4 The Correspondence of Dr William Cullen: Scottish Enlightenment and New Directions in Medicine-by-Post Dr Johnson has been very ill for some time; in a letter of anxious apprehension he writes to me, ‘Ask your physicians about my case.’ James Boswell, 7 March 1784, to Drs Cullen, Hope, and Monro at Edinburgh1 In the second half of the eighteenth-century, the rhetoric of medicine-by- post took on a new character and purpose as speculation on the physiology of the nervous system was refined and elaborated by doctors of the Scottish Enlightenment, in particular Robert Whytt (1714–66) and William Cullen (1710–90).2 The new physiology expanded the role of ‘sensibility’ in defining man as a reactive organism, especially sensitive to the influence of physical climate and social environment. Of equal importance, Scottish Enlightenment doctors now conceived of a total ‘sympathetic’ integration of body function – a communication between solid organs as regulated through the nervous system – with a sophistication unmatched in prior decades. ‘Sympathy’, explains John Mullan, was ‘the principle of coherence of those signs which possess the body to reveal the effects of passion and feeling.’3 In other words, sympathy was that principle which rendered sensibility visible and, therefore, capable of ‘touching’ other responsive human beings by arousing nervous vibrations within the spectator through the senses.4 Sympathy was the common denominator of ‘touch’, of ‘feeling’, as physical sensation and as metaphor; it was the interface between private sensation and the social world. Michael McKeon has suggested that in the earlier decades of the eighteenth century manly sensibility ‘lent to the ungendered industrious virtue of Protestant descent a subtly feminine receptivity’ that ‘pointed ahead to the cult of sensibility at midcentury.’ One attraction, says McKeon, of ‘aristocratic ideology had been its claim that inner virtue was visibly manifested in the external phenomena of rank, regalia, personal display, even complexion’, but ‘the cult of sensibility attempted to reinvent this notion of the body as a system of socioethical signification in terms of biological materialism that would evade the ideology of aristocratic privilege.’ For Cheyne, the appropriation of the 175 Wayne Wild image of the ‘Man of Feeling’ – of ‘nervous sensibility’ – had served primarily to ingratiate him into the world of aristocratic patients and to validate his particular brand of moralism (as described in the previous chapter). However, Scottish Enlightenment doctors not only elaborated upon the ethical implications of sensibility in a far more sophisticated and deliberate manner to bolster their professional status, but specified a professional sensibility that was particularly male. If, as McKeon claims, ‘the cult of sensibility was short-lived because masculinity was learning to elaborate its own, highly circumscribed mode of “public virtue”, alternative but complementary to the private domestic virtue of women’, then this process is especially clearly demonstrated in the medical profession of the late- eighteenth century in Scotland.5 Sympathy in the context of the Scottish Enlightenment was, as Christopher Lawrence advises, ‘a special case of sensibility’ responsible for the natural impulse of people to form social bonds with persons of like interests and to create civic institutions and select societies for the betterment of mankind.6 In medicine, sympathy would translate into the new fields of institutional and public health, in establishing voluntary hospitals and clinics to serve the poor. A medical physiology based on sensibility and sympathy, as Lawrence has suggested, perfectly complemented, and supported, the goals of the Scottish Enlightenment intellectuals and the landed elite who saw their role as the ‘custodians of civilisation’, as the ‘natural governors’ of a yet ‘backward society’ needing ‘improvement.’7 Although there was a general European move from the iatromechanical to a vitalistic conception of the body, only in Scotland did vitalism lead to such a unified speculative system in which the total integration of body function was dependent on the nervous system. In France, for example, vitalism was conceived as an independent force within each separate organ, and ‘in London, John Hunter ascribed his “living principle” to the blood’; but ‘the Edinburgh theory of the body and the Edinburgh theory of social order used a common concept, integration through feeling.’8 Civilised man had developed into a finely tuned organism whose health rested upon the perfect harmony of his internal body environment which, in turn, must be fully integrated with his external physical and social surroundings. It was a delicate arrangement put easily into disequilibrium, into a palpable and visible disorder which called for the expertise of the physician. But, importantly, ‘sensibility’ – as enlarged by the physiological and metaphorical principle of ‘sympathy’ – was viewed not as a medical liability – as it had with Cheyne – but as a desirable constitutional trait which, even if predisposing to certain states of ill health, positively enhanced society, civilization, and self-worth. 176.