‘The Medical Marketplace of the Eighteenth Century’ Lecture 1 Medicine, Disease and Society in Britain,

Lecture Outline 1.Components of the Medical Marketplace 2.Medical Practice 3.Contexts and Structures of Medical Practice (different forms of doctors) –3-Tier and its Collapse 4.New provisions of the Eighteenth Century –Self help –Charity and Hospitals –‘Quackery’

James Gillray, ‘The Cow Pock’ (1802).

(1739) Elizabeth Montagu, ‘I have swallowed the weight of an Apothecary in medicine, and what I am better for it, except more patient and less credulous, I know not. I have learnt to bear my infirmaries and not to trust to the skills of physicians for curing them’. ( ) Leading surgeon-anatomist, Matthew Baillie, ‘I know better perhaps than another man, from my knowledge of anatomy, how to discover disease, but when I have done so, I don’t know better how to cure it!’ (1784) Physician, John Berkenhout, ‘I do not deny that many lives might be saved – by the skilful administration of proper medicine; but a thousand undisputable facts convince me, that the present established practice of physic in England is infinitely destructive of the lives of his Majesty’s subjects. I prefer that practice of old women, because they do not sport with edged tools; being unacquainted with the powerful articles of the Materia Medica’. Medical Encounters

Advantages of the Medical Marketplace Model: (a) It provides the opportunity to place medical practice within a range of economic and social activities, to look at access to medical treatment in terms of wealth and the ability to pay, at local contexts, to explore how patients chose certain practitioners for certain ailments. (b) It allows us to shift our focus to the patient. (c) It also solves the problem of deciding who was a qualified doctor and who wasn’t.

Objections to the Medical Marketplace Model: (a) Where we drawn the line? Do we, for example, include a grocer who happened to sell drugs, or a helpful neighbour who occasionally delivered babies? (b) Does it offer a way of distinguishing in terms if skill and expertise? (c) Do we include the fraudulent, the ineffective, and how can this be judged? (d) How much choice did patients really have?

Eighteenth Century medicine.

A Visit to the Doctor (Thomas Rowlandson).

‘Medico-chirurgus’, A Letter addressed to the Medical Profession on the Encroachments on the Practice of the Surgeon-Apothecary by a New Set of Physicians (London, 1826).

3-Tier Hierarchy of Practitioners Physicians Surgeons Apothecaries

How Merrily We Live That Doctors Be (Robert Dighton).

The Company of Undertakers (William Hogarth), 1737.

Barber-Surgeons, 1752 (Hogarth)

Patient power. Goldsmith, the physician, leaves in a huff because the patient prefers to follow the advice of the apothecary.

1783 Medical Register list of practitioners Physicians % Surgeons792.5% Apothecaries642% Surgeon apothecaries2, % Total practitioners 3,120

A quack and his patient (William Gillray), c

‘ Doctor Botherum’, perhaps based on Doctor Bossy, sells his ware to a raucous crowd with the aid of assistants. Coloured engraving by T. Rowlandson, 1800.

Humoral theory HumourSeasonElementOrganQualitiesAncient name Bloodspringairliverwarm & moistsanguine Yellow bilesummerfire gall bladder warm & drycholeric Black bileautumnearthspleencold & drymelancholic Phlegmwinterwaterbrain/lungscold & moistphlegmatic

James Gillray, ‘Breathing a Vein’ (1804).

- Westminster (1720) - Guy’s (1724) - St George’s (1733) - London (1740) - Middlesex (1745) - Edinburgh Royal Infirmary (1729) - Winchester (1736-7) - Bristol (1736-7) - York (1740) - Exeter (1741) - Bath (1742) - Northampton (1743) Eighteenth Century Hospitals

Middlesex Hospital, London, early 19 th Century.

Doncaster Dispensary, These images show the small, simple premises that housed the institution in the mid-nineteenth century.

Conclusion Breadth of eighteenth century medical practice Rise in number of practitioners due to: –Consumer boom –Enlightenment thinking NOT: –Advances in treatment –Professional reform With boom came bust – not all practitioners were able to survive in such a competitive marketplace. Importantly, market was demand-led