(17101790), chemist and physician
, was born in Hamilton, Lanarkshire, near Glasgow, on 15 April 1710, the second son of William Cullen and his wife, Elizabeth, the daughter of Mr Robertson of Whistleberry. There were seven sons and daughters from the marriage, and after his father's death Cullen's mother had two further children from her second marriage, to a Mr Nasmyth. Cullen's father was an attorney and agent for the duke of Hamilton, and the proprietor of a small estate in Bothwell. William studied at the local grammar school, under Mr Findlater, and then proceeded in 1726 to the University of Glasgow, where his arts subjects included mathematics, under Robert Simson, in 1727.
Establishing a career
It is not known why Cullen decided on a career in medicine, but he was briefly apprenticed to John Paisley, a Glasgow surgeon apothecary with an excellent reputation as a teacher. Having moved to London in 1729 to obtain greater practical experience, Cullen quickly obtained the post as surgeon on a ship (captained by a relative) bound for the West Indies. He remained in Porto-Bello for six months, acquiring an interest in medical geography and the role of climate in the causation of disease. Subsequently he spent some months attached to the apothecary's shop of a Mr William [?] Murray in Henrietta Street, London.
Cullen had returned to Scotland by early 1732 to practise medicine and surgery in Shotts, near Hamilton, and to busy himself in the settlement and education of his siblings, his father and elder brother having died. A small legacy gave him the independence to continue his education. He studied literature and philosophy for several months with a dissenting minister in Northumberland, and then spent two winter sessions at the University of Edinburgh (17346), where he was a founder member of what became the Royal Medical Society, a student organization that fostered debate and self-improvement. On leaving Edinburgh he established a practice in Hamilton; here the duke of Hamilton quickly became both patient and patron, and Cullen gained the confidence of most of the grand families of the area. He served as a magistrate for two years, and in 1737 acquired as a pupil . Hunter stayed for three years before continuing his studies in London and Paris. Although he had originally intended to return to Hamilton as Cullen's surgical partner, his career became based in London; however, he once entertained the idea that he and Cullen (then in Edinburgh) would together make Glasgow a major medical rival to the Scottish capital.
Cullen disliked the surgical aspects of what was in essence a general practice, and in order to practise solely as a physician he acquired his MD from the University of Glasgow in 1740. In the following year he married Anna Johnstone (d
. 1786), whose father was the minister in Kilbarchan. She was a highly intelligent, much admired woman who was happy to open their houses in Glasgow and Edinburgh to Cullen's many pupils and friends. They had seven sons, one of whom was , and four daughters. Cullen's practice in Hamilton flourished, and the duke promised him a laboratory and the superintendence of his botanical garden. However, the declining health and premature death of Cullen's patron scotched those expectations, and in 1744 Cullen was induced to move to Glasgow, where the prospects of medical practice were greater and where he could try his hand at teaching.
Becoming a permanent teacher
Although Glasgow University had had professors in several medical subjects since early in the eighteenth century, there was nothing which could be called a medical school there. In winter 1746 Cullen offered lectures on the theory and practice of physic; the following year he successfully added materia medica and botany to his repertory, and he and John Carrick were supplied with apparatus so that they might begin a course in chemistry. Carrick almost immediately fell ill, so Cullen was forced to teach the course by himself. During Cullen's Glasgow period, chemistry was his principal scientific preoccupation, his course being taken by many arts students as well as those pursuing medicine. Among his pupils was Joseph Black, who became a friend and shared many of his research interests. Cullen always preferred to lecture in English, although some of his early teaching in botany was in Latin and he corresponded easily in the language. In his botanical lectures he expounded the sexual system of plants that Linnaeus had only recently first elaborated.
Although he continued to teach chemistry, in 1751 Cullen became professor of medicine in Glasgow, only a few days before his lifelong friend Adam Smith was installed in the chair of logic. When Smith transferred shortly afterwards to the chair of moral philosophy, Cullen supported the unsuccessful candidacy of David Hume for Smith's old chair. But Cullen's success as a teacher in Glasgow was not matched with a lucrative private practice, nor did the medical school prosper in comparison to its rival in Edinburgh. For several years influential friends, among them Henry Home (Lord Kames), had urged Cullen to move to Edinburgh. He also secured the patronage of the third duke of Argyll, a major power broker in Edinburgh University politics. Cullen was finally invited by Edinburgh's town council in 1755 to share the chair in chemistry with Andrew Plummer, who had had a stroke and was unable to give his lectures. The appointment raised some controversy, not least because Black had already been asked by Plummer's relatives to do his teaching. In addition Black was more attractive to the Edinburgh medical community, since he had no interest in becoming a rival in private practice. Black deferred to his former teacher, assuring him that it would be impossible for Cullen's course not to be better than Plummer's had been, even though the latter refused to let Cullen use his apparatus. Plummer died in 1756 and Cullen became sole occupant of the chair. Black succeeded Cullen in the chemistry lectureship in Glasgow.
Cullen was always a natural and successful teacher, attendance at his chemistry courses increasing from seventeen students in his first year to fifty-nine the following year, afterwards rising to 145. Within two years of moving to Edinburgh he was also giving clinical lectures at the Edinburgh Royal Infirmary; only John Rutherford, professor of the practice of physic, had previously availed himself of the invitation of the infirmary's managers. Cullen's move induced Robert Whytt and Alexander Monro also to offer clinical lectures there, so beginning a golden age of clinical instruction in the infirmary. In the winter session of 176061, following the death of Charles Alston, professor of materia medica, Cullen gave a course of lectures on that subject, at the request of the students. He had already lectured on materia medica in Glasgow. Although Cullen never repeated the course, copies of lecture notes began to circulate, one set of which became the basis of an unauthorized published edition in 1772. Cullen initially sought an injunction to prevent their sale; however, it emerged that a large number of copies of the volume had already been sold, and the physician who supplied the transcript was not financially involved. Consequently, Cullen agreed to a reissue of the lectures, with a supplement correcting some errors and omissions, and in return for a share of the profits. At the end of his life Cullen rewrote the volume, having never been satisfied with the earlier compromise.
Cullen's clinical lectures at the Edinburgh Royal Infirmary were immensely popular; in addition, his private practice was flourishing, so many students favoured him to succeed Rutherford in his chair in the practice of physic. Rutherford resigned in 1766, but his known preference as successor was John Gregory, then professor of medicine in Aberdeen. The appointment of Gregory deeply disappointed Cullen, to the extent that he initially declined to apply for the chair in the theory of medicine that became vacant later that year on the death of Robert Whytt. By accepting the chair he vacated his own in chemistry, to which Joseph Black was appointed; to their credit, Gregory and Cullen agreed to the petitions of both faculty and students and alternated lectures in the theory and in the practice of medicine. Gregory's death in 1773 left Cullen in sole command of the more prestigious chair in the practice of medicine, and he was without doubt for the rest of his life the principal ornament of the increasingly successful medical school in Edinburgh. He continued his lecturing, clinical teaching, and private practice until late 1789, when ill health and advanced years at last forced him to resign his chair, only shortly before his death. In 1778 Cullen acquired his own property at Ormiston Hill, in the parish of Kirknewton, and he spent as much time as possible there during his last years.
The enquiring mind
Cullen's success as a teacher was in part due to the freshness he brought to the many subjects he taught. He was a figure integral to the Scottish Enlightenment, committed to the pursuit of science both for its own sake and for the practical consequences that were assumed to flow from it. He came from the improving, landowning stock of southern Scotland, and he never forgot his roots. His chemistry has been properly described as philosophical in its aims, concerned as it was with the classification of substances into different groups (salts, oils, waters, earths, and metals); with the nature and effects of heat and cold on chemical and physical change; with acidity and alkalinity; and with the natural philosophical principles underlying the material world. He was devoted to experimenting and demonstrating experiments to his students.
At the same time Cullen was alive to the economic potential of natural knowledge. He and his most gifted chemistry student, Black, were ever searching for chemical projects with practical potential. His friendship with Lord Kames was cemented by Cullen's interest in agricultural chemistry and botany, in fertilizers, brewing, sugar production, mining, and other arts. He used a family farm as an arena for putting into practice the fruits of his scientific investigations. In addition, he searched systematically for a cheap manufacturing process to supply bleach for the Scottish linen industry. Kames tried unsuccessfully to convince the (Scottish) board of trustees for manufacturers to provide material support for Cullen's researches.
Cullen also brought the same enquiring spirit to materia medica and its close ally, medical botany. He used existing remediestartar emetic, James's powders, hyoscyamus (black henbane), cicuta (hemlock)with care, noting their physiological effects and employing them in ways that rationally related to his theories of the animal oeconomy (physiology) and his physiological notions of disease.
Like many eighteenth-century medical teachers, Cullen was fascinated by the classification of disease (nosology), and his own published works in the field (for which, see below) exerted a major international influence on both medical theory and medical practice of his era and slightly beyond. Cullen constructed his nosological system as a pedagogical device, to assist in his clinical teaching. It was typical of eighteenth-century nosologies in elevating into disease categories what were later called signs and symptoms, such as pain, fever, or haemoptysis (spitting up blood). Cullen also grappled with the difficulties of relating general, holistic manifestations of disease with the local changes or lesions that could be discovered on examining the patient, or conducting a post-mortem in fatal cases. His compromise was to lump local diseases together as one of his four nosological classes, the other three disease classes being the fevers, wasting diseases (cachexias), and the neuroses. He further subdivided these classes into nineteen orders and 132 genera. His system in essence recognized only two grand divisions of disease, those that were local and those that were general.
Cullen devoted much time to the study of the fevers, fever itself being then regarded as a specific but variable disease of the whole body rather than simply as one symptom of other diseases. The major epidemic diseases such as smallpox were included as fevers, but Cullen classified the various fevers according to the sequence and intensity of differing bedside phenomena associated with them, among them pulse rate, headache, chills, or sweats, and whether the symptoms were continuous or intermittent. He implicated cold in the production of many fevers, only some of which he held to be contagious.
Cullen introduced the term neurosis into medicine, the act for which he is most commonly remembered historically. Although the word has become assimilated into psychiatry (and general culture), for Cullen, a neurosis was any disorder of sense or motion in which there was no fever or local disease. It incorporated eighteenth-century categories of insanity (melancholy, mania, dementia), but also convulsions, apoplexy (stroke), asthma, colic, diarrhoea, diabetes, rabies, and many other disorders. The neuroses were obviously of major concern to him, since he was long convinced that the nervous system played a fundamental role in producing disease and its symptoms. As he famously remarked, In a certain view, almost the whole of the diseases of the human body might be called NERVOUS (W. Cullen, Works
, ed. J. Thomson, 2 vols., 1828, 2.330).
Cullen was thus at the forefront of a mid-eighteenth-century fascination with the nervous system, in contrast to Hermann Boerhaave's earlier emphasis on the cardiovascular system, or John Hunter's contemporary one on the blood. Boerhaave's system had been taught to him when he had studied at Edinburgh, but he was then already a mature student with several years of medical practice behind him, and maintained his own ideas. Cullen was extraordinarily well read, possessed a fine personal library, and was acutely conscious of the relationship between his own ideas and approaches and those of his predecessors and contemporaries. He invariably began his courses with a historical lecture, so he was well aware that the German physician Friedrich Hoffmann had also placed the nervous system at the centre of his own system of medicine. Cullen developed his own ideas of neuropathology in his Glasgow days, and his teaching in Edinburgh was especially important in spreading the gospel of the nerves throughout the English-speaking world and, through translations of his books, to Europe.
Cullen's neuropathology informed two important aspects of his medical thinking. It was thoroughly integrated into his physiological approach to disease, whereby the carefully observed sequence of signs and symptoms was rendered intelligible. This sequence in turn dictated the specific therapeutic measures he advocated. His therapeutic approach was equally physiological in its goal of combating the patient's symptoms as they appeared. He was admirably realistic about the limits of the therapies available to him and absorbed from his friend David Hume some of the latter's scepticism about the limits of human knowledge. For Cullen, as for Hume, the constant conjunction of events was what human beings experienced as cause. His lectures were littered with caveats such as I am inclined to think, or I believe.
Second, Cullen's doctrine of the nervous system was central to his more general beliefs about culture, civilization, improvement, and sensibility. He accepted Enlightenment ideas of progress and of how the nerves of individuals reflected their race, class, gender, or time of life. Thus, Europeans were more sensitive than inhabitants of rude nations, where the differences between men and women were also minimized. He invoked both social and environmental causes to explain such differencesarguing, for instance, that hysteria was more common in southern Europe than in the northern countries, or more common in England than Scotland, primarily because of the colder climate's impact on the nerves of women.
Cullen's beliefs on these matters mirrored more general cultural notions, but he was less doctrinaire than many of his contemporaries. At the same time he repeatedly emphasized the value of system within medicine and science. System gave order and coherence to thinking and the organization of facts and observations, and Cullen held that the history of medicine revealed a series of tensions between empiricists and dogmatists, with the latter being the source of medical progress. Being a dogmatist, or systematist, was not the same as being dogmatic, which attitude he abhorred. This position gave his own system of medicine both a coherence and an intensely personal gloss, attributes that contributed to his outstanding success as a teacher.
A reluctant author
Cullen wrote a good deal, but his career as a prolific author began late and was in many ways forced upon him. His first publication, a chemical article on cold and evaporation, did not appear until 1756, when he was forty-six, and his first book, a minor catalogue of materia medica, did not come out until five years later. He did not publish the books for which he is remembered until after the age at which most people retire. Cullen's reluctance to commit himself to print has been attributed to his earning much of his income in both Glasgow and Edinburgh from student fees. He thus lived in a culture where professors were reluctant to publish their lectures lest students would simply buy their books rather than enrol in their courses.
This economic structure within the Scottish universities undoubtedly contributed to Cullen's diffidence, but the simple pressure of time was probably also to blame. There is evidence that he was planning treatises on both agriculture and chemistry in his Glasgow days, and edited translations of two authors that he admired, Gerard van Swieten and Thomas Sydenham, were also mentioned in letters. That none of these works actually appeared suggests that Cullen was shy about committing his ideas to public scrutiny, although teaching and medical practice were also more immediately rewarding financially.
Cullen had been teaching in Edinburgh for more than a decade before he offered to the world at large his nosology (in Latin), Synopsis nosologiae methodicae
(1769), the organizing principles of his clinical teaching, without its practical details. It was sufficiently successful to go through four editions during his lifetime, the last one (1784) incorporating his final thoughts on the subject. English translations did not appear until after his death.
Cullen's lectures on the theoretical basis of medicine, called the institutes, formed the basis of the 1772 volume Institutes of Medicine, Part 1, Physiology
. By then, the pirated edition of his lectures on materia medica having just been published, Cullen would have been aware of how many manuscript copies of all of his lectures were circulating. The fact that he called the volume part 1 suggests that he intended to publish companion volumes on the other parts of the institutes, pathology and therapeutics, but these never appeared. Gregory's death in the following year meant that he was then in sole possession of the chair of the practice of medicine, to which his teaching was henceforth exclusively devoted.
This led to the serial publication, over seven years, of the four volumes of Cullen's magnum opus
, First Lines of the Practice of Physic
(177784). A fifth volume on diseases of women and children was planned but never appeared. The volumes were arranged nosologically, but they discussed in detail the symptoms and treatments of the diseases that he classified. They contained Cullen's mature thoughts on the essence of medical practice, and they were instantly accorded classic status, going through numerous editions and translations into all the major European languages, as well as adaptations by authors anxious to relate their disease constructs and treatments to differing national contexts. The volumes display Cullen at his clinical best, alert to the complexities of disease, concerned to do his best for his patients, and aware of the strengths and weaknesses of what he had to offer. First Lines
should be seen as both a culmination and the swansong of Enlightenment medicine. It consolidated its systematic, nosological approach based primarily on symptoms, rather than the pathological changes produced by disease. The latter was the basis of the medicine advocated in France and elsewhere from the early nineteenth century. This meant that Cullen's influence began to wane shortly after his death. By the time John Thomson edited Cullen's Works
in two volumes (1828), it was partly an act of historical piety. That much of Thomson's edition was reconstructed from manuscripts further testifies to the fact that Cullen always considered teaching as the primary vehicle for communicating his ideas.
The established physician
Cullen moved from Glasgow to Edinburgh in 1755 partly because the prospects of medical practice were better in the capital. He was never short of private practice in Edinburgh, despite the fact that the established medical community initially looked upon him as an outsider who was sceptical of Boerhaave's system, even though he had spent two years studying in Edinburgh. In addition to face-to-face encounters with patients, Cullen acquired an extensive practice based on postal consultations, especially after the deaths of Robert Whytt and John Gregory left him as the premier physician in Scotland. Cullen's annual postal consultations doubled (from about fifteen to thirty-five) after 1766, and increased dramatically after 1773 to between 150 and 200 per year. These letters came from many parts of the world, including France, Belgium, Italy, Prussia, the United States, and Madeira. Most originated closer by, from many parts of the British Isles, and from aristocrats as well as untitled men and women. One valetudinarian wrote a twenty-eight-page review of his case. Cullen took these consultations seriously (the standard fee was a guinea each), dictating a careful reply to an amanuensis. He advised on lifestyle, constitution, and diet, as well as ordering interventions such as bloodletting or cupping and the usual gamut of medicines. After 1780 copies of Cullen's replies were duplicated on the famous copying machine patented by James Watt.
In addition to his private and epistolary practice, Cullen regularly saw patients in the teaching wards of the Edinburgh Royal Infirmary. Student case notes survive for a number of patients under his ultimate care. Patients were selected for admission to the wards because their diseases were deemed to have important pedagogical value, so they cannot be easily compared to his middle- and upper-class patients and correspondents. Unsurprisingly, Cullen's hospital patients were more likely to be treated more formulaically according to the diagnosis they carried, in contrast to the highly individualized range of advice he offered to his private patients. Phlebotomies were rather more vigorous within hospital than outside of it, but in both sets of patients Cullen showed himself to be a caring physician, although one practising entirely within the conventions of his time.
Father figure and friend
Cullen was a major figure in the Edinburgh medical school virtually from his arrival there as a teacher, and, with Alexander Monro secundus, a central figure for the last two decades of his life, at a time when the medical school was probably the leading one in the world. His teaching and publications played an important role, but he had other personal qualities that contributed to the affection felt for him among Edinburgh students. His extensive correspondence, much of it still unpublished, shows how he followed the careers of many of his protégés, a number of whom gained positions of influence within the late Enlightenment medical world.
Among his American students, John Morgan, William Shippen jun., and Benjamin Rush took the Edinburgh ethos across the Atlantic and established the medical school at the University of Pennsylvania, in Philadelphia. William Hunter, from Cullen's early days, remained loyal, and pupils from the Edinburgh period spread out across the British Isles and beyond. These include John Haygarth in Chester and Bath, William Withering in Birmingham and the midlands, William Falconer in Bath, James Carmichael Smyth, John Coakley Lettsom, Robert Willan, and Charles Blagden in London, and Thomas Percival in Manchester. At a time when Scottish and Edinburgh-trained medical men dominated the medical services of the various agencies of the British empire, naval men such as Thomas Trotter and Gilbert Blane remained faithful to their principal medical teacher. Many of his pupils had particular reason to be grateful to Cullen, since he was also the usual port of call if they fell ill during their studies in Edinburgh. His home in the Cowgate, Mint Court, South Gray's Close, in a fashionable part of Edinburgh, was familiar to many of his students.
Cullen was not always lucky with his students. One of his favourites, John Brown, whom at one time he had wished to see in his own chair of the practice of medicine at Edinburgh, took parts of Cullen's neuropathological teaching and developed it into an entire rival system. Brown believed that all diseases were caused by either over- or under-stimulation of the nervesthat is, they were either asthenic or sthenic, and were to be treated by either depletion or stimulation. His ideas (and personality) earned him the enmity of the Edinburgh medical faculty (including Cullen), with the result that he was forced to take his medical doctorate at St Andrews, and eventually set himself up in London. Although Brown's system was sometimes seen as a logical consequence of Cullen's own emphasis on the primacy of the nervous system in disease, it lacked the subtlety of Cullen's teachings. Brunonianism (as it was called) exerted a considerable influence in Europe, but Brown's death in 1788 meant that his possible succession to Cullen's chair was never an issue.
Cullen also moved with easy familiarity among the literati of Enlightenment Edinburgh. Like Cullen, Adam Smith returned to Edinburgh, and the two remained close friends, exchanging an interesting correspondence on the consequences of a laissez-faire
market place for medical care. Cullen tended Dugald Stewart in an illness when the latter was a teenager and saw David Hume on the philosopher's deathbed. Francis Hutcheson's son was one of his pupils. When Samuel Johnson visited Edinburgh in 1773, Cullen and his eldest son were among five guests invited to dine with Johnson and Boswell.
Cullen was a sociable man, a member of several of the debating and dining clubs that were central to the exchange of ideas and conviviality in Edinburgh. Among these was the Philosophical Society, which in 1783 became the Royal Society of Edinburgh. He was elected to the Royal Society of London in 1777, although he never went south to sign the admission register, and he was active in the Royal College of Physicians of Edinburgh, of which he became a fellow in 1756. He served as president from 1773 to 1775, during which time he was active in revising the Edinburgh Pharmacopoeia
. John Pringle (then president of the Royal Society of London) also helped in the new edition. Cullen and Pringle carried on a warm correspondence, even if the latter did not share Cullen's reliance on nosology. Cullen worked to liberalize the entrance criteria of the college, so that those with backgrounds in midwifery or practice under an apothecary might be eligible.
The tenor of Cullen's life carried on regularly for years. His eldest son went into the law, but two of his younger ones opted for medicine. Only Henry sought a medical career. He was appointed a physician to the Edinburgh Royal Infirmary, but William Cullen's attempts to secure him an academic post in the medical school failed, and Henry died only a few months after his father. The death of his wife, Anna, in 1786 affected Cullen deeply, although he finished his treatise on materia medica and began his lectures for the academic year 178990. He was unable to continue beyond November, when he tendered his resignation. It was not formally accepted, but James Gregory, professor of the institutes of medicine, was co-appointed to Cullen's chair in the practice of medicine. Cullen died at his house in the Mint, Edinburgh, on 5 February 1790 and was buried in Kirknewton on 10 February.
Cullen received the usual round of obituary notices and a short biography, but it was understood that Robert Cullen, the eldest son, was going to prepare a full-scale biography, based on his father's extensive collection of papers as well as on his intimate knowledge. It never appeared, and it was left to John Thomson, professor of pathology in Edinburgh, to take up the task more than a generation after Cullen's death. Twenty-seven years separated the two volumes of Thomson's massive account of Cullen's life, by which time Thomson and his son William, with whom he collaborated, were both dead, the second volume being completed by David Craigie. By then (1859), Cullen's reputation had fallen dramatically, most commentators considering him a doctor more concerned with arrangement and generalization than with discovery.
Cullen was generally condemned along with his whole century by late nineteenth- and early twentieth-century whiggish historians of science and medicine. His thought remains difficult to study since his lectures changed subtly each year, and much of the evidence of his teaching is still in manuscript form, in his own archives or in numerous student notes in scattered libraries. Seen from the present, eighteenth-century medicine is remote and archaic in ways that the medicine of the nineteenth is not, but the historical Cullen was a wise doctor and a man whose status within his own society was thoroughly earned.
W. F. Bynum