Dr James Cullen: The 18th Century mail-order medic

Dr Cullen. Picture: contributed
Dr Cullen. Picture: contributed
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A new Fringe show tells the story of a now little-known but at the time famous Edinburgh doctor who dispensed advice all over the world.

Sitting at his desk in his Edinburgh study, Dr James Cullen laboured intensely over every single response, carefully instructing his long-
distance patients on what to do – cold baths and travel were particular favourite remedies – meticulously logging each patient’s correspondence and then copying one of his replies for his records.

A wall at the Royal College of Physicians with Dr Cullen at the centre.   'Picture: Neil Hanna

A wall at the Royal College of Physicians with Dr Cullen at the centre. 'Picture: Neil Hanna

Sealed and stamped, letters between doctor and patient winged their way – or, as this was the 18th century, they trotted along in horse-drawn carriages and bobbed over sea by boat – to places as far distant as Elgin and Manchester, Antwerp, 
Berlin and Madeira.

After all, Dr James Cullen was the most famous medicine man of his era, a mail order medic whose knowledge, advice and flair for communicating the mysteries and marvels of his profession had turned him into a global superstar.

And one who, for some of his despairing patients, must have been their final, maybe their only hope.

At his peak and at a time long 
before modern communication, the Edinburgh doctor was known around the English speaking world. Eventually, however, his fame dwindled to within the walls of the Royal College of Physicians, Edinburgh (RCPE), where he was once president and where his portraits hang and items he once used – such as his pestle and mortar – are currently on show.

Iain Milne, David Purdie and Elayne Sharling reveal the doctor's secrets. 'Picture: Neil Hanna

Iain Milne, David Purdie and Elayne Sharling reveal the doctor's secrets. 'Picture: Neil Hanna

Now his fame in a fascinating and at times bizarre role as global mail order medic is being revisited in a Fringe production, using letters drawn from his own collection which not only reveal in absorbing detail the myriad of medical woes that afflicted his patients but his own, sometimes quite surprising, recommended cures.

“He became known as ‘The Doctor’,” says Iain Milne, Sibbald Librarian at the RCPE, where Dr Cullen’s letters are kept. “He was probably the most famous doctor in the English speaking world, so well known that people would simply address their letters to him as Dr Cullen, 

“What’s remarkable is that he wasn’t famous because he discovered anything in particular, but because he had this remarkable reputation that spread across countries. “

Patients hundreds of miles away would hang on his every word, taking advice for remedies – perhaps much to their relief he did not favour old-fashioned prescriptions involving things like snails, cobwebs, vipers and powdered skull – and accepting suggestions that they exercise, take cold baths and travel.

Among the letters that arrived at his Edinburgh study were some from patients with what seem to be very modern troubles. For in an age before vaccinations and antibiotics, when it might be expected that people’s health troubles would focus on how to survive everyday illnesses, many instead dwelt on issues like weight gain, stress and stomach ache. “The problem was that 18th century doctors couldn’t do much about things like infections or curing many diseases, they didn’t have the knowledge,” adds Iain. “So they tended to prescribe for the patient rather than the disease.”

People wrote seeking advice over fevers, colic, tumours and scabs. Some wanted help with toothache and worms, others for troubles with itches, nauseas, deleriums and 

Some of the letters, viewed through modern eyes, can be amusing, Iain adds, others devastatingly poignant, oozing the writer’s misery for the plight they find themselves having to endure.

“One,” he explains, “from a man in Dumfries is a brilliant description of depression,” he explains. “Another letter from Perth was from a man suffering from venereal disease – who pleads for discretion – who is given a very long and complicated 

“Jane Webster from Yorkshire wrote to him very concerned about her weight,” adds Iain. “There’s one long letter from her wondering what her weight should be for her height, she says she is a ‘44-year-old with dark hair, dark complexion and warm temper’ but had begun to grow fat before she was 20.

“She talks of having a father who was also very ‘corpulent’, and tells how she was 18st 2lb but had reduced her weight,” he adds. “She writes to him to ask what she should do, and his reply is that she ‘persist in present measures’.

“He also suggests she take great bodily exercise and cold bathing.”

Indeed, cold bathing features in many replies, adds Mr Milne, who presents part of the Fringe show, in which a selection of letters and Dr Cullen’s responses are shared with the audience.

“He often suggests people travel because he thinks that is good for them and also so they can take the waters at various spas.

“He suggests travelling to Germany for some patients and cold bathing in Peterhead during winter for others.”

He meticulously detailed what his patients should do while travelling, even down to choice of clothing, vehicle, where to sit on the coach and which windows to open.

Letters arrived daily and Dr 
Cullen, having risen every morning at 6.45am, would spend around two hours composing his responses before visiting his Edinburgh patients.

Incredibly, he would copy out his response – word for word – to create a full medical record of his patients’ troubles, eventually in 1781 opting to use an early copy machine designed by his friend, James Watt.

“One patient’s letter was 12 pages long and describes everything about diet and environment, the weather – if it’s cold or windy – and wonders what impact it has on their health,” adds Iain.

“There were a lot of people who’d write with stomach pains. One from Aberdeen suffered from an excess of bile and writes to Cullen detailing all the things he’s taking for it – it’s an extraordinary letter – and Cullen writes back saying he’s worried about him taking too many medicines.”

In return, his patients would part with two guineas for each consultation – around £250 by today’s standards, not only making Dr Cullen a world famous doctor, but quite a wealthy one too.

His fame, explains Iain, was the result of his fine reputation as a medical lecturer, his status at the head of the RCPE in a city recognised globally as a centre of excellence for 

“It was during the Enlightenment, the Edinburgh medical school was at its height, and he was one of its leading professors,” he adds. “He wrote two very important textbooks – one, First Lines in Practise of Physique, was a hugely successful medical textbook at a time when lots of people were learning medicine.

“And he must have been a fantastic teacher. He was certainly very 

Dear Doctor, with Professor David Purdie, College Librarian Iain Milne and actress Elayne Sharling, is at the Royal College of Physicians, Edinburgh, until Saturday. Tickets £8 (£6).