengthners, as Tinct: Cort: Peruv.
Elix: Stomach: Vin: Chalyb: which produced very good effects, as his strength
was restored his Appetite very much mended and the Nausea & Languor
(to which He had been almost daily subject for some years) were removed.
After this was effected, I desisted from their further use as you Justly cauti¬
oned against the too long continued use of such remedies.




[Page 2]


He passed the Summer very well, and the following winter about Christmass
had a fit of the Gout as usual, after his recovery from which He was recommended
by a Physician a course of Selters water, this He constantly used as drink at dinner
and Supper, ever since, the apparent effects were the removal of the Gout, as He
had no fit in the Winter 69- or 70 : It is proper to observe that the view with
which the Selters Water was ordered, was the preventing the attacks of the Gout, or
at least diminishing the frequency or violence of the fits. He continued well
while last September, when after severe exercise and fatigue, He becam languid.
Had a cough & hoarseneess and loss of Appetite. He continued to be affected with
those (more or less) untill the middle of last November, when without any known
occasional cause, He was seized with Horripilations, succeeded by an encreas'd
Heat
, frequency of Pulse, and pain in the Region of the Liver, Singultus
a very great fullness and tension about the Stomach, His countenance became
yellow, his stools bilious. (without any Diarrhoa) in this situation
He got a dose of Sal Polych: & Rhubarb, but as his complaints encreased
on the 20th. of November a Physician was call'd in, He order'd a repetition of the
Purge, and to diminish the violence of the pain order'd the parts externally
to be anointed with the Linim: Volat: to promote perspiration
a solution of Tart: Emetic: was ordered, but the quantitity (½ a gutta in 24 hours)
so small, that it cou'd not possibly produce any effects, it was therefore laid aside



[Page 3]

And never again repeated. The pain in the side became more violent, and
extended to the Shoulder, and violently attacked the back of the Pelvis, so low
downe as the os Coxcyg. He sometimes had slight pains in his Legs,
which however did not Diminish the violence of the pain on the Side back [de?]
The Determination to the surface (naturally great in him) was totally put
a stop to, his skin became dry and parched, his thirst great and
his fever always encreased at night violently, accompani'd {illeg} with
an intermission of his Pulse, altho He was attended constantly by
a Physician, the only remedy ordered ↑was↑ port largely diluted with Selters
Water
, of which He daily tooke two quarts, this with little variation
was his situation untill the end of February, when the Symptoms
became gradually less violent, and in the begining of March altogeather
disapeared, however He continued exceedingly low and languid, his
appetite bad, had a total loss of Spirits, was drowsy and not inclined
to converse with his Friends, after continuing in this situation, his
Legs began to swell, in the end of March or begining of April, on Which
his Physician was again consulted, who ordered a continuance of
his [Panaciea?], the Selters Water, the Legs swelled more & more, and in
the middle of May when I saw him for the first time, I found


[Page 4]

The swelling very great extending up to the Knees, pitting very deep in all
parts of the Legs and feet, and for a long time retaining the Impression
and entirely indolent, encreasing very much at night; on considering his
situation attentively, I was of oppinion: the Selters water was improper for
him from the begining, and for the following reasons laid aside its use.
In the first place as the chief Ingredient in Selters water, is an Alkalin Salt
the effects which we are to expect: & which is generally attributed to it is diuretic
and tho we are not well acquainted with the nature of the Gout, still from
constant observation and experience we find all remedies for preventing
the Gout to be unsafe, as they act by altering the determination of nature
to deposit the morbid matter on the extremities, and that carrying of the
matter by any other channell is ever dangerous, unless we may except
the discharge by the Skin promoted by gentle exercise, but allowing
the Indication of carrying off the Arthritic matter from the System
by the Kidneys (as a preventative) safe, still it apeared to me that
the choice of Selters water a very injudicious one, as by so large a quan¬
tity of a relaxing fluid, the system naturally Lax, and now so to the
most extreme degree, must become daily more relaxed, and enervated.
Another circumstance that had great weight with me, was the daily diminuation
of, and at length the total stoppage of the Cuticular discharge,


[Page 5]

Which must have been owing to the determination to the Kidneys produced
by the Selters Water. In the situation I found him, with a great dropsical
swelling in his Legs, a general relocation of the solid, which gave cause to
apprehend its becoming general, it's use apear'd to me dangerous to the
last degree, however as there was an absolut necessity of carrying off the
disorder by the Kidneys, I thought the best for the purpose were those that
stimulate and promoted the action of the relax'd & torpid Solids, and at
the same time increased the excretion by the Kidneys. I therefore gave
him an Infusion in wine of. Rad: Raphan. Semi: Sinap: Cortex:
Infusion: Sambuc: Cinam & to this I added a portion of a [fiat?] alkal.
Salt. disolv'd in Wine.
([the Wines es Geniste?]) 1 this Course produced
very happy effects as they greatly encreased the Discharge by Urine
consequently daily lessened, and at length, totally removed the swelling
in his Legs, at the same time that his appetite and Spirits are quite
restored and He seems now in as good health and Spirits as He has
been in at any time those two years. past: The only remaining Indica¬
tion that preventing a return of his complaints by restoring the lost
tone to the Solids, I hope to effect by the Course of strengthners
you already recommended


[Page 6]

and which produced such good effects before. Those are the only circum¬
stances necessary to mention to you - As I live at above 500 Miles distance from
Towne, I did not attend him during his disorder, therefore was obliged to
depend on such an account as his Memory, and a Surgeon's who attended him
could furnish; this will appologize for any Inaccuracies or omission that may occurr.
As the Gout has been unsettled and seems disposed to affect the Liver, I dread
He may have {illeg} (a return )of his complaints next winter, unless prevented by your
advice, I therefore once more entreat you will be as full as possible in all
your directions, which you may be assured that he punctually followed.
What are your Sentiments about the Bath Waters? do you imagine does
the disposition his Liver has to Inflammation render them improper for him.

I hope you will favor me with an answer without any delay, and you
will much oblige him who is with great respect
Dear Sir
Your very Affectionate
& most Obedient Servant
[Tn:?]Shiells


P:S:
I think it necessary to acquaint you that his Legs now at the natural size
are reduced above two Inches & a halfe at the Ancle, from this you may Judge to
what a length the swelling had gone: The yellowness of his countenance quite gone




[Page 7]


As Mrs Know has been for many years subject to a severe Headache, and could
never receive the least benefit from any remedies, I beg you may give me your
sentiments and advice for her. She is a Lady at present in the 42d. year of her Age
born of healthy Parents of a slender delecate make, lively parts and quick appre¬
hension, never recollects her having had any complaints from her Infancy to this
day, except a fever two years agoe, which produced no other change that rendering
her more easily terrified in a carriage or otherwise. About 19 years agoe, two after
marriage she was attacked with a Headache which affect'd one side of her Head
causes a heaviness in her Eyes, loss of rest and appetite. it has been ever
since uncertain in its return duration a violence, lasting from one to four
days without intermission, and goes of without any sensible evacuation
by Perspiration or otherwise. It affects both sides of her Head Indiscrimi¬
nately but never both at once, and is confined to the os Frontis never
shooting to the Occiput. She has taken vomits and bitters without
effect which shows it does not depend on the Stomach. The Fatid Gums
she tells me have been tried in vain - ----
She is sometimes a month or more free from it -




[Page 8]


As Mr. Knox read the within I take an opportunity of writing a few
words for you in owne private perusal: For some years past Mr Knox
has chang'd his residence, and lives at present in or at his seat within
three miles of Dublin by which means I could not attend him during
the course of his disorder, tho from no great Dependance and
prejudice in my favor, He sent for me frequently but from the
number of my engagements in my own Country it was out my power
to see him before the middle of may. From what I said you see the
reasons that deterimined me to lay aside the use of the Selters
water
- the event has Justified my proceedings, still it is so
unusually fashionable here, that I have many to contend with
I therefore hope to have your oppinion which will effectually support
mine, and I beg that you may be particular on that subject
Indeed your former. Directions for Mr Knox rendered me still
more positive, as you granded him against all [reall?] or
pretended cures of the Gout: People here have
a great oppinion of the Efficacy of the Bath Waters
please to give your sentiments on them: Spa &c. ---
I have no more to say about Mr Knox but must tell you that I have
been in a very bad state of health for 10 months past, I am now
alarmed and my only dependance for recovery is on you, I will send
you a state of my case in two or three Parts, [&?] if Mr Knox becomes
ill next winter, I have recommended it to him to go to Edinburgh
to remain under your care, which on my solliciations He has

[Start of margin text]Doctor Cullen[End of margin text]

Notes:

1: This is unclear: if the word is "Genista" it may indicate that the wine employed was made with Broom; alternatively if the word is "Geneva" it indicates Gin.

Diplomatic Text

[Page 1]
Dublin June 30th. 1772
Dear Sir


I have been lately called upon to see Mr. Knox
Who has been for some months past in a very bad state of health, and as I wo'd
which that He shou'd have all the assitance in the power of Medicine to bestow
I again address myselfe to you about him as the Person the best qualified
to ↑do↑ him all possible Justice and from a conviction that your regard for me
will lead you to pay the greatest attention to the case of a Gentleman
Who had ever been my warmest and best Friend.


Having in my former State of his case described his habit of Body, Age &c.
it will be unecessary to recaptitulate those circumstances here, I shall
therefore confine my account to the changes He underwent, since the rect.
of your directions for him in 1767: After his recovery from the Inflamn.
in his Liver, I put him on a course of Strengthners, as Tinct: Cort: Peruv.
Elix: Stomach: Vin: Chalyb: which produced very good effects, as his strength
was restored his Appetite very much mended and the Nausea & Languor
(to which He had been almost daily subject for some years) were removed.
After this was effected, I desisted from their further use as you Justly cauti¬
oned against the too long continued use of such remedies.




[Page 2]


He passed the Summer very well, and the following winter about Christmass
had a fit of the Gout as usual, after his recovery from which He was recommended
by a Physician a course of Selters water, this He constantly used as drink at dinner
and Supper, ever since, the apparent effects were the removal of the Gout, as He
had no fit in the Winter 69- or 70 : It is proper to observe that the view with
which the Selters Water was ordered, was the preventing the attacks of the Gout, or
at least diminishing the frequency or violence of the fits. He continued well
while last September, when after severe exercise and fatigue, He becam languid.
Had a cough & hoarseneess and loss of Appetite. He continued to be affected with
those (more or less) untill the middle of last Novr., when without any known
occasional cause, He was seized with Horripilations, succeeded by an encreas'd
Heat
, frequency of Pulse, and pain in the Region of the Liver, Singultus
a very great fullness and tension about the Stomach, His countenance became
yellow, his stools bilious. (without any Diarrhoa) in this situation
He got a dose of Sal Polych: & Rhubarb, but as his complaints encreased
on the 20th. of Novr. a Physician was call'd in, He order'd a repetition of the
Purge, and to diminish the violence of the pain order'd the parts externally
to be anointed with the Linim: Volat: to promote perspiration
a solution of Tart: Emetic: was ordered, but the quantitity (½ a gt. in 24 hours)
so small, that it cou'd not possibly produce any effects, it was therefore laid aside



[Page 3]

And never again rep.d. The pain in the side became more violent, and
extended to the Shoulder, and violently attacked the back of the Pelvis, so low
downe as the os Coxcyg. He sometimes had slight pains in his Legs,
which however did not Diminish the violence of the pain on the Side back [de?]
The Determination to the surface (naturally great in him) was totally put
a stop to, his skin became dry and parched, his thirst great and
his fever always encreased at night violently, accompani'd {illeg} with
an intermission of his Pulse, altho He was attended constantly by
a Physician, the only remedy ordered ↑was↑ port largely diluted with Selters
Water
, of which He daily tooke two quarts, this with little variation
was his situation untill the end of February, when the Symptoms
became gradually less violent, and in the begining of March altogeather
disapeared, however He continued exceedingly low and languid, his
appetite bad, had a total loss of Spirits, was drowsy and not inclined
to converse with his Friends, after continuing in this situation, his
Legs began to swell, in the end of March or begining of April, on Which
his Physician was again consulted, who ordered a continuance of
his [Panaciea?], the Selters Water, the Legs swelled more & more, and in
the middle of May when I saw him for the first time, I found


[Page 4]

The swelling very great extending up to the Knees, pitting very deep in all
parts of the Legs and feet, and for a long time retaining the Impression
and entirely indolent, encreasing very much at night; on considering his
situation attentively, I was of oppinion: the Selters water was improper for
him from the begining, and for the following reasons laid aside its use.
In the first place as the chief Ingredient in Selters water, is an Alkalin Salt
the effects which we are to expect: & which is generally attributed to it is diuretic
and tho we are not well acquainted with the nature of the Gout, still from
constant observation and experience we find all remedies for preventing
the Gout to be unsafe, as they act by altering the determination of nature
to deposit the morbid matter on the extremities, and that carrying of the
matter by any other channell is ever dangerous, unless we may except
the discharge by the Skin promoted by gentle exercise, but allowing
the Indication of carrying off the Arthritic matter from the System
by the Kidneys (as a preventative) safe, still it apeared to me that
the choice of Selters water a very injudicious one, as by so large a quan¬
tity of a relaxing fluid, the system naturally Lax, and now so to the
most extreme degree, must become daily more relaxed, and enervated.
Another circumstance that had great weight with me, was the daily diminuation
of, and at length the total stoppage of the Cuticular discharge,


[Page 5]

Which must have been owing to the determination to the Kidneys produced
by the Selters Water. In the situation I found him, with a great dropsical
swelling in his Legs, a general relocation of the solid, which gave cause to
apprehend its becoming general, it's use apear'd to me dangerous to the
last degree, however as there was an absolut necessity of carrying off the
disorder by the Kidneys, I thought the best for the purpose were those that
stimulate and promoted the action of the relax'd & torpid Solids, and at
the same time increased the excretion by the Kidneys. I therefore gave
him an Infusion in wine of. Rad: Raphan. Semi: Sinap: Cortex:
Infusion: Sambuc: Cinam & to this I added a portion of a [fiat?] alkal.
Salt. disolv'd in Wine.
([the Wines es Geniste?]) 1 this Course produced
very happy effects as they greatly encreased the Discharge by Urine
consequently daily lessened, and at length, totally removed the swelling
in his Legs, at the same time that his appetite and Spirits are quite
restored and He seems now in as good health and Spirits as He has
been in at any time those two years. past: The only remaining Indica¬
tion that preventing a return of his complaints by restoring the lost
tone to the Solids, I hope to effect by the Course of strengthners
you already recommended


[Page 6]

and which produced such good effects before. Those are the only circum¬
stances necessary to mention to you - As I live at above 500 Miles distance from
Towne, I did not attend him during his disorder, therefore was obliged to
depend on such an account as his Memory, and a Surgeon's who attended him
cou'd furnish; this will appologize for any Inaccuracies or omission that may occurr.
As the Gout has been unsettled and seems disposed to affect the Liver, I dread
He may have {illeg} (a return )of his complaints next winter, unless prevented by your
advice, I therefore once more entreat you will be as full as possible in all
your directions, which you may be assured that he punctually followed.
What are your Sentiments about the Bath Waters? do you imagine does
the disposition his Liver has to Inflammation render them improper for him.

I hope you will favor me with an answer without any delay, and you
will much oblige him who is with great respect
Dear Sir
Yr. very Affecte.
& most Obedt. Servt.
[Tn:?]Shiells


P:S:
I think it necessary to acquaint you that his Legs now at the natural size
are reduced above two Inches & a halfe at the Ancle, from this you may Judge to
what a length the swelling had gone: The yellowness of his countenance quite gone




[Page 7]


As Mrs Know has been for many years subject to a severe Headache, and cou'd
never receive the least benefit from any remedies, I beg you may give me your
sentiments and advice for her. She is a Lady at present in the 42d. year of her Age
born of healthy Parents of a slender delecate make, lively parts and quick appre¬
hension, never recollects her having had any complaints from her Infancy to this
day, except a fever two years agoe, which produced no other change that rendering
her more easily terrified in a carriage or otherwise. About 19 years agoe, two after
marriage she was attacked with a Headache which affect'd one side of her Head
causes a heaviness in her Eyes, loss of rest and appetite. it has been ever
since uncertain in its return duration a violence, lasting from one to four
days without intermission, and goes of without any sensible evacuation
by Perspiration or otherwise. It affects both sides of her Head Indiscrimi¬
nately but never both at once, and is confined to the os Frontis never
shooting to the Occiput. She has taken vomits and bitters without
effect which shows it does not depend on the Stomach. The Fatid Gums
she tells me have been tried in vain - ----
She is sometimes a month or more free from it -




[Page 8]


As Mr. Knox read the within I take an opportunity of writing a few
words for you in owne private perusal: For some years past Mr Knox
has chang'd his residence, and lives at present in or at his seat within
three miles of Dublin by which means I cou'd not attend him during
the course of his disorder, tho from no great Dependance and
prejudice in my favor, He sent for me frequently but from the
number of my engagements in my own Country it was out my power
to see him before the middle of may. From what I said you see the
reasons that deterimined me to lay aside the use of the Selters
water
- the event has Justified my proceedings, still it is so
unusually fashionable here, that I have many to contend with
I therefore hope to have your oppinion which will effectually support
mine, and I beg that you may be particular on that subject
Indeed yr former. Directions for Mr Knox rendered me still
more positive, as you granded him against all [reall?] or
pretended cures of the Gout: People here have
a great oppinion of the Efficacy of the Bath Waters
please to give your sentiments on them: Spa &c. ---
I have no more to say about Mr Knox but must tell you that I have
been in a very bad state of health for 10 months past, I am now
alarmed and my only dependance for recovery is on you, I will send
you a state of my case in two or three Parts, [&?] if Mr Knox becomes
ill next winter, I have recommended it to him to go to Edinburgh
to remain under your care, which on my solliciations He has

[Start of margin text]Doctor Cullen[End of margin text]

Notes:

1: This is unclear: if the word is "Genista" it may indicate that the wine employed was made with Broom; alternatively if the word is "Geneva" it indicates Gin.

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