Book Review

William Cullen and the Eighteenth Century Medical World

N Engl J Med 1994; 330:581February 24, 1994

Article

William Cullen and the Eighteenth Century Medical World
Edited by A. Doig, J.P.S. Ferguson, I.A. Milne, and R. Passmore. 256 pp., illustrated. Edinburgh, Scotland, Edinburgh University Press, 1993. $49. ISBN: 0-7486-0302-6 (Distributed in the U.S. by Columbia University Press, New York).

Two centuries ago, the medical school at the University of Edinburgh was the finest in the world, and its outstanding physician was William Cullen (1710-1790). To mark the bicentennial of his death, the Royal College of Physicians of Edinburgh mounted an exhibition of biographical, medical, and cultural material. An accompanying symposium discussed selected aspects of Cullen's work and its relation to the culture of the era. This book, with its high-quality illustrations, reproduces the material from the exhibit and presents the symposium papers.

Readers versed in the medicine and culture of the period will appreciate the extensive new data that research in the past two decades has uncovered. Much of the archival material -- especially lecture notes and correspondence -- has been combed. Especially important is the integration of the medical scene with the mid-18th-century cultural movement known as the Scottish Enlightenment, which included David Hume, Adam Smith, Francis Hutcheson, Lord Kames, and others whom we do not ordinarily associate with medicine. This expansion of the scope of medical history is indeed welcome.

Quite appropriately, the clinical aspects of Cullen's work receive the most attention. In an outstanding contribution, Risse, drawing chiefly on manuscript sources, describes Cullen's consultation and dispensary practice. A complementary chapter by Passmore, relying on both manuscript and printed sources, clarifies Cullen's views on diet and provides considerable information on his physiologic rationale. In a brief but graceful paper, Buckley describes Cullen's country practice.

The more scientific aspects also receive attention. Christie devotes a paper to chemistry but deals with the essentially nonmedical research in which Cullen had a considerable role. Several papers discuss the conceptual and doctrinal features of Cullen's teachings. Bynum analyzes the role of the nervous system, which played an important part in Cullen's specifically medical doctrines. “Philosophy and Method” is the title of Barfoot's paper, in which he tries to analyze the basic concepts of system (as in “system of medicine”), fact, and theory. In my opinion, however, the analysis is not at all cogent. Kendall offers a superficial analysis of Cullen's nosology but ignores the deeper implications.

Education receives considerable attention. Emerson analyzes the role of politics and politicians in medical education and professional appointments. Also on the topic of education, O'Donnel discusses Cullen's influence on American medicine through his pupils who founded the first American medical school, in Philadelphia.

The final paper describes the Royal Medical Society, one of the oldest medical societies in Europe, to which Cullen contributed.

As with all multiauthored books, there is great variation among the papers in the clarity of thought and expository skill. Despite some shortcomings, this book, which covers a wide range of topics, illuminates the cultural patterns of the later 18th century and is an important contribution to our knowledge of 18th-century medicine.

Lester S. King, M.D.
Chicago, IL 60657