Dr. William Cullen: A Case Study of Gender and Nervousness
Dr William Cullen was a prominent Edinburgh physician at the end of the eighteenth century whose records provide a unique look at gendered medical care. This period is notorious for a lack of unedited primary sources on medicine, but Dr Cullen’s views have survived in postal records of exchanges between patients and doctors. While women were more often considered ‘nervous’ than men because of their weaker, feminine natures, Cullen’s records show that in practice, physicians did not always participate in gendered medical treatment. Instead, Cullen treated both males and females with nervous temperaments, and recommended lifestyle changes similar to his suggestions for other medical ailments.
Before Cullen, physicians had struggled to identify and diagnose various ‘nervous’ diseases, specifically hysteria and hypochondria. In 1764, Robert Whytt published Observations on the Nature, Causes, and Cure of Those Disorders which Have Been Commonly Called Nervous, Hypochondriac, Or Hysteric, which distinguished hysteria as a female disease, and hypochondria as a male disease. This provided a textual basis for the beliefs of many physicians on the distinction of nervous diseases based on sex. Whytt drew on the authority of previous physicians, who had claimed that the seat of hysteria resided in the womb, making it decidedly female. Though by the end of the seventeenth century physicians theorized that the disease was caused by the nervous system rather than the womb, in practice, they were still reluctant to diagnose a man with a historically ‘female’ disease.
Dr Cullen, however, did not hold the same expectations of nervous sufferers as did many of his contemporaries. While numerous physicians thought that nervousness was an upper-class malady, Cullen treated wealthy patients and paupers of both sexes. Male patients wrote to him self diagnosed as nervous, sometimes writing about themselves in the third person: ‘Mr Munro Imagines his complaints are attended with these, & has many Symptoms of the Nervous kind’. Women also felt comfortable writing to Cullen on behalf of male patients – despite a tradition of men writing to doctors on behalf of women. Mrs Esther MacNeill wrote to Cullen about Captain Duncan MacNeill: ‘his nerves is much weakned by his Complains & Begs againe that the Doctor will lost no time in writing him.’ Cullen replied to this letter with the same advice that he would give any other patient with a ‘disorder of nerves a ‘very troublesome but not a dangerous disease’, by recommending exercise on horseback, avoiding cold weather, and a moderate diet.
While contemporary physicians such as Whytt relied on separating nervous diseases based on sex, Cullen instead employed his established recommendation of moderate living. Rather than categorize nervous sufferers as female or male, rich or poor, Cullen instead considered patient history and recommended lifestyle changes that he thought would ease the suffering of nervous patients.