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


Dr William Cullen

By the time of his death in 1790 William Cullen had long been recognised throughout Britain, Europe and the Americas as the most influential physician of his generation; an experimental chemist, learned physician, successful practitioner, popular university lecturer, generous mentor and the author of a number of much-reprinted medical textbooks. He was born near Glasgow in 1710 at Hamilton (Lanarkshire), where his father was a lawyer, landowner and factor to the Duke of Hamilton. After attending the local grammar school Cullen studied mathematics and general arts subjects at Glasgow University before being apprenticed to a Glasgow surgeon-apothecary. Moving to London in 1729, Cullen quickly secured a post as surgeon on a ship bound for the West Indies where a six-month stay stimulated his interest in the influence of climate on disease and health. On his return an attachment to a London apothecary encouraged his interest in materia medica (pharmacology). Back in Scotland in 1732 he established himself in what we would now term general practice at Shotts near Hamilton. In order to advance his professional status, he then studied medicine at Edinburgh University (1734-6) where he was a founding member of the Medical Society. With promises of a laboratory and the management of a botanical garden from his patient and patron the Duke of Hamilton, Cullen concentrated on enlarging his Hamilton practice where, in 1737, he acquired a pupil and potential professional partner, William Hunter. Although Hunter eventually left for London, where he became a very successful physician-surgeon, "man-midwife" and leading lecturer on anatomy, the two men continued a close correspondence. As the eventual inheritor of a modest and encumbered family estate, Cullen's developing interest in experimental chemistry was closely tied to his practical concerns with agricultural improvement.

Disliking having to undertake surgery and hoping to advance his professional standing, in 1740 Cullen obtained an M.D. from Glasgow University where, four years later, he began delivering public lectures on chemistry, medicine, botany and (briefly) materia medica. In 1746-7 he was President of the Faculty of Physicians and Surgeons of Glasgow (which became the Royal College of Physician and Surgeons of Glasgow) and in 1751 he became the Glasgow professor of medicine.

Mausoleum, bearing a profile in relief, erected in the mid-nineteenth century over Cullen's grave in the burial-ground at Kirknewton, Midlothian by the Royal College and the physician's descendants.

When Cullen's private practice in the city did not flourish, after much lobbying, in late 1755 he transferred to Edinburgh as joint, later sole professor of Chemistry (Cullen's pupil, the famous chemist Joseph Black, took over Cullen's Glasgow chair before following his colleague to Edinburgh). Cullen also began offering clinical lectures at Edinburgh Royal Infirmary, which he continued to undertake until 1776. To his annoyance some impromptu lectures on materia medica delivered over two sessions in 1760-1 and 1761-2, were later published by two over-eager students but Cullen eventually published an authoritative Treatise on Materia Medica in 1789. He was subsequently professor of the Institutes of Medicine (1766-69), joint professor - with John Gregory - of the Theory and Practice of Physic (1769-73) and, following Gregory's death, sole professor of the Practice of Physic from 1773 onwards. Throughout his academic tenure Cullen concerned himself with institutional reforms and in 1775, during a term as President of the Royal College of Physicians of Edinburgh, he laid the foundation stone for their new college building in George Street. He had originally been the college's secretary and, being a keen bibliophile, he also served as their library keeper. In 1778 Cullen purchased a farm eight miles outside Edinburgh at Ormiston Hill in the parish of Kirknewton where he actively pursued his interests in agricultural improvement and botanical collecting. Cullen only retired from lecturing in his eightieth year, in the autumn of 1789, when his health began to fail. He died at his Edinburgh house in Mint Close off the Cowgate on 5 February 1790 and was buried at Kirknewton. While at Glasgow Cullen had played a crucial role in establishing chemistry as an academic subject and giving the medical school credibility. As Edinburgh's leading lecturer he became internationally recognised as the towering figure in Scottish medical education at this crucial period of enlightened expansion.

The Consultations

Address page of a sample letter of 1784, bearing marks of posting and later annotations.

Once settled in Edinburgh, Cullen established a successful private medical practice much of it conducted, as was often the case in this period, through the medium of letters. The annual number of these 'consultations' rapidly increases after the death of his colleague and professional rival Dr John Gregory in 1773. A substantial number were penned by the patients themselves while many were composed on their behalf by attending physicians who included a number of Cullen's former pupils. Cullen was routinely sending out individualised replies, often on a daily basis, until shortly before his own death in 1790. Places of posting include locations throughout Scotland, England, Ireland and Continental Europe with some communications from the West Indies and the Americas. On occasion Cullen willingly waived his fees for poorer patients and, according to his daughter, Presbyterian ministers who were wholly reliant upon a stipend but the usual cost of a consultation (two guineas) meant that they largely relate to the middle and upper ranks of Georgian society, but there is an enquiry from an Edinburgh weaver and one concerning an American slave while letters by patients reveal a wide range of literary skills ranging from improvised phonetic spelling to rhetorically sophisticated prose. The many socially prominent correspondents include the biographer and journalist James Boswell writing on behalf of an infirm Dr Samuel Johnson. Cullen's practical advice to patients often reflects his concern with how climatic or environmental factors such as heat and cold, or dryness and dampness, impact upon health. He is also deeply concerned with the effects of "Habit and Custom", in which he included diet, exercise and the exposure to social pressures; or what might now be loosely termed "lifestyle". A large proportion of Cullen's replies include medical recipes (prescriptions), in the form of abbreviated instructions drawn up for an apothecary.

Cullen's Medical Ideas

As a close associate of Henry Home (Lord Kames), Adam Smith, David Hume, John Gregory and other leading Scottish Enlightenment literati, Cullen shared their concern with material and cultural "improvement" and the "science of man". He made no major clinical breakthroughs and, unlike Parkinson or Alzheimer, his name is not associated with any eponymous disease but it would be hard to exaggerate the reach of Cullen's influence as a lecturer, mentor and author; tellingly, half of the senior members of the first American college of physicians (founded at Philadelphia) had been his pupils.

Cullen is best known for adopting the term "neuroses". This concept was later adopted into psychiatry and popular discourse, but in the process substantially changed its meaning. Cullen originally employed it to describe any 'general injury of the sense or motion' where there were no signs of fever or 'local affection' (disease). For Cullen the term embraced a wide range of afflictions, not all of which we would now consider to be psychiatric disorders; alongside those associated at the time with insanity - melancholy, mania and dementia - he also includes amongst the "neuroses" such afflictions as paralysis, palpitations, convulsions, apoplexy (stroke), asthma, colic, dyspepsia, diabetes, diarrhoea and tetanus. The term reflects the crucial role Cullen accorded to the 'nerves', 'nervous sympathy' and related ideas of 'irritability' in his conception of the root cause of disease. Cullen opens his account of the nerves with the famous assertion that 'in a certain view, almost the whole of the diseases of the human body might be called NERVOUS' (Works, ed. J. Thomson, 2 vols., 1828, 2.330). This commitment to neuropathological explanations was one Cullen shared with a number of his contemporaries and indeed it partly derived from an early critical engagement with clinical developments in Scotland, Germany and France (especially the work of Whytt, Haller and Hoffmann). But as a leading lecturer Cullen played a major role in the dissemination of what amounted to a significant shift away from Boerhaave's mechanistic model - based upon the cardiovascular system - towards the so-called medical vitalism of the Romantic era.

Medical "recipe" ("prescription", or "formula"), drawn-up for handing to an apothecary.

As the author of a once popular "nosology" (system of disease classification) Cullen was traditionally portrayed as a mere taxonomist and rigid system-builder but more recent interpretations alert us to the extent to which his characteristically cautious, skeptical approach to medical knowledge was informed by the philosophical methodology of Hume and the historicist interests he shared with many of his Scottish intellectual associates. In turn, through his well-attended lectures and widely translated textbooks Cullen's own career served to encourage a prevalent, often class-inflected moral engagement with explanatory notions of "nervous sensibility". This broad cultural phenomena is most blatantly articulated in the popular novel of sentiment as epitomized in The Man of Feeling (1771) by Cullen's Edinburgh associate Henry Mackenzie but evident throughout much of the literature of the period.