The Consultation Letters of Dr William Cullen (1710-1790) at the Royal College of Physicians of Edinburgh
[ID:4698] From: Dr William Cullen (Professor Cullen) / To: Mr John Crellin / Regarding: Reverend George Mason (Patient) / 29 August 1783 / (Outgoing)
Reply, 'For The Right Revered The Lord Bishop of Sodor and Man'. The Reverend Mason's complaints are diagnosed by Cullen as haemorrhoidal. Included are recipes for an enema, an anodyne mixture, laxative oil, discutient pills, a balsamic mixture and a strengthening infusion.
- Facsimile
- Normalized Text
- Diplomatic Text
- Metadata
- Case
- People
- Places
Facsimile
There are 11 images for this document.
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[Page 2]
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Metadata
| Field | Data |
|---|---|
| DOC ID | 4698 |
| RCPE Catalogue Number | CUL/1/1/16/102 |
| Main Language | English |
| Document Direction | Outgoing |
| Date | 29 August 1783 |
| Annotation | None |
| Type | Machine copy |
| Enclosure(s) | No enclosure(s) |
| Autopsy | No |
| Recipe | Yes |
| Regimen | No |
| Letter of Introduction | No |
| Case Note | No |
| Summary | Reply, 'For The Right Revered The Lord Bishop of Sodor and Man'. The Reverend Mason's complaints are diagnosed by Cullen as haemorrhoidal. Included are recipes for an enema, an anodyne mixture, laxative oil, discutient pills, a balsamic mixture and a strengthening infusion. |
| Manuscript Incomplete? | No |
| Evidence of Commercial Posting | No |
Case
Cases that this document belongs to:
| Case ID | Description | Num Docs |
|---|---|---|
| [Case ID:1596] |
Case of the Bishop of Man who is being treated for passing mucus. |
3 |
People linked to this document
| Person ID | Role in document | Person |
|---|---|---|
| [PERS ID:1] | Author | Dr William Cullen (Professor Cullen) |
| [PERS ID:3461] | Addressee | Mr John Crellin |
| [PERS ID:3457] | Patient | Reverend George Mason |
| [PERS ID:1] | Patient's Physician / Surgeon / Apothecary | Dr William Cullen (Professor Cullen) |
| [PERS ID:3461] | Patient's Physician / Surgeon / Apothecary | Mr John Crellin |
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 | Kirkcudbright | Borders | Scotland | Europe | inferred | |
| Mentioned / Other | Sodor and Man | Isle of Man | England | Europe | certain |
Normalized Text
For The Right Reverend
The Lord Bishop of Sodor and Man
It appears that for two years past his Lordship
has been affected with an Hæmorrhoidal affection and which
for the year immediately past had been extremely distressing
by a very frequent irritation and calls to stool when only
for the most part some bloody mucus was discharged.
These discharges were not preceeded by much griping
nor followed by much Tenesmus but even after the
discharges were followed by painful and uneasy sen¬
sations in the part and such sensations were indeed
very constantly present except when the body was in
a horizontal posture. This was the condition in which
his Lordship came to us and we readily concluded that
the whole depended upon an Hæmorrhoidal effort and
which by frequent repetition had become confirmed
and habitual. An ordinary Pile has frequently come
[Page 2]
down without being attended with any pain and has com¬
monly in the course of a night again receded. Upon exami¬
ning the Rectum a considerable schirrosity is discovered
on one side of it, circumscribed and a little firm but
with no hardness and is not pained upon being touched
or pressed. We have examined his stools every day for a
month past but have never discovered the smallest
quantity of purulent matter, the mucus discharged ex¬
cept in so far as it is sometimes tinged and always mixed
with a little blood is otherwise like a clear Jelly. In
every other respect his Lordship seems to be in good
health taking for the most part his Meat and Sleep
like a person in that condition. At two or three diffe¬
rent times he has been seized with some cold shivering
followed by some heat and little sweat but these fits
have always been of short duration and of no conse¬
quence. In the course of twenty four hours the pulse
has always returned to its natural state which is
rather more frequent ↑than↑ in ↑many↑ other persons but without
[Page 3]
any other febrile symptoms.
In view of all these circumstances which we have
thought proper to give in full detail we have con¬
cluded the disease to be entirely Hæmorrhoidal without
any condition of the bile having the smallest share
in it. We have concluded the disease as it came
to us to consist in a habitual Hæmorrhoidal effort
with a considerable acquired irritability and we judged
that both the irritation and irritability were only
to be overcome by such Anodyne Injections as are
prescribed below. Such an injection has been
employed almost every night at bed time ever
since his Lordship came here and we suspect that
they must still continue to be employed for a long
time to come. These Injections have succeeded to
our wish as they have for the most part very
entirely relieved every complaint, they have pre¬
vented any call to stool during the night which
[Page 4]
used formerly to be frequent, they had allowed in the
morning the making water freely without any call
to stool which had hardly happened for a twelve month
before and thought they did not entirely prevent some
cause to stool in the course of the day these were
however always very few and hardly ever with
the pain and uneasiness that had been so usual
before. To avoid if possible the trouble of injections
we sometimes tried to obtain the same good effects
from an Anodyne given by the mouth but by
this means we never could obtain such certain
and entire relief and therefore it is that we have
so constantly employed the injections.
In employing these however we found that
the natural Constitution of the guts to accumulate
forever was increased by our medicine and we found
it necessary from time to time to employ a laxative
and the one that has answered most properly
[Page 5]
is the Oleum Ricini sometimes by itself but commonly
better as compounded in the manner prescribed below.
While we were proceeding in this manner
we have at the same time employed a medicine which
we have frequently found of use in Hæmorrhoidal
affections. We have given the prescription for it
below under the title of the Balsamic mixture
we think it has been of service and may still be
employed at times for two three weeks together.
As we judged the tone of the parts especially
affected and perhaps of the whole Alimentary Canal
to be considerably weakened we employed the
Strengthening infusion as also prescribed below.
Those were the remedies we employed in
view of the Hæmorrhoidal affection and in this re¬
spect we have found them extremely useful and
hope they will continue to be so. We think they
have been even of considerable service in checking
[Page 6]
the progress of the internal tumour mentioned above but
we have not found them to diminish that tumour so much
as we wished and suspecting that it might continue to
give some irritation we wished to use some remedies
which might contribute more to its discussion. For
this purpose we have for some time past employed
the Extract of the Hyosciamus to the quantity of
six grains in the forenoon and of four towards the
Evening but it seem to disturb the stomach a little
and as it has not otherwise operated as we wished
we propose now to lay it aside and in place of it
we would employ the discutient Pills ordered below
they may be taken at first in the dose there ordered
but afterwards the dose may be increased till it
has some sensible effects, such as, producing
some sickness, tremor, or giddiness and at such a
dose as has these effects the pills may be continued
for a long time.
[Page 7]
With these several remedies we think there is
little occasion for any nice choise of Diet. The most
part of ordinary fare may be taken avoiding only
the grosser and heavier kinds of food and the heavier
and more heating modes of Cookery.
For ordinary Drink we prefer plain water
or with a little wine in it to any kind of Malt liquor
and we hold it to be very allowable for his Lordship
to take two or three glasses of Red wine at Dinner
every day and a glass or two either red or white
in his Gruel at night.
We think that Exercise in a Carriage taken
very frequently will be of great service but we
suspect that for a long time to come that walking
except in the most gentle and moderate manner
will be hazardous.
At all times it will be of the utmost con¬
sequences to avoid Cold and therefore while abroad
[Page 8]
abroad to be always warmly Cloathed and particularly
to take care to keep his feet and legs always warm
and dry.
Edinburgh 29th. August
1783
[Page 9]
For The Lord Bishop of Man
Take one drachm of powdered Galls and three drachms of Gum Arabic. Pour in four ounces of boiling water. Let it infuse for eight hours, and to the strained liquid add one spoonful or half an ounce of anodyne Mixture. Mix and let there be made an Enema to be injected at bedtime.
Take eight ounces each of Rosewater and Thebaic Tincture. Mix. Label: Anodyne Mixture; a tablespoon or half an ounce to be mixed with the Injection.
Take three ounces of Castor Oil and one ounce of Tincture of Seneka as described in the Pharmacopoeia Edinburgensis. Mix. Label: Laxative Oil; a tablespoonful for a dose to be taken in the morning, Shaking the phial always very well before pouring out.
W.C.
29th. August 1783.
[Page 10]
For The Lord Bishop of Man
Take two drachms of liquorice Extract and three drachms of powdered cicuta leaves. After having broken up into pieces the extract, cover it with enough boiling water in order to let it soften and grind it a pulp, to which add the powder, and with a sufficient quantity of Gum Arabic mucilage to make a mass to be divided into pills of five grains each. Label: Discutient Pills; three to be taken twice a day.
W.C.
29 August 1783.
[Page 11]
For the Lord Bishop of Man
Take half an ounce of Balsam of Capivi and one egg Yolk. Grind them together diligently, and add half an ounce each of balsamic Syrup, and Spirit of cinnamon Water and three ounces of rose Water. Mix. Label: Balsamic Mixture; two tablespoonfulls to be taken for a dose at bedtime, shaking the phial always very well before pouring out.
Take one ounce of ground Peruvian Bark, two drachms of bruised orange Peel and pour over two pounds of boiling water. Let it infuse for ten hours, and strain, adding two ounces of Tincture of Peruvian bark. Mix. Label: Strengthening Infusion, two tablespoonfuls to be taken twice a day.
W.C.
29th. August
1783.
Diplomatic Text
For The Right Reverend
The Lord Bishop of Sodor and Man
It appears that for two years past his Lordship
has been affected with an Hæmorrhoidal affection and which
for the year immediately past had been extremely distressing
by a very frequent irritation and calls to stool when only
for the most part some bloody mucus was discharged.
These discharges were not preceeded by much griping
nor followed by much Tenesmus but even after the
discharges were followed by painful and uneasy sen¬
sations in the part and such sensations were indeed
very constantly present except when the body was in
a horizontal posture. This was the condition in which
his Lordship came to us and we readily concluded that
the whole depended upon an Hæmorrhoidal effort and
which by frequent repetition had become confirmed
and habitual. An ordinary Pile has frequently come
[Page 2]
down without being attended with any pain and has com¬
monly in the course of a night again receded. Upon exami¬
ning the Rectum a considerable schirrosity is discovered
on one side of it, circumscribed and a little firm but
with no hardness and is not pained upon being touched
or pressed. We have examined his stools every day for a
month past but have never discovered the smallest
quantity of purulent matter, the mucus discharged ex¬
cept in so far as it is sometimes tinged and always mixed
with a little blood is otherwise like a clear Jelly. In
every other respect his Lordship seems to be in good
health taking for the most part his Meat and Sleep
like a person in that condition. At two or three diffe¬
rent times he has been seized with some cold shivering
followed by some heat and little sweat but these fits
have always been of short duration and of no conse¬
quence. In the course of twenty four hours the pulse
has always returned to its natural state which is
rather more frequent ↑than↑ in ↑many↑ other persons but without
[Page 3]
any other febrile symptoms.
In view of all these circumstances which we have
thought proper to give in full detail we have con¬
cluded the disease to be entirely Hæmorrhoidal without
any condition of the bile having the smallest share
in it. We have concluded the disease as it came
to us to consist in a habitual Hæmorrhoidal effort
with a considerable acquired irritability and we judged
that both the irritation and irritability were only
to be overcome by such Anodyne Injections as are
prescribed below. Such an injection has been
employed almost every night at bed time ever
since his Lordship came here and we suspect that
they must still continue to be employed for a long
time to come. These Injections have succeeded to
our wish as they have for the most part very
entirely relieved every complaint, they have pre¬
vented any call to stool during the night which
[Page 4]
used formerly to be frequent, they had allowed in the
morning the making water freely without any call
to stool which had hardly happened for a twelve month
before and thought they did not entirely prevent some
cause to stool in the course of the day these were
however always very few and hardly ever with
the pain and uneasiness that had been so usual
before. To avoid if possible the trouble of injections
we sometimes tried to obtain the same good effects
from an Anodyne given by the mouth but by
this means we never could obtain such certain
and entire relief and therefore it is that we have
so constantly employed the injections.
In employing these however we found that
the natural Constitution of the guts to accumulate
forever was increased by our medicine and we found
it necessary from time to time to employ a laxative
and the one that has answered most properly
[Page 5]
is the Oleum Ricini sometimes by itself but commonly
better as compounded in the manner prescribed below.
While we were proceeding in this manner
we have at the same time employed a medicine which
we have frequently found of use in Hæmorrhoidal
affections. We have given the prescription for it
below under the title of the Balsamic mixture
we think it has been of service and may still be
employed at times for two three weeks together.
As we judged the tone of the parts especially
affected and perhaps of the whole Alimentary Canal
to be considerably weakened we employed the
Strengthening infusion as also prescribed below.
Those were the remedies we employed in
view of the Hæmorrhoidal affection and in this re¬
spect we have found them extremely useful and
hope they will continue to be so. We think they
have been even of considerable service in checking
[Page 6]
the progress of the internal tumour mentioned above but
we have not found them to diminish that tumour so much
as we wished and suspecting that it might continue to
give some irritation we wished to use some remedies
which might contribute more to its discussion. For
this purpose we have for some time past employed
the Extract of the Hyosciamus to the quantity of
six grains in the forenoon and of four towards the
Evening but it seem to disturb the stomach a little
and as it has not otherwise operated as we wished
we propose now to lay it aside and in place of it
we would employ the discutient Pills ordered below
they may be taken at first in the dose there ordered
but afterwards the dose may be increased till it
has some sensible effects, such as, producing
some sickness, tremor, or giddiness and at such a
dose as has these effects the pills may be continued
for a long time.
[Page 7]
With these several remedies we think there is
little occasion for any nice choise of Diet. The most
part of ordinary fare may be taken avoiding only
the grosser and heavier kinds of food and the heavier
and more heating modes of Cookery.
For ordinary Drink we prefer plain water
or with a little wine in it to any kind of Malt liquor
and we hold it to be very allowable for his Lordship
to take two or three glasses of Red wine at Dinner
every day and a glass or two either red or white
in his Gruel at night.
We think that Exercise in a Carriage taken
very frequently will be of great service but we
suspect that for a long time to come that walking
except in the most gentle and moderate manner
will be hazardous.
At all times it will be of the utmost con¬
sequences to avoid Cold and therefore while abroad
[Page 8]
abroad to be always warmly Cloathed and particularly
to take care to keep his feet and legs always warm
and dry.
Edinr. 29th. August
1783
[Page 9]
For The Lord Bishop of Man
℞ Gallar. pulv. ʒj
Gum Arabic. ʒiij
Affunde aquæ bullient. ℥fs
Digere horas octo et colaturæ adde
Mistur. anodyn. cochleare unum sive ℥fs
ℳ. f Enemate h. s. injiciendo.
℞ Aquæ rosar. ℥viij
Tinct. Thebaic.
ℳ. Sig. Anodyne Mixture a table spoonfull
or half an ounce to be mixed with the Injection
℞ Ol. ricin. opt. ℥iij
Tinct. Senn. comp. Ph. Ed. ℥j
ℳ. Sig. Laxative Oil a table Spoonfull for
a dose to be taken in the morning, Shaking
the phial always very well before pouring out
W.C.
29th. Augst. 1783.
[Page 10]
For The Lord Bishop of Man
℞ Extract. glycyrrh. ʒij
pulv. folior. cicut. ʒiij
Extracto in frustula conciso affunde aquæ fer¬
ventis q. s. ut mollescat et in pulpam contun¬
datur cui adde pulverem et cum mucilag. G.
Arabic. q. s. ut f. massa in pil. Sing. gr. v.
dividenda
Sig. Discutient Pills three to be taken twice
a day
W.C.
29 Augst. 1783.
[Page 11]
For the Lord Bishop of Man
℞ Balsam. Copaib. ℥fs
Vitell. unius ovi
Terito Simul. diligenter et paulatim adde
Syr. balsam.
Aq. cinnam. Spirit. @℥fs
--- rosar. ℥iij
ℳ. Sig. Balsamic Mixture two table Spoonfulls
to be taken for a dose at bedtime, Shaking the
phial always very well before pouring out.
℞ Cort. Peruvian. trit. ℥j
--- aurantior. cont. ʒij
Affunde aquæ bullient. ℔ij
Digere horas decem et colaturæ adde
Tinct. cort. Peruvian. ℥ij
ℳ. Sig. Strengthening Infusion two table Spoon¬
fulls to be taken twice a day.
W.C.
29th. August
1783.
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