At the beginning of 1751, by the interest of the Duke of Argyll, Dr. Cullen succeeded Dr. Johnstone as Professor of Medicine in the University of Glasgow, at the same time that Adam Smith was appointed to the Chair of Logic; and a friendship of great intimacy arose between these thoughtful minds. Only a few months afterwards, Adam Smith’s transfer to the Moral Philosophy chair led Dr. Cullen to favour strongly the election of David Hume to the vacant chair, on an occasion when Edmund Burke was also a candidate. Neither was elected, strict orthodoxy carrying the day. At this period the applications of chemistry to arts and manufactures and to agriculture engaged Cullen’s attention considerably, and he proposed to carry out a process for purifying common salt, but it proved too expensive.
Cullen, finding that Glasgow did not promise to build up a large medical school at present, and being compelled to take country practice, began to look longingly to Edinburgh, to which also his friends were calling him. He says in a letter to William Hunter, in August 1751, “I am quite tired of my present life; I have a good deal of country practice, which takes up a great deal of time, and hardly even allows me an hour’s leisure. I get but little money for my labour; and indeed by country practice, with our payments, a man cannot make money.” Various circumstances, however, prevented this step being taken, until, in the beginning of 1756, he was appointed to the professorship of chemistry at Edinburgh, and was thus fairly launched on his notable career. In the competition for this chair, Joseph Black had been nominated, but the two friends honourably refused to do anything to prejudice each other, and on appointment indeed Cullen offered Black all the fees if he would assist him. Cullen’s first course at Edinburgh was attended by only 17 students, his second by 59, while it rose later to 145. Practice soon came to him, and freed him from his pecuniary struggles.
In 1757 Dr. Cullen first undertook to give clinical lectures in the infirmary, and in this work his especial talents shone. He had now had sufficient experience of practice, with the best knowledge of chemistry and materia medica that the time afforded; and his skill in observation and graphic description of disease, added to his zeal for imparting knowledge, soon made his clinical lectures renowned. In these lectures, for eighteen years most carefully prepared, the first real model of what is now so familiar to medical students as a clinical lecture was afforded. His candour may be judged from the following expressions: “In these lectures, however, I hazard my credit for your instruction, my first views, my conjectures, my projects, my trials, in short, my thoughts, which I may correct and if necessary change; and whenever you yourselves shall be above mistakes, or can find anybody else who is, I shall allow you to rate me as a very inferior person. In the meantime I think I am no more liable to mistakes than my neighbours, and therefore I shall go on in telling you of them when they occur.” Promoted by such candour, Cullen’s reputation rapidly grew. His lectures were remarkable for simplicity, ingenuity, and comprehensiveness of view, with copiousness of illustration. He taught his students to observe the course of nature in diseases, to distinguish between essential and accidental symptoms, and to carefully discriminate the influence of remedies from the curative operations of nature. “There is nothing,” he said, “I desire so much as that every disease we treat here should be a matter of experience to you, so you must not be surprised that I use only one remedy when I might employ two or three; for in using a multiplicity of remedies, when a cure does succeed, it is not easy to perceive which is most effectual.” Again, he says, “Every wise physician is a dogmatist, but a dogmatical physician is one of the most absurd animals that lives. We say he is a dogmatist in physic who employs his reason, and, from some acquaintance with the nature of the human body, thinks he can throw some light upon diseases and ascertain the proper methods of cure; and I have known none who were not dogmatists except those who seemed to be incapable of reasoning, or who were too lazy for it. On the other hand, I call him a dogmatical physician who is very ready to assume opinions, to be prejudiced in favour of them, and to retain and assert very tenaciously, and with too much confidence, the opinions or prejudices which he has already taken up in common life, or in the study of the sciences.” He sought to build up rational views of medicine, indeed, on the basis of fact and experiment. In giving his clinical lectures he was at great pains to choose diseases of the most common types, as most useful to the students. He adhered to great simplicity of prescriptions, compared with the complex and barbarous nostrums of preceding times, and he experimentally used and introduced many new drugs of great value, such as Cream of Tartar, Henbane, James’s Powder, and Tartar Emetic.
The novelty with which Cullen invested his subject and the boldness of his views made many, especially conventional practitioners and lecturers, regard him with disfavour, and decry him for not regarding Boerhaave’s views as final, and for adopting those of Hoffmann in conjunction with his own. Yet his lively and entertaining lectures, combined with his pleasing treatment of patients, and “his manner, so open, so kind, and so little regulated by pecuniary considerations, made him win his way more and more. He was the friend of every family he visited.” William Hunter writes in 1758, “I do assure you I have never found anything in business so pleasing to me as to hear my patients telling me, with approbation, what Dr. Cullen had done for them, and to hear my pupils speaking with the reverence and esteem of Dr. Cullen that is so natural to young minds.”
As a sign of the general mental attitude of Dr. Cullen, the following extract from a letter to his son James, on setting out for a foreign voyage, is of interest: “Study your trade eagerly, decline no labour, recommend yourself by briskness and diligence, bear hardships with patience and resolution, be obliging to everybody, whether above or below you, and hold up your head both in a literal and figurative sense.” While he aided his juniors in the best sense to acquire independence of character, he “admitted them freely to his house; conversed with them on the most familiar terms; solved their doubts and difficulties; gave them the use of his library; and, in every respect, treated them with the affection of a friend and the regard of a parent. It is impossible for those who personally knew him in this relation,” says Dr. Aikin, “ever to forget the ardour of attachment which he inspired.” Another and not less pleasing view of Cullen is shown in his recommendation of “Don Quixote” to Dugald Stewart when a boy suffering from some indisposition, and the interest he manifested in his patient’s progress in that delight. He used to talk over with the lad every successive incident, scene, and character, manifesting the minutest accuracy of recollection of the master-piece.
We shall not follow the discussions which arose at Edinburgh about the succession to Dr. Rutherford’s chair of the Practice of Physic, nor the circumstances which led to Dr. John Gregory’s appointment. Suffice it to say that on the death of Dr. Whytt, Cullen consented to accept the chair of the Theory of Physic in 1766, and that subsequently an arrangement was made by which the two professors lectured alternately on the Theory and Practice of Physic, to the still greater advantage of the now celebrated school. This appointment was strongly promoted by both the Monros, and by an address signed by 160 medical students. The arrangement now made lasted till Dr. Gregory’s death in 1773, when Cullen became sole Professor of the Practice of Physic. Black was brought to Edinburgh to succeed Cullen in the Chair of Chemistry.
Cullen’s principal works are the “Nosology,” a synopsis and classification of diseases, with definitions, which obtained wide popularity, although only an approximation to a sound system; and his “First Lines of the Practice of Physic,” 4 vols., 1778-85, which went through numerous editions. One of its especial merits was that it pointed out more clearly than preceding works the extensive and powerful influence of the nervous system on disease. It is now held as the defect of his system that it was too theoretical, and that its views were not adequately supported by facts. It cannot be denied that Cullen had but moderate anatomical and physiological knowledge, and this has prevented him from leaving works capable of being read with much profit by the practitioners of the present day.
It is after all on William Cullen’s personal influence on the School of Medicine, which he did so much to maintain, that his fame will chiefly rest. The character of this influence is honourable and stainless. Dr. James Anderson has left in unequivocal language a record of his bearing in his conspicuous position which does equal honour to his intellectual energy and to his qualities of heart. Dr. Cullen, he says, was employed five or six hours a day in visiting patients and prescribing by letter; lecturing never less than two hours a day, sometimes four; yet, when encountered, he never seemed in a hurry or discomposed—always easy, cheerful, and sociably inclined. He would play at whist before supper with as keen interest as if a thousand pounds depended on it.
Cullen did not leave his acquaintance with his students to originate by chance, but invited them early in their attendance, by twos, threes, and fours, to supper, and gaining their confidence about their studies, amusements, difficulties, hopes, and prospects. Thus he got to know all his class, and paid especial attention to those who were most assiduous, best disposed, or most friendless. He made a point of finding out who among them were most hampered by poverty, and often found some polite excuse for refusing to take a fee even for their first course, and in many cases for their second course. One method he adopted was to express his wish to have their opinion on a particular part of his course which had been omitted for want of time the previous session, and he would thereupon present them with a ticket for the second course. After two courses he did not require any fee for further attendance. He is credited, too, with having introduced into Edinburgh the practice of not taking fees for medical attendance on students of the university. This ease and generosity about money matters was the cause of his eventually dying without any fortune. It is said that he used to put sums of money into an open drawer, to which he and his wife went when they wanted any.
We shall not enter here into the controversy between Dr. John Brown, founder of the Brunonian theory of medicine, and his disciples, and Dr. Cullen, to whom Brown had owed everything in his youth. Brown’s system proved to be no more stable than his personal character, although its noisy advocacy, and the abuse heaped upon him personally, caused Dr. Cullen much pain.