First lines of the Practice of Physic

William Cullen

with practical and explanatory notes by John Rotheram

1805

New York
T&J Swords, 160 Pearl-Street

There is a good entry in Wikipedia on William Cullen [1710-1790, “Scottish physician, chemist and agriculturalist, and one of the most important professors at the Edinburgh Medical School, during its heyday as the leading centre of medical education in the English-speaking world. He served as President of the Royal College of Physicians and Surgeons of Glasgow (1746–47) and President of the Royal College of Physicians of Edinburgh (1773–1775)” ].
The edition of “First lines of the Practice of Physic” reviewed was the 1805 American edition. This proved little hard to align with the original Edinburgh edition, which appears to be the 'First Lines of the Practice of Physic, for the Use of Students in the University of Edinburgh' 1777. Volume I of the latter is viewable in entirety on the archive.org site, 417 pages of very spread out small sections within chapters. It is unclear when the remaining volumes emerged in Edinburgh or how many there were. What appears to be the first American edition in 1790, printed in Worcester, MA, and viewable in entirety on the NIH site, is in 3 volumes, with 1.5 spacing of lines, ending on page 368.
In this 1805 edition, all Cullen’s original volumes are combined into two volumes, 582 pages (plus index) in closely printed approximately 9 font with frequent footnotes in very small print. Volume 1 is divided into four Books and with Volume 2 commencing at page 301 iwith a complex of further Books and Parts. The lengthy 46-page preface and the text throughout appear unchanged from the 1790 volume apart from the footnotes by Dr Rotheram and the date at the end of the preface - “Edinburgh, Nov. 1789” in 1805 and “Edinburgh, Nov. 1783” in the 1790 edition. It would appear that Cullen’s original wording is unchanged in the 1805 edition, only footnotes being added throughout.

Understandably, the attempts at elucidating the causes of types of illness still common today are more interesting than the descriptions of the still familiar symptoms. Fevers are put down to a tangle of internal events involving muscle fibers, the nervous system, ‘atony in the extreme vessels on the surface of the body’ p35 and so on, and ‘chiefly depend upon changes in the state of the moving powers of the animal system’ p39. ‘As fevers are so generally epidemic, it is probable, that some matter floating in the atmosphere ... ought to be considered as the remote cause of fevers ... either as CONTAGIONS ... effluvia arising ... from the body of a man under a particular disease ... or MIASMATA ... effluvia ... from other substances than the bodies of men’ p42. The discussion continues along the lines of refuting the common belief that contagions are of a great variety, that ‘the genera and species of contagious diseases ... are in number not very great’ p46. Indeed ‘We know with certainty only one species of miasma ... so universally the cause of fever, is that which arises from marshes of moist ground ... What is the particular nature of this miasma, we know not’ p48.

The important relationship between cold and fevers is then discussed. Death, when resulting from fevers, results from destruction of ‘the vital principle’ in the nervous system p54. The cure, in attempt to “moderate the violence of reaction” includes avoidance of all motion of the body and exercise of the mind (“a stimulus to the body”) pp62/3.Avoidance of irritation by the stimuli ‘constitutes the antiphlogistic regimen’. Avoidance of heat and administration of ‘refrigerant’ sedative powders (tartaric acid and vegetable acids which ‘generate cold’) are prescribed p63. The violence of reaction leads to ‘the tendency of fluids to putrefaction’ p62 and these are best removed by blood-letting – ‘the most powerful means of diminishing the activity of the body’ p66.

The theme is continued in Book II on inflammation (p91) where the amount of ‘gluten’ separating from the blood is an indication of extent of inflammation p92. Abscesses, suppuration and gangrene are brought into the picture. Topical bleeding to take off the phlogistic diathesis by cupping or leeches is prescribed p103 though gangrene needs ‘separation of the dead from the living parts ... performed by the knife ...’ p105.

Contagious disease is recognised but not much differentiated. Cynanche clearly covers a number of these which probably include what later became named whooping cough p121, glandular fever p124, scarlet fever p216, etc.. No attempt at defining the contagious element appears to be made. Turning to the extreme example of smallpox p200, understanding is limited to “It is evident that the contagion of the small-pox is a ferment with respect to the human fluids, and assimilates a great part of them to its own nature.” Not yet influenced by the findings of Jenner and forerunners, Cullen’s reasonings for variolation and its procedure, running to many pages, makes fascinating reading.

The author specifically states that coverage of surgery is beyond his remit here p105. The book is an excellent reflection of the close observations of disease at the turn of the 19th century and the rather woolly and often very wordy explanations and hypotheses for those observations and the reasoning for the treatments proposed, including, of course, the much-lauded blood-letting.