Cullen

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

 

[ID:914] From: Dr R. W. Stack / To: Dr William Cullen (Professor Cullen) / Regarding: Mr Thomas Stapleton (of Carlton) (Patient) / 26 September 1774 / (Incoming)

Letter from R. W. Stack in London, giving further information on the case of Mr Stapleton in response to Cullen's request. Includes detailed recipes and with some parts of the very closely written text indecipherable.

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Metadata

FieldData
DOC ID 914
RCPE Catalogue Number CUL/1/2/177
Main Language English
Document Direction Incoming
Date26 September 1774
Annotation None
TypeAuthorial original
Enclosure(s) No enclosure(s)
Autopsy No
Recipe Yes
Regimen No
Letter of Introduction No
Case Note No
Summary Letter from R. W. Stack in London, giving further information on the case of Mr Stapleton in response to Cullen's request. Includes detailed recipes and with some parts of the very closely written text indecipherable.
Manuscript Incomplete? No
Evidence of Commercial Posting Yes

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:142]
Case of Thomas Stapleton with worsening digestive ailments.
4


People linked to this document

Person IDRole in documentPerson
[PERS ID:430]AuthorDr R. W. Stack
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:431]PatientMr Thomas Stapleton (of Carlton)
[PERS ID:430]Patient's Physician / Surgeon / ApothecaryDr R. W. Stack
[PERS ID:728]Patient's Physician / Surgeon / ApothecaryDr Turton
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:1423]Other Physician / Surgeon De Haen (De Haen of Vienna)

Places linked to this document

Role in document Specific Place Settlements / Areas Region Country Global Region Confidence
Place of Writing London London and South-East England Europe certain
Destination of Letter Edinburgh Edinburgh and East Scotland Europe certain
Therapeutic Recommendation Aix-la-Chapelle (Aachen) Germany Germany Europe certain
Therapeutic Recommendation Spa Belgium Belgium Europe certain
Mentioned / Other Paris France France Europe certain
Mentioned / Other Vienna Austria Austria Europe certain
Mentioned / Other Yorkshire North-East England Europe certain

Normalized Text

[Page 1]
Dear Sir


I received last Saturday your esteemed favour of the 19th [Current?] It gives me great pleasure to know that my
Patient has, at length, consulted you on his very obstinate Disorder, for which he has had the advice of
many Physicians, to very little purpose. I have had the pleasure, more than once, of mentioning to him
your eminent ability, and am persuaded that you will, if possible, reinstate him


I am sorry it is not in my power to give you any material information, either as to the Opinions of
his former Physicians, the remedies prescribed or their Effects: But I shall endeavour to give you a faith¬
ful detail of mine own observations &c; and hope it will appear to you that every probable mean
has been tried, tho' I acknowlege, with very little advantage, save that of procuring a more regular
habit of Body, and, at times, longer intervals of ease. There was indeed a Period, when I began to flatter
myself with a prospect of success: But, his aversion to Exercise; his indulgence in Bed, late hours, and
frequent trespasses in point of Diet, deprived us of our capital resources.


In December 1772, when I first had the honour of seeing Mr Stapleton, he complained of a Disorder in his
Stomach, of many years standing; and a costiveness which required, as I was informed, frequent doses of
strong purging Physick. His stools were, for the most part, not unlike those of a Jaundiced Patient & hurt
him, as he said, in their passage thro' the Intestines, particularly near the seat of his complaint. His Urine
was generally turbid, & covered with a considerable pellicle; It sometimes deposited a soft pink colour
sediment, at other times a considerable quantity of mucus. He was often seized with a numbness of
his
hands & legs; a weakness at his knees, and such a Giddiness as, sometimes, to make him appre¬
hensive of falling
. His Skin was temperate; rather discoloured, dry & crisp especially at his hands &
feet. His Tongue was moist & foul: indeed it never appeared clean. His pulse was invariably
regular, soft, and tho' full yet weak; at a medium from 70 to 80 strokes in a minute
. The whites of
his Eyes were foul; his appetite was good: perhaps too good for his digestive powers, whence
considerable flatulency; frequent hawkings of ill flavoured mucus; Inquietude; unrefreshing sleep;
apprehensions & dejection, with other Hypochondriacal Symptoms.


It may be proper to inform you that, on enquiry, I learned that his mother had been always subject
to a bad stomach, and a variety of complaints call'd nervous: And that I have lately seen a Brother of
his, on my return from Paris, who consulted me for a similar disorder, tho' not so complicated.


Having duly considered the above case, it appeared to me very probable that a relax'd state of the
alimentary canal; a too great secretion of mucus, & frequent imperfect Digestions had laid the founda¬
tion of Morbid Acidity; spasmodic affections of the Duodenum; obstruction in the Liver; foul bowels;
general constriction of the surface; suppressed perspiration, and all the variety of symptoms dependent
thereon. Nor was I free from suspicions of a scorbutic acrimony, and unmanifested disposition
to the Gout
, altho' his manner of Life temperate & free from Debauches of any kind -- or his hereditary
claim had not exposed him to the latter.


The principal indication of cure seemed to consist in endeavouring by a proper Regimen, and tonic
medicines, to strengthen the organs of Digestion, & thereby to invigorate the whole system; so that the
due secretions & excretions may be restored, and any latent principle of Disease - be it cause or
effect - exterminated to the surface or to the Extremeties. But before this could be undertaken, I
deem'd it indispensibly necessary to cleanse the [1dsid?], and to remove the obstructions which had been
formed; for which purpose I prescribed what follows. But before I mention the medicines, it may
be proper to lay before you the Regimen which I recommended.


His Diet was to consist of mild animal food, plainly dress'd. His drink at meals, to be wine & water,
or, in preference water with 9th part of Brandy. He was allowed to take at Dinner, according to
his custom, a pint of pure generous wine. He was advised to keep his hands & legs warm; to wear
a flannel waistcoat inside; to wear a thin Belt, lined with flannel, round his body with an easy
pressure on the part affected. To keep regular hours. To exercise moderately on horseback everyday,
and to guard against any of the slow passions. He was cautioned against gross meats; anything highly
seasoned or smoked; much garden stuff; malt Liquors, except Porter; Pastry, sweets, Butter, Tea, Coffee
and Fish, except Crab & Lobster without additions.


1772 December 16.

Twelve grains of aloe hepatica, four grains of soap, four grains of calomel and one grain of oil of Cinnamon, [and?] make a pill [to take?] of four [grains?]


17. one stool. 18th no stool.

{illeg} a pill {illeg} and early {illeg} make a draught {illeg} [ only the stool will hold the answers ?]

Take two drachms of Soluble Tartar, two ounces Infusion of Senna, 2 ounces each of Tincture of Senna and rose Syrup, mix.


It was taken (the pills not answering) the effect 2 stools large & solid, and one small thin stool
coloured. two ounces of Vin. Ipecac operated well & brought up a vast quantity of foul viscid stuff.
The next day he had 2 stools the first thin & brown, the second solid & greyish.




[Page 2]


December 22:

Twelve grains of aloe hepatica, eight grains of soap, four grains of {illeg}, three grains of [oil of cinnamon?], and make a pill of nine {illeg}, three per day.


Taken regularly for
six days, without intermission. Procured stools one or two each day: They became now coloured & fecal His
Stomach easier, his spirits better, his skin & eyes clearer, the hardness near the [pit?] of the Stomach removed.


28.

One ounce of peppermint, two drachms of Peruvian Bark, and one drachm each of bitters and [Chalybeate in wine?], for a draft to be taken noon and evening.


no stool for 2 days. 31st

Take one drachm of {illeg}, half a drachm each of extract of Gentian and flowers of Steel, and four drops of oil of Cinnamon, and make a pill of twenty-seven {illeg} three times per day.


Every complaint mitigated. Belly rather bound, not withstanding the Pills. Calcined
magnesia
was taken occasionally & assisted. The hypochondria were anointed every morning with
a solution of Camphire in olive oil. Pediluvia useful.


1773 January An obstinate Cold; a tickling Cough; appetite diminished dejection of Spirits; Costiveness and a return of
many of his former Complaints. No medicine take for many days, except camphorated Draughts
with puls. contrayerv. & Elix. Paregor at night; pectoral Lozenges by day, and magnesia occasionally.
These not succeeding I gave 2 ounces Vin. Ipecac. which brought up a great quantity of viscid stuff, and
removed the bulk of his complaints. It should, I think, be mentioned in this place that he was very
subject to colds this Winter. That he had taken an Emetic four or five different times, and that
he, every time, threw up an abundance of glarey stuff - seldome any Bile.


February

One ounce of Peppermint water, three drachms of Peruvian Bark, two drachms of Rhubarb, one drachm of [Chalybeates in Wine?], sixteen drops of Canthradin, and make {illeg}


These draughts (with a daily increase of 2 drops of Tinct. Cantharid) were continued for a considerable
time, so that at length he took more than one hundred Drops per Diem, & that without the least
uneasy sensation. An Evidence, I think, of the morbid excess of the Mucous Secretions, whereby the
different organs were rendered, in a manner, insensible to a stimulus. During the use of these
draughts, & calcined Magnes, pro re Nata, the Intestines performed their office regularly; the Urine
was more plentiful & less loaded; the skin was softer; the appetite & Digestion improved; numbness,
weakness or giddiness not frequent: Complexion and Spirits good. I now began to conceive great
hope & indeed so did my Patient & his Friends.


March

Four ounces of tincture of Peruvian Bark, one and a half ounces each of bitters and Cardamom, one ounce of snakeroot, and mix. {illeg} Two hours before lunch, and at the hour of tpm in four ounces of tepid water.


prandium horis, et hora[t?] 6r p.m. in ℥iv aq. tepid. This was taken for some days with
advantage: but, omissions, colds, & some little Errors in point of Diet, brought on again a return
of complaints.


April Tepid Baths were tried & found useful. Indeed any circumstance that contributed to lessen the strictures
on the skin, relieved all his complaints for a time. From this observation, repeatedly made, I
recommended Dover's sudorific powder, & desired the assistance of another Physician. The first dose,
20 grains, had no effect. The second dose, 25 grains, produced a moist skin & great relief. The third dose, 30 grains,
occasioned a great propensity to sweat, which he prevented by getting out of Bed.


In three days after, Costiveness & a sense of Fulness required a dose of Aloetic pills with [I?] gr. of Tart. Emet,
which afforded so much relief, that of his own accord, he had them repeated at different times, & always
with advantage pro tempore. On the 25th of this month I had a second interview with D.r Turton, who
proposed the following prescription, which he had seen successfully employed, by De Haen at Vienna,
in similar cases

Two ounces of spanish Soap, one drachm of Gum ammoniac, two scruples of Diuretic Salts, {illeg} and make a pill {illeg}

Take 10 drachms each of root {illeg}, 1 handful each of St John's Wort and Chamomile and 2 ounces of Liquorice root, boil a little in sufficient quantity of water and strain {illeg}


These medicines were taken for 8 or 9 days without sensible advantage.


May. I prescribed the following Boluses which were taken for many days. The effects were, a regular habit of
Body; a softer skin; better urine, and a crop of Eruptions on the back & shoulders.

Take 15 grains extract of soft peruvian bark, 10 grains of salsola soda, {illeg} 5 grains of flowers of sulphur, 2 drops of Aniseed oil let it be made into large pills and taken morning and evening.


June I advised the cold Bath after a due preperation by a few tepid Baths &c. The latter was complied with, and
always gave relief by relaxing the surface. Cold Bathing was defer'd till his return to Yorkshire, and
then not used.


On his return to town, last winter, his complaints were nearly as various as the year before. On the whole
however he was better. I realy did not know what plan to adopt for his greater advantage, and therefore
only recommended a strict attention to Regimen; an aloetic purge [T?] Tart. emet, occasionally; & sometimes
a tepid Bath.


1774 March. He complained of a Tenesmus & frequent irritation to make water, with an uneasy sensation in his Loins,
and great Rumbling in the bottom of his belly. I suspected Hæmorrhoids & wish'd for a flux of Blood. It did
not happen. Fl. sulph. [lot.?] & magnes. , half a drachm of each, gave him ease; the following Electary cured him.

Take 1 ounce each of Electuary of Cassia and [æth. Min.?], 3 drachms [P e?]senna complex, and sufficient quantity of simple syrup let him take [the quantity?] of a nutmeg at bed time and the following morning. everyday, increasing or decreasing the dose as the belly requires.


In a few days after this complaint had been over, I was induced to try 5 gtt of [Ipec?] Rhubarb, and
1 gr. of Ipecac. gradually increased, every morning. The first day it caused a sickness for a short time: he
thought himself better the rest of the day. half a grain was added every morning till the dose amounted to
three grains. From 2 to 3 grains sickend him much & occasioned him to vomit some ropey stuff mix'd
with Bile, as I imagined at first; but I rather suspect the Rhubarb deceived us. He passed the remainder of



[Page 3]

Each day tolerably well, but but at length grew tired of his morning sickness, & the remedy was discontinued.


In april I tried the following, which did not answer my Expectation.

Take an ounce of Columbo root {illeg}, half an ounce of Orange Peel, 12 ounces of spring water, four ounces of simple Cinnamon Water, soak for seven hours without heat.

Take two ounces of an Infusion of the above prescription with two grains of Ipecacuanha [p?] to make a draught to be taken in the morning everyday: and repeated {illeg} hour before dinner without Ipecacuanha.


My last advice was, to go to Aix la Chapelle, and, under proper direction, to use those excellent waters intern¬
ally & externally for 3 weeks or a month. Then, and not before, to repair to the Pouhon & Geronsterre springs
at Spa. His Engagements have prevented him this summer.


He is a most amiable man & deserves good health. I most sincerely wish you success in your endeavour to
restore him so invaluable a blessing. But if your prescriptions should happen to fail, will it not
be right to try these Waters during the warm months next Summer?


I need not tell you that the Generality of Patients, in his way, are to prone to transgress as soon
as they find Relief: This is a Rock he has often struck against. I doubt not you will gain his implicit
confidence, perhaps more than any other Physician has; and there is not, I am sure, a Physician who
can more strongly, than your self, enforce the words of, I think, Montanus "In curatione hujus
"morbi, non licet præfinire tempus mensis unius, aut anni, sicut in aliis contingat;
"sed oportet in toto vitæ suæ tempore curationi operam dare; interdum curationi;
"intendum præservationi attendendo." 1


I should be very happy to be honoured with your thoughts on this subject, & request you will believe
that I am, with great respect & esteem, Dear Sir,
your most obedient servant
R. W. Stack
London
26th September 1774



[Page 4]


To
Doctor Cullen
Professor of Physick
Edinburgh


Dr Stack
about Mr Stapleton
September 26. 1774

Notes:

1: Johannes Baptista Montanus (1496-1551), was the leading Italian humanist physician of his era, who became professor at Padua. The immediate source of this quotation was probably Robert Whytt, Oberservatations on the Nature, Causes and Cure of those Disorders which have been commonly called nervous, hypochondriac, or hysteric (Edinburgh: 1767), p. 324, where Whytt cites the source as Montanus, Chirugica Consilia (Nuremberg: 1559), p. 230. The passage refers to the treatment of hypochondria. In paraphrase it cautions that 'in the course of treating this disease one must not merely observe any appearances for a predetermined period of one month, or the year, as in others; rather, it is necessary to give attention to the whole of the patient's life at the time of treatment and sometimes, beyond.'

Diplomatic Text

[Page 1]
Dr Sir


I received last Saturday your esteemed favour of the 19th [Currt?] It gives me great pleasure to know that my
Patient has, at length, consulted you on his very obstinate Disorder, for which he has had the advice of
many Physicians, to very little purpose. I have had the pleasure, more than once, of mentioning to him
your eminent ability, and am persuaded that you will, if possible, reinstate him


I am sorry it is not in my power to give you any material information, either as to the Opinions of
his former Physicians, the remedies prescribed or their Effects: But I shall endeavour to give you a faith¬
ful detail of mine own observations &c; and hope it will appear to you that every probable mean
has been tried, tho' I acknowlege, with very little advantage, save that of procuring a more regular
habit of Body, and, at times, longer intervals of ease. There was indeed a Period, when I began to flatter
myself with a prospect of success: But, his aversion to Exercise; his indulgence in Bed, late hours, and
frequent trespasses in point of Diet, deprived us of our capital resources.


In Decemr. 1772, when I first had the honour of seeing Mr Stapleton, he complained of a Disorder in his
Stomach, of many years standing; and a costiveness which required, as I was informed, frequent doses of
strong purging Physick. His stools were, for the most part, not unlike those of a Jaundiced Patient & hurt
him, as he said, in their passage thro' the Intestines, particularly near the seat of his complaint. His Urine
was generally turbid, & covered with a considerable pellicle; It sometimes deposited a soft pink colour
sediment, at other times a considerable quantity of mucus. He was often seized with a numbness of
his
hands & legs; a weakness at his knees, and such a Giddiness as, sometimes, to make him appre¬
hensive of falling
. His Skin was temperate; rather discoloured, dry & crisp especially at his hands &
feet. His Tongue was moist & foul: indeed it never appeared clean. His pulse was invariably
regular, soft, and tho' full yet weak; at a medium from 70 to 80 strokes in a minute
. The whites of
his Eyes were foul; his appetite was good: perhaps too good for his digestive powers, whence
considerable flatulency; frequent hawkings of ill flavoured mucus; Inquietude; unrefreshing sleep;
apprehensions & dejection, with other Hypochondriacal Symptoms.


It may be proper to inform you that, on enquiry, I learned that his mother had been always subject
to a bad stomach, and a variety of complaints call'd nervous: And that I have lately seen a Brother of
his, on my return from Paris, who consulted me for a similar disorder, tho' not so complicated.


Having duly considered the above case, it appeared to me very probable that a relax'd state of the
alimentary canal; a too great secretion of mucus, & frequent imperfect Digestions had laid the founda¬
tion of Morbid Acidity; spasmodic affections of the Duodenum; obstruction in the Liver; foul bowels;
general constriction of the surface; suppressed perspiration, and all the variety of symptoms dependent
thereon. Nor was I free from suspicions of a scorbutic acrimony, and unmanifested disposition
to the Gout
, altho' his manner of Life temperate & free from Debauches of any kind -- or his hereditary
claim had not exposed him to the latter.


The principal indication of cure seemed to consist in endeavouring by a proper Regimen, and tonic
medicines, to strengthen the organs of Digestion, & thereby to invigorate the whole system; so that the
due secretions & excretions may be restored, and any latent principle of Disease - be it cause or
effect - exterminated to the surface or to the Extremeties. But before this could be undertaken, I
deem'd it indispensibly necessary to cleanse the [1dsid?], and to remove the obstructions which had been
formed; for which purpose I prescribed what follows. But before I mention the medicines, it may
be proper to lay before you the Regimen which I recommended.


His Diet was to consist of mild animal food, plainly dress'd. His drink at meals, to be wine & water,
or, in preference water with 9th part of Brandy. He was allowed to take at Dinner, according to
his custom, a pint of pure generous wine. He was advised to keep his hands & legs warm; to wear
a flannel waistcoat inside; to wear a thin Belt, lined with flannel, round his body with an easy
pressure on the part affected. To keep regular hours. To exercise moderately on horseback everyday,
and to guard against any of the slow passions. He was cautioned against gross meats; anything highly
seasoned or smoked; much garden stuff; malt Liquors, except Porter; Pastry, sweets, Butter, Tea, Coffee
and Fish, except Crab & Lobster without additions.


1772 Decr 16.


Aloes hepat gr xii. sapon. gr vi. Calomel. gr iv. ol. Cinnam. gt. i ft Pil. iv h.s. sumend


17. one stool. 18th no stool.


[Ressr?] Pilule h.s. et mane seq. sumat haust seq. nisi [his tene?]
responderit alvus.


It was taken (the pills not answering) the effect 2 stools large & solid, and one small thin stool
coloured. ℥ij Vin. Ipecac operated well & brought up a vast quantity of foul viscid stuff.
The next day he had 2 stools the first thin & brown, the second solid & greyish.




[Page 2]


Decr 22:


Aloes hepat gr. xii Sapon gr. viii [Kerm.?] min. gr iv [ol cinnam?] gt. iij ft pil. ix Capt iij ter Die.


Taken regularly for
six days, without intermission. Procured stools one or two each day: They became now coloured & fecal His
Stomach easier, his spirits better, his skin & eyes clearer, the hardness near the [pit?] of the Stomach removed.


28.


Aq. menth. pip ℥i. [T?] Cort. Peruv. ʒij [T.?] amar Vin. Chalyb. aa ʒi. pro haustu meridie & vesperis sumendo.


no stool for 2 days. 31st


R. Pil [Extract?] ʒi Extr. Gent. fl. Mart. aa ʒſs ol. Cinnam. gtt. iv ft Pil. xxvii
Capt iij ter die.


Every complaint mitigated. Belly rather bound, not withstanding the Pills. Calcined
magnesia
was taken occasionally & assisted. The hypochondria were anointed every morning with
a solution of Camphire in olive oil. Pediluvia useful.


1773 Jan An obstinate Cold; a tickling Cough; appetite diminished dejection of Spirits; Costiveness and a return of
many of his former Complaints. No medicine take for many days, except camphorated Draughts
with puls. contrayerv. & Elix. Paregor at night; pectoral Lozenges by day, and magnesia occasionally.
These not succeeding I gave 2 oz. Vin. Ipecac. which brought up a great quantity of viscid stuff, and
removed the bulk of his complaints. It should, I think, be mentioned in this place that he was very
subject to colds this Winter. That he had taken an Emetic four or five different times, and that
he, every time, threw up an abundance of glarey stuff - seldome any Bile.


Feb


Aq. Menth pip. ℥i [T?] Cort. Peruv. ʒiij [T?] Rhei ʒij. Vin. Chalyb. ʒi [T.?] Cantharid gtt. xvi. ft h. mane [st.s.s.?]


These draughts (with a daily increase of 2 drops of Tinct. Cantharid) were continued for a considerable
time, so that at length he took more than one hundred Drops per Diem, & that without the least
uneasy sensation. An Evidence, I think, of the morbid excess of the Mucous Secretions, whereby the
different organs were rendered, in a manner, insensible to a stimulus. During the use of these
draughts, & calcined Magnes, as needed, the Intestines performed their office regularly; the Urine
was more plentiful & less loaded; the skin was softer; the appetite & Digestion improved; numbness,
weakness or giddiness not frequent: Complexion and Spirits good. I now began to conceive great
hope & indeed so did my Patient & his Friends.


Mch


Tinct. Cort. Peruv ℥iv. [T?] amar - Cardamom aa ℥iſs serpentar ℥j ℳ Cap.t Coch. I duabus ante
prandium horis, et hora[t?] 6r p.m. in ℥iv aq. tepid.


prandium horis, et hora[t?] 6r p.m. in ℥iv aq. tepid. This was taken for some days with
advantage: but, omissions, colds, & some little Errors in point of Diet, brought on again a return
of complaints.


Apl Tepid Baths were tried & found useful. Indeed any circumstance that contributed to lessen the strictures
on the skin, relieved all his complaints for a time. From this observation, repeatedly made, I
recommended Dover's sudorific powder, & desired the assistance of another Physician. The first dose,
20 gr., had no effect. The second dose, 25 gr., produced a moist skin & great relief. The third dose, 30 gr.,
occasioned a great propensity to sweat, which he prevented by getting out of Bed.


In three days after, Costiveness & a sense of Fulness required a dose of Aloetic pills with [I?] gr. of Tart. Emet,
which afforded so much relief, that of his own accord, he had them repeated at different times, & always
with advantage pro tempore. On the 25th of this month I had a second interview with D.r Turton, who
proposed the following prescription, which he had seen successfully employed, by De Haen at Vienna,
in similar cases


Sapon hisspan ℥ij. G. ammon ʒi Sal. Diuret ℈ij Decoct seq. [Tereb venet?]. q.s. ft. Pil Medioc


℞ Rad {illeg} aa ʒx
flor. hyperici Chamæm aa Mj Rad. Glycirrhiz ℥ij coque parum in Aq. Q.S. et colentur [libræ dud?]


These medicines were taken for 8 or 9 days without sensible advantage.


May. I prescribed the following Boluses which were taken for many days. The effects were, a regular habit of
Body; a softer skin; better urine, and a crop of Eruptions on the back & shoulders.


Extr. Cort. Peruv. mol. gr. xv sal. sodœ gr. x fl. sulph. [lot.?] gr. v. ol. Anis gt. ij ft mane & vesp. sumend


June I advised the cold Bath after a due preperation by a few tepid Baths &c. The latter was complied with, and
always gave relief by relaxing the surface. Cold Bathing was defer'd till his return to Yorkshire, and
then not used.


On his return to town, last winter, his complaints were nearly as various as the year before. On the whole
however he was better. I realy did not know what plan to adopt for his greater advantage, and therefore
only recommended a strict attention to Regimen; an aloetic purge [T?] Tart. emet, occasionally; & sometimes
a tepid Bath.


1774 March. He complained of a Tenesmus & frequent irritation to make water, with an uneasy sensation in his Loins,
and great Rumbling in the bottom of his belly. I suspected Hæmorrhoids & wish'd for a flux of Blood. It did
not happen. Fl. sulph. [lot.?] & magnes. aa ʒſs gave him ease; the following Electary cured him.


Elect. e Casia [æth. Min.?] aa ℥j [P e?] Sena comp. ʒiij Syr. simpl. q.s. Capt [q?] n. m. h.s. & mane seq.
quotidie, augendo vel minuend dosin prout responderit alvus.


In a few days after this complaint had been over, I was induced to try 5 gtt of [Ipec?] Rhubarb, and
1 gr. of Ipecac. gradually increased, every morning. The first day it caused a sickness for a short time: he
thought himself better the rest of the day. half a grain was added every morning till the dose amounted to
three grains. From 2 to 3 grains sickend him much & occasioned him to vomit some ropey stuff mix'd
with Bile, as I imagined at first; but I rather suspect the Rhubarb deceived us. He passed the remainder of



[Page 3]

Each day tolerably well, but but at length grew tired of his morning sickness, & the remedy was discontinued.


In april I tried the following, which did not answer my Expectation.


Rad. Columb. [p.?] ℥i Cort. Aurant ℥ſs
aquæ font. ℥xii. Aq. Cinnam. sp. ℥iv macerentur [p?] vij horas sine Calore.


℞ Infus. supra prescript. ℥ij. Ipecac. [p.?] gr. ft haust. mane sumend quotidie et repetend
[Unis?] horis ante prand. sine Ipecac.


My last advice was, to go to Aix la Chapelle, and, under proper direction, to use those excellent waters intern¬
ally & externally for 3 weeks or a month. Then, and not before, to repair to the Pouhon & Geronsterre springs
at Spa. His Engagements have prevented him this summer.


He is a most amiable man & deserves good health. I most sincerely wish you success in your endeavour to
restore him so invaluable a blessing. But if your prescriptions should happen to fail, will it not
be right to try these Waters during the warm months next Summer?


I need not tell you that the Generality of Patients, in his way, are to prone to transgress as soon
as they find Relief: This is a Rock he has often struck against. I doubt not you will gain his implicit
confidence, perhaps more than any other Physician has; and there is not, I am sure, a Physician who
can more strongly, than your self, enforce the words of, I think, Montanus "In curatione hujus
"morbi, non licet præfinire tempus mensis unius, aut anni, sicut in aliis contingat;
"sed oportet in toto vitæ suæ tempore curationi operam dare; interdum curationi;
"intendum præservationi attendendo." 1


I should be very happy to be honoured with your thoughts on this subject, & request you will believe
that I am, with great respect & esteem, Dear Sir,
your most obedient servant
R. W. Stack
London
26th Sepr. 1774



[Page 4]


To
Doctor Cullen
Professor of Physick
Edinburgh


Dr Stack
abt Mr Stapleton
Septr 26. 1774

Notes:

1: Johannes Baptista Montanus (1496-1551), was the leading Italian humanist physician of his era, who became professor at Padua. The immediate source of this quotation was probably Robert Whytt, Oberservatations on the Nature, Causes and Cure of those Disorders which have been commonly called nervous, hypochondriac, or hysteric (Edinburgh: 1767), p. 324, where Whytt cites the source as Montanus, Chirugica Consilia (Nuremberg: 1559), p. 230. The passage refers to the treatment of hypochondria. In paraphrase it cautions that 'in the course of treating this disease one must not merely observe any appearances for a predetermined period of one month, or the year, as in others; rather, it is necessary to give attention to the whole of the patient's life at the time of treatment and sometimes, beyond.'

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