The Medical Consultation Letters of Dr William Cullen: the launch of a digital edition

DE Shuttleton
Reader in Literature and Medical Culture, School of Critical Studies, University of Glasgow, Glasgow, UK

On the afternoon of 11 May of 2015, the Royal College of Physicians of Edinburgh (RCPE) held a well-attended event to announce the launch of the online digital edition of the ‘Consultation Letters of Dr William Cullen (1710–1790)’; the result of a four-year project undertaken in collaboration with Glasgow University with the support of a major award from the Arts and Humanities Research Council. The event was chaired by Professor Iain Donaldson, Honorary Librarian, while the edition was formally ‘launched’ by College President Professor Derek Bell, accompanied by Professor Jeremy Smith, Head of the School of Critical Studies at Glasgow.

Cullen’s ‘Consultations’ archive is one of the most substantial records of a private medical practice to survive from the Enlightenment era and as such is one of the greatest treasures among many in the College’s remarkable historical collection. Containing over 5,000 written communications concerning diagnosis, prognosis, and methods of treatment, Cullen’s ‘Consultations’ are especially valuable given his standing as 18th-century Scotland’s most respected academic physician. Apart from offering a comprehensive insight into his own practice, the essentially narrative nature of the Georgian practice of ‘medicine-by-post’, provides a remarkable means of witnessing how his patients comprehended and expressed their own experiences of illness. Cullen was not the only prominent 18th-century physician to conduct an epistolary practice, but his ‘Consultations’ are exceptional not only in terms of sheer number, but also for completeness since Cullen recorded both sides of his exchanges.

But who was William Cullen? Unlike Parkinson or Alzheimer, Cullen’s name is not associated with any eponymous disease – indeed he made no major clinical breakthroughs – yet it would be hard to exaggerate his fame and influence as a pedagogue, theorist and author. By the time of his death in 1790 Cullen had long been celebrated internationally as an experimental chemist, learned physician, generous practitioner, popular university lecturer, respected mentor and author of standard medical textbooks. Born in Hamilton in Lanarkshire where his father, a modest landowner, was legal-factor to the Duke of Hamilton, William studied mathematics and general arts subjects at Glasgow University before being apprenticed to a Glasgow surgeon-apothecary. A trip to the West Indies from 1729–30 as a ship’s surgeon stimulated Cullen’s concern with the influence of climate on health, while a brief attachment to a London apothecary encouraged his lifelong interest in materia medica.

He then studied medicine at Edinburgh University (1734–6), where he was a founding member of the Medical Society. Back in Hamilton, as family physician to the Duke, he took on William Hunter, a local lad, as pupil. Cullen disliked surgery, so with a view to forging a professional partnership, he encouraged Hunter to study anatomy in London; in the event Hunter stayed on in London where he eventually found fame and fortune as a leading ‘man-midwife’ and lecturer on anatomy.

In 1740 Cullen obtained an MD from Glasgow University where he subsequently delivered innovative public lectures – in English – on chemistry, medicine, botany and materia medica. In 1751 he became Glasgow’s professor of medicine. In 1755, hoping to expand his private practice, Cullen transferred to Edinburgh as joint, later sole, professor of chemistry and also began offering clinical lectures at Edinburgh Royal Infirmary. He was subsequently Edinburgh’s professor of the Institutes of Medicine (1766–69), joint professor – with John Gregory – of the Theory and Practice of Physic (1769–73) and, after 1773, sole professor of the Practice of Physic at which date he was also appointed Royal Physician in Scotland.

In 1775, when President of the RCPE, he laid the foundation stone for the new college building in George Street. In the 1770s Cullen purchased Ormiston Hill, a farm eight miles from Edinburgh, above Kirknewton, but he only retired from lecturing a few months before his death on 5 February 1790. He was buried at Kirknewton, where the RCPE eventually oversaw the erection of a monument.

Alongside his academic achievements, Cullen became a much sought-after private practitioner. From the mid-1760s onwards he meticulously retained the bulk of his incoming postal enquiries. These loose letters fill 17 boxes. A significant number were written by the patients themselves, ranging from brief requests to detailed and candid personal histories (autopathographies). Others were penned by family members, employers or other carers, while many are letters of referral sent by medical professionals, largely local physicians or surgeons eager for Cullen’s expert opinion, including many former pupils. Women wrote about themselves, though more frequently fathers, husbands or brothers wrote to Cullen on their behalf. Other documents include completed diagnostic questionnaires as well as formal case histories and autopsy reports forwarded to Cullen as enclosures.

For the early period Cullen copied his responses into a series of case-books. These entries are either in his own neat hand, or those of assistants and often include medical recipes (prescriptions), set out in abbreviated Latin. As these were typically penned on ‘a paper apart’ for handing over to an apothecary, they are often absent from related medical archives. After 1 April 1781 the retained replies are in the form of physical copies of the posted originals made on a ‘pressure’ (or ‘wet-paper’) copying machine, newly invented by James Watt.

The early ‘case-books’ had been re-bound in the late 19th century so it proved expedient to have them carefully dis-bound by professional conservators to enable digital capture, before rebinding to modern conservation standards. The earliest volume begins in January 1764 and, although the retention of incoming letters was patchy until the mid-1770s, thereafter Cullen’s archiving becomes very comprehensive. Places of posting include locations throughout Scotland, England, Ireland and Continental Europe with some communications from the West Indies and the Americas. Cullen had a policy of waiving his fee for poor widows, his own students and Presbyterian ministers who only had their stipends to live on, but with the usual cost of a consultation at two guineas the bulk of his patients inevitably came from the wealthier sectors. Nevertheless one finds a wide social spectrum, from a Russian princess and many leading Scottish and English aristocrats, to ‘bonnet lairds’, military officers, sailors, clergymen, politicians, merchants, excise officers, farmers, academics, ‘manufacturers’, and a few poets. There are also enquiries on behalf of servants and a request for medicine to treat an American slave for epilepsy, while Cullen’s more famous correspondents include the diarist James Boswell writing on behalf of an infirm Dr Samuel Johnson.

In his day Cullen played a crucial role in promoting an increasingly fashionable theoretical model of disease that attributed everything to the state of the nerves. However in his general practice – where he largely dealt with long-term chronic conditions – Cullen framed his practical advice within a traditional Hippocratic model of self-management through regimen. Although he advises on current treatment methods – including electricity for paralysis – his advice often focuses on the so-called six ‘non-naturals’ of classical hygiene: diet, exercise, watching (sleeping), air, the excretions (including perspiration) and the passions. His advice on moderate diets, cutting back on strong drink and the need for exercise can sound remarkably modern. Cullen also shows an awareness of the role of psychological factors such as grief or the mental pressures of business, while his interest in the effects of climate informs his often very detailed directives over the best ways to travel for health. Consumptives in particular are advised to escape the Scottish winter; he particularly recommended Madeira and the south of France.

Although this material had been examined by a few specialist historians, the scale of the archive had inhibited detailed collation and mitigated against any comprehensive overview. These concerns were uppermost when planning the edition’s bespoke database management system, which was created by Mark Harraghty at Glasgow. Our basic aim was to make the original texts viewable as high-quality digital facsimiles, alongside searchable scholarly transcriptions. Internal references to specific symptoms, conditions, treatments, medicines, types of preparation, actions (such as ‘diuretic’), and body parts were all tagged using XML mark-up, while additional metadata for each item, including associated dates, persons and places of posting etc, were systematically logged.

Given the navigational problems noted above, creating the facility to generate a patient’s entire case history over time and thus enabling the reader to follow their ‘story’ through was particularly satisfying. The research required to create the edition, as well as related events including an international academic symposium hosted by the RCPE in 2014, has already enabled us to map the geographical range of Cullen’s patients, the diseases being presented and the medicines and forms of treatments being recommended as well as furthering our understanding of how Cullen managed such an extensive postal practice and dealt with sometimes delicate private and professional referrals.

I take this opportunity to, once again, thank all involved while hoping that this new resource will prove of lasting value to anyone interested in the social history of medicine, specialists and non-specialist readers alike.