The history of medicine: A Scottish perspective
The history of medicine: A Scottish perspective

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The history of medicine: A Scottish perspective

2.2 The popularisation of ideas

One of the media that helped to popularise the importance of nerves and the concept of sensibility was to be found outside medical encounters, in a new and extremely successful literary genre, the ‘novel of sentiment’. Writers such as Samuel Richardson, Laurence Sterne and Henry Mackenzie, who were familiar with the current medico-physiological debate, openly drew on these notions and made their characters' sensibility and response to external events the driving force of their writing (Barker-Benfield, 1992, pp. 15–36). By adopting the language of physiology as the tool with which to explore the emotional adventures of their heroes and, especially, their heroines, these writers contributed to circulating the idea that ‘delicacy of feeling’ and ‘a high sensibility’ should be regarded as the quintessential qualities of a human being (Figure 4). Not only were characters and plot now built around sentiments, but readers were also meant to respond with heightened ‘feeling’ to what they read. Never before had physiology so directly shaped literature, and never before had literature served medicine so well.

Figure 4
(Wellcome Library, London) ©
Wellcome Library, London
Figure 4 Richard Earlom, stipple engraving after George Romney, Sensibility, 1789. Unsurprisingly, the personification of sensibility in this picture is a young woman, whose bodily language expresses her heightened feelings, here anguish. Historians have argued that the emergence of sensibility brought about a certain feminisation of social customs

Exercise 2

Read ‘The popularisation of the new medical theories in the eighteenth century: the novels of Laurence Sterne [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ’. Make a note of the various physiological concepts which, albeit expressed with much irony, pepper Sterne's writing.


Extract (i) is a hymn to sensibility, which is praised for being not only the source of our feelings as individuals and a sort of divine presence in human beings, but also the basis for social bonding. It is because we feel that we are able to go beyond ourselves and act with compassion.

In extract (ii), the question of the origin of intelligence and the site and function of the soul in relation to the body is discussed with reference to the theories of famous philosophers such as Descartes and anatomists such as Bartholinus. In making fun of some of these theories – for example, by comparing the activity of the soul to that of a ‘tad-pole’ – Sterne assumes that his readers are at least conversant with discussions on the structure of the brain and the cerebellum, the intricacy of nerves and the location of the soul. Moreover, Tristram's father, a man deeply involved in these debates, who even proposes his own theory, was presumably a familiar character to contemporary readers. They would regard issues such as the source of intelligence, wit and memory as plausible topics of conversation between gentlemen with no specific scientific or medical expertise, though how it was conducted might stir a smile.

Through novels, a growing readership familiarised themselves with a whole set of expressions and concepts based on the ‘sensible’ body, which they might then apply to their own bodies, health and feelings. Despite Sterne's reference to the sensibility of the ‘roughest peasant’, sensibility was increasingly regarded as an attribute confined to those whose nervous apparatus was well developed. As opposed to coarseness, delicacy became a valued quality, which, though it might imply a tendency to develop nervous disorders, was generally perceived as socially positive.

To explain the success of this new model of the body, particularly in England and Scotland, Christopher Lawrence has looked at its broader social and political implications and argued that it served well a specific political and ideological project first proposed by eighteenth-century Scottish philosophers and politicians:

The nervous system gained importance in Scotland not only from the physiological side of the bridge but from the philosophical side also. In the second quarter of the century Scottish philosophy turned from reason to feeling, both as the basis of morals, and as the mainspring of action. On this foundation was developed a sophisticated theory of society and history, as well as a school of sentimental novel-writing … Scottish social thinkers discerned a relation between social life and the quality of sensibility. History was a process involving a gradual refinement of feeling.

(Lawrence, 1979, pp. 28–9)

The social implications of such thinking – found, for example, in the writings of such leading authors of the Scottish Enlightenment as David Hume (1711–76) and Adam Smith (1723–90) – were clear. Uncivilised populations and the labouring poor were regarded as devoid of sensibility, their skin, muscles and nerves being different from those of refined people. At the medical level, they were thus unlikely to develop nervous conditions. It is not surprising then that we find a clear distinction between the needs of different patients in Cullen's practice. Stomach problems, menstrual disorders, colic, hysteria and gout were the chronic ailments that characteristically afflicted his wealthy, private patients. In such cases, the best solution was to restore the balance of the nervous system through exercise, diet and the appropriate degree of stimulation. By contrast, poor, hard-working people could not afford to be as fussy about their health as the wealthy; nor could society in general, as Cullen explained:

Happily their manner of life and even their hardships are the best means of preserving their health. It is true that this is not universal and many men are doomed to employments more or less directly pernicious to health, but it is necessary for the good of the whole society, and the only compensation the society can make to them is the taking the greatest care of them, in disease and old age.

(quoted in Stott, 1987, p. 140)

Thus, political thought and medical theories successfully interacted in providing ‘rational’ justification for contemporary social hierarchy.

Finally, we might ask, what impact did the model of the sensible body have on therapy? Once again, the picture is a mixed one. As studies in electricity grew in the 1740s and 1750s, a link between nervous excitement and the regenerative and therapeutic value of electrical force was established. Machines generating shocks were devised and applied to cure a range of illnesses, including hysteria and paralysis. By acquiring one of these machines in 1750, the Edinburgh Infirmary made electric shock therapy available to the sick poor. As one physician observed, servants through ‘continual intercourse with people of decent manners’ acquired a ‘delicacy of body and sensibility of mind’ similar to that displayed by their employers (Risse, 1988, pp. 11, 15). However, following initial interest, learned physicians across Europe tended to become sceptical about the benefits of electrical therapy, which subsequently became the preserve of the numerous non-learned medical practitioners who thrived in the commercial economy of the late eighteenth century. Cullen did recommend electric shock treatment, but his favourite remedies to strengthen or relax the nerves were still diet, exercise, change of air and taking the waters. You may remember from the reading in Exercise 1 that to treat the servant Janet, Cullen prescribed the tried and tested procedures of applying fomentations, bloodletting and blistering. True, the rationale for these treatments had changed; by their use, Cullen was seeking to stimulate the nervous system, not purge the body. But for most of his patients, the notion of disease as the result of extreme hot or cold, humoral imbalance, impeded evacuations and blockage of the free flow of fluids still held true. Cullen's blisters and emetics were at one and the same time both innovative and traditional.


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