Cullen

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

 

[ID:974] From: Dr William Cullen (Professor Cullen) / To: Dr Alexander Taylor (Sanders) / Regarding: Mr Robert Neilson (Nielson, of Paisley) (Patient) / 5 June 1780 / (Outgoing)

Reply 'For Mr Neilson', whose case is 'a singular combination of a Rheumatic or Phlogistic Diathesis with a great deal of Nervous affection'.

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Metadata

FieldData
DOC ID 974
RCPE Catalogue Number CUL/1/1/13/29
Main Language English
Document Direction Outgoing
Date5 June 1780
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 'For Mr Neilson', whose case is 'a singular combination of a Rheumatic or Phlogistic Diathesis with a great deal of Nervous affection'.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:316]
Case of Mr Robert Neilson with a chronic, progressive illness, probably pulmonary (consumption) but possible cardiac. After a gap, in early January 1782, Cullen confirms that Neilson's condition is terminal. An autopsy soon follows.
22


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:206]PatientMr Robert Neilson (Nielson, of Paisley)
[PERS ID:207]Patient's Physician / Surgeon / ApothecaryDr Alexander Taylor (Sanders)
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:975]Other Physician / SurgeonDr John Clerk (Clerke)

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]
For Mr Nielson. vid. p. 19 &c.


The Case is a singular combination of a Rheumatic or
Phlogistic Diathesis with a great deal of nervous affection and it is
from the later that so many anomalous appearances have occured -


To mend and eradicate both these consitutional disorders
must be a difficult work, but I think we have made a great progress
in getting over so bad a winter and Spring so well as we have
done and I hope during the Summer we shall get much farther.


There is one measure in which I am very clear & that is the propriety
of the Diet he is on and which muct be strictly continued and so
far am I from thinking of making it any better that I would
make it still lower if I could - A late eminent Practitioner
here 1 who was afflicted for more than twenty years with an
obstinate Rheumatic disposition which obliged him to avoid



[Page 2]

all animal food and he found that after using a
milk Diet some time length of Time it was not sufficient
to take down the Tone of his System. He gave up entire milk
and took to Buttermilk alone. - Some years before his Death
he told me he was still taking down - he had taken to Whey
and if that should not answer, he was at a loss what to do
next -- However this Gentleman was still able to
carry on a very extensive practice and died only at 68 of an
Apoplexy which had been a family Disease - We cannot
entirely new model Constitutions and Mr Neilson must make
the most of his he can and if by low living he can enjoy
tolerable health he must not grudge the means - You put
a question with regard to a glass of Wine or Toddy and I own
to you that I think a glass of Wine much safer than an
Ounce of Animal food and in the Case of occasional fain¬
tishness
such as you employed it in I would certainly allow
of a little Wine, but I am very averse to allow it as any
part of his regular establishment


However if there is any degree of faintishness frequently recur¬
ring I would allow him to take a spoonful of Wine and Water
either at noon or night as his feelings shall direct and if he does
get into such regular Course, I prefer the Wine and Water
to Toddy, but if he should feel or apprehend that the Wine in
any way interferes with the digestion of his milk I would allow
Toddy in the same circumstances in which I allow the Wine, but
with more caution with respect to quantity. I have nothing more
to say with respect to Diet, but that he will now digest Vegetables
better than he did when they were mixed with animal food and



[Page 3]

therefore I think he may try several garden
things as they come in season for while they
are still young and tender and well boiled
they do not readily give flatulency & he must
not try any Sallad or other raw vegetables.


For Mr Neilsons further recovery I depend
especially upon his travelling & now is the
proper season. I would therefore have him
set out upon a jaunt as soon as his conveniency
will allow but I am clear that no mineral
water
whatever can be of any service to him
or at least half so much as being in gentle
daily exercise. He may therefore chuse his own
route & take that where he may have best
accomodation & most amusement. I have only
to say that he is to guard well against cold & also
against much fatigue. I think from thirty to forty
miles is the proper measure & even when he
goes so far as forty miles in the day, he
should divide it so as to avoid either hurry or
fatigue. I find nothing else to say, but I am
anxious to say as much as I can & therefore
if either you or Mr. Neilson or Mrs. Neilson have
any questions to put I beg to have them -
I think there are no medicines to be employed
upon the journey but a little Spirit of Hartshorn
& Laudanum might be carried along tho I hope



[Page 4]

there shall be no occasion for them. -


This to yourself.


I am persuaded that Mr. Neilson has an aneurism
in the heart or some of the greater vessels next
to it. I have not time to explain myself ful more
particularly but I can assure you I have known all
his symptoms connected with such an affection - but
supposing it to be as I say there are no other meas¬
ures to be pursued than those in the letter inclosing
this. The mildest regimen - fresh air and gentle
exercise - bleeding may be sometimes of use but
still employed sparingly & cautiously.

yours &c. W.C.
June 5th 1780

Notes:

1: Cullen's mentor Dr John Clerk (d. 1757), one of his early mentors. This anecdote appears in the eulogy Cullen delivered at Clerk's funeral which is partly reproduced in Thomson An Account (1732), pp. 525-536 (esp. 536),

Diplomatic Text

[Page 1]
For Mr Nielson. vid. p. 19 &c.


The Case is a singular combination of a Rheumatic or
Phlogistic Diathesis with a great deal of nervous affection and it is
from the later that so many anomalous appearances have occured -


To mend and eradicate both these consitutional disorders
must be a difficult work, but I think we have made a great progress
in getting over so bad a winter and Spring so well as we have
done and I hope during the Summer we shall get much farther.


There is one measure in which I am very clear & that is the propriety
of the Diet he is on and which muct be strictly continued and so
far am I from thinking of making it any better that I would
make it still lower if I could - A late eminent Practitioner
here 1 who was afflicted for more than twenty years with an
obstinate Rheumatic disposition which obliged him to avoid



[Page 2]

all animal food and he found that after using a
milk Diet some time length of Time it was not sufficient
to take down the Tone of his System. He gave up entire milk
and took to Buttermilk alone. - Some years before his Death
he told me he was still taking down - he had taken to Whey
and if that should not answer, he was at a loss what to do
next -- However this Gentleman was still able to
carry on a very extensive practice and died only at 68 of an
Apoplexy which had been a family Disease - We cannot
entirely new model Constitutions and Mr Neilson must make
the most of his he can and if by low living he can enjoy
tolerable health he must not grudge the means - You put
a question with regard to a glass of Wine or Toddy and I own
to you that I think a glass of Wine much safer than an
Ounce of Animal food and in the Case of occasional fain¬
tishness
such as you employed it in I would certainly allow
of a little Wine, but I am very averse to allow it as any
part of his regular establishment


However if there is any degree of faintishness frequently recur¬
ring I would allow him to take a spoonful of Wine and Water
either at noon or night as his feelings shall direct and if he does
get into such regular Course, I prefer the Wine and Water
to Toddy, but if he should feel or apprehend that the Wine in
any way interferes with the digestion of his milk I would allow
Toddy in the same circumstances in which I allow the Wine, but
with more caution with respect to quantity. I have nothing more
to say with respect to Diet, but that he will now digest Vegetables
better than he did when they were mixed with animal food and



[Page 3]

therefore I think he may try several garden
things as they come in season for while they
are still young and tender and well boiled
they do not readily give flatulency & he must
not try any Sallad or other raw vegetables.


For Mr Neilsons further recovery I depend
especially upon his travelling & now is the
proper season. I would therefore have him
set out upon a jaunt as soon as his conveniency
will allow but I am clear that no mineral
water
whatever can be of any service to him
or at least half so much as being in gentle
daily exercise. He may therefore chuse his own
route & take that where he may have best
accomodation & most amusement. I have only
to say that he is to guard well against cold & also
against much fatigue. I think from thirty to forty
miles is the proper measure & even when he
goes so far as forty miles in the day, he
should divide it so as to avoid either hurry or
fatigue. I find nothing else to say, but I am
anxious to say as much as I can & therefore
if either you or Mr. Neilson or Mrs. Neilson have
any questions to put I beg to have them -
I think there are no medicines to be employed
upon the journey but a little Spirit of Hartshorn
& Laudanum might be carried along tho I hope



[Page 4]

there shall be no occasion for them. -


This to yourself.


I am persuaded that Mr. Neilson has an aneurism
in the heart or some of the greater vessels next
to it. I have not time to explain myself ful more
particularly but I can assure you I have known all
his symptoms connected with such an affection - but
supposing it to be as I say there are no other meas¬
ures to be pursued than those in the letter inclosing
this. The mildest regimen - fresh air and gentle
exercise - bleeding may be sometimes of use but
still employed sparingly & cautiously.

yours &c. W.C.
June 5th 1780

Notes:

1: Cullen's mentor Dr John Clerk (d. 1757), one of his early mentors. This anecdote appears in the eulogy Cullen delivered at Clerk's funeral which is partly reproduced in Thomson An Account (1732), pp. 525-536 (esp. 536),

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