Title page of 'First lines of the practice of physic'There really is a difference between hearing or reading about a ‘great man’ of science or medicine and reading his works up close. From a safe distance away (over 200 years and counting), William Cullen looks like quite the innovator: the heir of Sydenham, disciple of Boerhaave and coiner of the term ‘neurosis’; but up close this heroic image dissipates rapidly into that of an intelligent man unlucky enough to be born in medically interesting times. For example, although dismissive of the humoural system of pathology, Cullen still recommends a pharmacopoeia of different laxatives, emetics and opiates (don’t even ask what he recommends for haemorrhoids).

But what I find particularly interesting is what we’d see as the mish-mash of physical and psychological factors that cause (or are symptomatic of) disease. Hypochondria, today considered a psychological disturbance, was for Cullen closer to dyspepsia and so was more nosologically-related to gout and dysentery than to mania and melancholia. These types of insanity, too, reflected more on an individual’s temperament (welcome back, humours!) than on the physical condition of the brain or nerves.

Conveniently, this brings me to Cullen’s favourite topic: the nervous system. While Cullen used to be hailed for his discovery of ‘neurosis’, it should come as no surprise that he had a far more encompassing view of what this term entailed. For Cullen, all diseases involved the nervous system and so all could be called neurosis. This passage is from his discussion of fevers:

‘To discover the cause of the cold stages of fevers, we may observe, that it is always preceded by strong marks of general debility prevailing in the system. The smallness and weakness of the pulse, the paleness and coldness of the extreme parts, with the shrinking of the whole body, sufficiently shew, that the action of the heart and larger arteries is, for the time, extremely weakened. Together with this, the languor, inactivity, and debility of the animal motions, the imperfect sensations, the feeling of cold, while the body is truly warm, and some other symptoms, all shew that the energy of the brain is, on this occasion, greatly weakened; and I presume, that, as the weakness of the action of the heart can hardly be imputed to any other cause, this weakness also is a proof of the diminished energy of the brain.’

Quite something, I hope you agree. But for those of you who don’t and who might be concluding that such anachronistic tittering is unseemly, then I should point out that the above paragraph comes from the 1791 edition of ‘First Lines of Physic’ – a year after Cullen died. I merely echo the editor, therefore, in pointing out that Cullen seems to have returned to this particular theme at every opportunity. And if there is anything that can span across human culture and history, surely it is exasperation.

The Whipple has a later edition of ‘First Lines of the Practice of Physic’ published in 1816 (STORE 116:18-19)

By Sean Dyde