Cullen

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

 

[ID:2555] From: Dr John Gilchrist (of Speddoch) / To: Dr William Cullen (Professor Cullen) / Regarding: Miss Aitken (Patient) / 10 January 1785 / (Incoming)

Letter from John Gilchrist, concerning the case of Miss Aitken, aged twenty-eight, the only child of 'a very worthy Man of the Profession of the Law in this town [Dumfries]'. Miss Aitken suffers from a long-standing, intermittent, painful chest complaint.

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Metadata

FieldData
DOC ID 2555
RCPE Catalogue Number CUL/1/2/1604
Main Language English
Document Direction Incoming
Date10 January 1785
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 John Gilchrist, concerning the case of Miss Aitken, aged twenty-eight, the only child of 'a very worthy Man of the Profession of the Law in this town [Dumfries]'. Miss Aitken suffers from a long-standing, intermittent, painful chest complaint.
Manuscript Incomplete? No
Evidence of Commercial Posting No

Case

Cases that this document belongs to:

Case ID Description Num Docs
[Case ID:1410]
Case of Miss Aitken who has a long-standing, intermittent, painful chest complaint.
5


People linked to this document

Person IDRole in documentPerson
[PERS ID:115]AuthorDr John Gilchrist (of Speddoch)
[PERS ID:1]AddresseeDr William Cullen (Professor Cullen)
[PERS ID:2748]PatientMiss Aitken
[PERS ID:1]Patient's Physician / Surgeon / ApothecaryDr William Cullen (Professor Cullen)
[PERS ID:115]Patient's Physician / Surgeon / ApothecaryDr John Gilchrist (of Speddoch)
[PERS ID:4347]Patient's Relative / Spouse / FriendMrs Aitken
[PERS ID:4346]Patient's Relative / Spouse / FriendMr Aitken

Places linked to this document

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

Normalized Text

[Page 1]
Dumfries January 10. 1785
Dear Sir


I sit down to write and consult you in a Case, which, tho uni¬
form enough in its nature and symptoms, has been such a tedious
one that I will rather endeavour to give you a general view of it,
mentioning the principal occurrences, than enter into too minute a
detail of all its circumstances


Miss Aitken, now aged 28, the only child, I may say, of a very worthy
Man of the Profession of the Law in this town; -- and herself a most de¬
serving, and once a beautiful young Lady, was strong and healthy
in her Infancy, till, at the age of about five years, and as was sup¬
posed in consequence of some improper exposure to cold, ↑she↑ became
subject, in a remarkable and unusual manner for a child, to --
rheumatic complaints. As her Mother is long since dead, I can give
no very particular account of this state of her ailments, except
↑that↑ it lasted for seven or eight years; that it was attended with many
and severe feverish attacks; and that many or perhaps most of her
Joints were affected; for she mentions that the joinings of the Vertebræ
were long swelled or thickened; -- and that her hands were in such a
situation that the fingers could not be extended. -- By this disease
no doubt her Constitution was first broken, tho', about the age of
twelve she was thought to have got the better of it, as, for two
or three years thereafter, tho' thin and delicate, she remained pretty
free from Complaint. -- About fifteen however, and again in consequence
of some exposure to cold, she was seized with a Cough and pain of
her left side, continuing long, and attended with feverishness. ---
From that time, even in her intervals of greatest health, (I should
rather say of least disease), she has been liable to returns of
these pulmonary symptoms from but a ↑very↑ little Cold or dampness. ---
It was about the end of the year 1774 that I first took the charge
of her, and found her indeed a very delicate subject, both in regard to
her general frame, and the pulmonary affection. Having occasion very



[Page 2]

Soon to direct a vein to be opened, it appeared then, as it has frequently
done since on occasions of her being bled by different hands, that though
the orifice was certainly made in the best manner, the blood would never
flow but in ↑a↑ stream like a silk thread. I mention this circumstance,
which has been an invariable one, merely as shewing the exit--
(I was going to say exility, and with your leave will use the word) of
her vessels. -- Things went on in this way for three years, with inter¬
vals no doubt tolerably free from complaint. Health or strength she
could not expect much of, for at the best, she could scarely eat or
digest any thing, that is, the quantity of nourishment she received was
very triffling. -- During this period she never spit blood, nor was there
any thing remarkable either as to quantity or quality ↑in↑ what she
expectorated. --


Some time in 1778, she had a more severe attack than usual
of all her complaints, with more severe and more extended pains of
her breast than formerly, though one particular part of the left
side
she has, from the beginning till now, considered as the principal
seat of disease, and I must observe that she is extremely clear
and accurate in her Accounts and observations. -- About this time I pro¬
posed your being consulted; - but as symptoms began to subside again
it was not done, and, after some time Miss Aitken mended more than
I expected, for at different times in 1779 and 1780, she was not
only capable of using a good deal of exercise both in walking and
riding, but indulged her self in visiting after sun set, even at the
latest hours, and sometimes in going to public places, which last cir¬
cumstances I had all along strongly objected to. -- In 1781 there was
another severe attack, attended with a more general soreness or ten¬
derness
in the breast, and with a more copious expectoration; what
she brought up however, though it then became less clear, and more yellowish,
was not yet opake or pariform. -- Though she mended again before the



[Page 3]

end of this year, yet she has hardly ever since been free from a
short cough, as it is called, and more or less of Dyspnœa; and has been
much more frequently ill than before. In 1782 to her ordinary
attacks was added her full share of the Catarrhal fever of that year
which, we must suppose, exasperated all the symptoms; for, in
October or November, that year, she began to have what in all pro¬
bability are to be considered as purulent discharges from the lungs.
The appearances of purulence are not constant, but, since that date
upon four or five different occasions, after suffering much increase
of pain in the left side, much fever, pulsation, sense of internal
heat &c, she has begun; and continued for two, three, or four
weeks, -- (on the last occasion for six or eight) -- to bring up
considerable quantities of matter, which, in short, we judge
to be pus
, or at least some ↑thing↑ very different from the usual
matter of expectoration, This is always lightly tinged with
blood; - and sometimes ↑very↑ small clots of blood are mixed with it; - But
in October last, -- (and this is the most particular circumstance
at present in the Case) -- after having all the symptoms which
she considered as forerunners of a new discharge, she brought
up, in the course of an evening, and with repeated efforts in
Coughing, near a small tea cupful she thinks, (tho' probably it
was not so much) of unmixed, fluid blood. -- A few days there
after, and without the appearance of purulence, there began to
come away along with the usual expectoration, and without any
new feelings in the breast, small ↑and extremely light↑ portions, some times near as thick
as a goose quill, and from one inch, to three or four inches
long, of a substance, which I have little or no doubt must have
belonged to the lungs or branches of the trachea. - They ↑probably↑ are not
portions merely of concreted mucus, or other fluid, because they are


[Page 4]

tough in some degree, and sensibly elastic, besides they are evidentl[y]
when dried, of a vesicular or cellular texture; -- and, I may add, they
divide into branches, corresponding no doubt to those ramification
of the trachea from which they are discharged; from which last circum¬
stance indeed we might be led to infer that they are merely a concre¬
ted fluid, if their obvious structure & consistence did not render
it probable that they are something else. --But it is of no great con¬
sequence to say much on this point.,- unless it could afford any
hope that if the patients constitution was not irreparably
injured, nature might be thus throwing off some of the weak
or diseased parts of the lungs. -- These light substances have
been coming away pretty constantly, though with intervals
of eight or ten days, for more than two months past. -- Six
or eight portions, larger and smaller will be discharged
in the course of a night. --


------------


After filling the opposite page I come back here to say that
it would be quite unnecessary to trouble you with an account of all the {illeg} (↑means↑)
employed in this case, which have been, at their proper times, the obvious ones
for moderating or preventing inflammation, keeping up perspiration; restoring
the strength &c &c -- such as we well know how to employ, if we knew
how to give them much efficacy., -- Excepting her accustomed opiates (of which
very moderate doses have commonly been sufficient) there is nothing
she has used in a continued way with more advantage than Butter milk,
Goats whey she has used almost every season. - Frequently we have spoken
of some distant excursion or voyage; but this could never be undertaken.
Among the few medicines I have attempted to give, that is, as a course,
Myrrh did no good -- Tussilago I think her stomach did not bear.
Of late I have been thinking whether or not some application in the
way of steam or fume, would be adviseable, tho' probably her lungs would
not bear the irritation of the latter. -- Your thoughts and advice on this case will
be very acceptable to


Dear Sir
Yours always with much truth
John Gilchrist

Diplomatic Text

[Page 1]
Dumfries Jan 10. 1785
Dear Sir


I sit down to write and consult you in a Case, which, tho uni¬
form enough in its nature and symptoms, has been such a tedious
one that I will rather endeavour to give you a general view of it,
mentioning the principal occurrences, than enter into too minute a
detail of all its circumstances


Miss Aitken, now aged 28, the only child, I may say, of a very worthy
Man of the Profession of the Law in this town; -- and herself a most de¬
serving, and once a beautiful young Lady, was strong and healthy
in her Infancy, till, at the age of about five years, and as was sup¬
posed in consequence of some improper exposure to cold, ↑she↑ became
subject, in a remarkable and unusual manner for a child, to --
rheumatic complaints. As her Mother is long since dead, I can give
no very particular account of this state of her ailments, except
↑that↑ it lasted for seven or eight years; that it was attended with many
and severe feverish attacks; and that many or perhaps most of her
Joints were affected; for she mentions that the joinings of the Vertebræ
were long swelled or thickened; -- and that her hands were in such a
situation that the fingers could not be extended. -- By this disease
no doubt her Constitution was first broken, tho', about the age of
twelve she was thought to have got the better of it, as, for two
or three years thereafter, tho' thin and delicate, she remained pretty
free from Complaint. -- About fifteen however, and again in consequence
of some exposure to cold, she was seized with a Cough and pain of
her left side, continuing long, and attended with feverishness. ---
From that time, even in her intervals of greatest health, (I should
rather say of least disease), she has been liable to returns of
these pulmonary symptoms from but a ↑very↑ little Cold or dampness. ---
It was about the end of the year 1774 that I first took the charge
of her, and found her indeed a very delicate subject, both in regard to
her general frame, and the pulmonary affection. Having occasion very



[Page 2]

Soon to direct a vein to be opened, it appeared then, as it has frequently
done since on occasions of her being bled by different hands, that though
the orifice was certainly made in the best manner, the blood would never
flow but in ↑a↑ stream like a silk thread. I mention this circumstance,
which has been an invariable one, merely as shewing the exit--
(I was going to say exility, and with your leave will use the word) of
her vessels. -- Things went on in this way for three years, with inter¬
vals no doubt tolerably free from complaint. Health or strength she
could not expect much of, for at the best, she could scarely eat or
digest any thing, that is, the quantity of nourishment she received was
very triffling. -- During this period she never spit blood, nor was there
any thing remarkable either as to quantity or quality ↑in↑ what she
expectorated. --


Some time in 1778, she had a more severe attack than usual
of all her complaints, with more severe and more extended pains of
her breast than formerly, though one particular part of the left
side
she has, from the beginning till now, considered as the principal
seat of disease, and I must observe that she is extremely clear
and accurate in her Accounts and observations. -- About this time I pro¬
posed your being consulted; - but as symptoms began to subside again
it was not done, and, after some time Miss Aitken mended more than
I expected, for at different times in 1779 and 1780, she was not
only capable of using a good deal of exercise both in walking and
riding, but indulged her self in visiting after sun set, even at the
latest hours, and sometimes in going to public places, which last cir¬
cumstances I had all along strongly objected to. -- In 1781 there was
another severe attack, attended with a more general soreness or ten¬
derness
in the breast, and with a more copious expectoration; what
she brought up however, though it then became less clear, and more yellowish,
was not yet opake or pariform. -- Though she mended again before the



[Page 3]

end of this year, yet she has hardly ever since been free from a
short cough, as it is called, and more or less of Dyspnœa; and has been
much more frequently ill than before. In 1782 to her ordinary
attacks was added her full share of the Catarrhal fever of that year
which, we must suppose, exasperated all the symptoms; for, in
October or November, that year, she began to have what in all pro¬
bability are to be considered as purulent discharges from the lungs.
The appearances of purulence are not constant, but, since that date
upon four or five different occasions, after suffering much increase
of pain in the left side, much fever, pulsation, sense of internal
heat &c, she has begun; and continued for two, three, or four
weeks, -- (on the last occasion for six or eight) -- to bring up
considerable quantities of matter, which, in short, we judge
to be pus
, or at least some ↑thing↑ very different from the usual
matter of expectoration, This is always lightly tinged with
blood; - and sometimes ↑very↑ small clots of blood are mixed with it; - But
in October last, -- (and this is the most particular circumstance
at present in the Case) -- after having all the symptoms which
she considered as forerunners of a new discharge, she brought
up, in the course of an evening, and with repeated efforts in
Coughing, near a small tea cupful she thinks, (tho' probably it
was not so much) of unmixed, fluid blood. -- A few days there
after, and without the appearance of purulence, there began to
come away along with the usual expectoration, and without any
new feelings in the breast, small ↑and extremely light↑ portions, some times near as thick
as a goose quill, and from one inch, to three or four inches
long, of a substance, which I have little or no doubt must have
belonged to the lungs or branches of the trachea. - They ↑probably↑ are not
portions merely of concreted mucus, or other fluid, because they are


[Page 4]

tough in some degree, and sensibly elastic, besides they are evidentl[y]
when dried, of a vesicular or cellular texture; -- and, I may add, they
divide into branches, corresponding no doubt to those ramification
of the trachea from which they are discharged; from which last circum¬
stance indeed we might be led to infer that they are merely a concre¬
ted fluid, if their obvious structure & consistence did not render
it probable that they are something else. --But it is of no great con¬
sequence to say much on this point.,- unless it could afford any
hope that if the patients constitution was not irreparably
injured, nature might be thus throwing off some of the weak
or diseased parts of the lungs. -- These light substances have
been coming away pretty constantly, though with intervals
of eight or ten days, for more than two months past. -- Six
or eight portions, larger and smaller will be discharged
in the course of a night. --


------------


After filling the opposite page I come back here to say that
it would be quite unnecessary to trouble you with an account of all the {illeg} (↑means↑)
employed in this case, which have been, at their proper times, the obvious ones
for moderating or preventing inflammation, keeping up perspiration; restoring
the strength &c &c -- such as we well know how to employ, if we knew
how to give them much efficacy., -- Excepting her accustomed opiates (of wh
very moderate doses have commonly been sufficient) there is nothing
she has used in a continued way with more advantage than Butter milk,
Goats whey she has used almost every season. - Frequently we have spoken
of some distant excursion or voyage; but this could never be undertaken.
Among the few medicines I have attempted to give, that is, as a course,
Myrrh did no good -- Tussilago I think her stomach did not bear.
Of late I have been thinking whether or not some application in the
way of steam or fume, would be adviseable, tho' probably her lungs would
not bear the irritation of the latter. -- Your thoughts and advice on this case will
be very acceptable to


Dear Sir
Yours always with much truth
John Gilchrist

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