Quack Medicine in Georgian England

Roy Porter looks into medicine in Georgian England where sufferers from the 'Glimmering of the Gizzard' the 'Quavering of the Kidneys' and the 'Wambling Trot' could choose their cures from a cornucopia of remedies.

William Hogarth: Marriage à-la-mode: The Visit to the Quack Doctor, 1743In Georgian England, a medical orthodoxy existed which was socially well-defined and institutionally identified, in London at least, with the three-tiered hierarchy of the College of Physicians, the Incorporation of Surgeons and the Apothecaries' Company. In terms of individual practitioners, it was typified by the university educated physician, who practised physic as a liberal science; the surgeon, who had trained by apprenticeship or, increasingly, at Edinburgh University, and who practised a manual craft; and the apothecary who kept shop.

Around and beneath these regulars, an enormous range of other groups had provided medical services time out of mind, – wise-women, midwives, nurses, Lady Bountifuls, horse-doctors, chemists, grocers, itinerant pedlars – a list constituting a perennial penumbra of respectable and tolerated irregular.'

But in addition, there was another important medical presence in Georgian England, men such as Sir William Read, the Chevalier Taylor, Joshua ('Spot') Ward, Sir John Hill, Ebenezer Sibly, James Graham, and Dr William Brodum, many of them household names but for whom the common term was 'quack'.

'Quack' was and is a term of abuse, carrying the same kind of emotional venom as, in their own contexts, insults like heretic, revisionist, dunce, scab. When flung -- as it commonly was -- by Georgian physicians and their friends against the likes of Ward and Graham, it levelled two particular charges. It pointed a finger against incompetence: quacks are all mouth and no skill. It also branded a man as a fraud, a cheat, or, in Ben Jonson's inimitable phrase, a 'turdy-facy- nasty-paty-fartical rogue'. Dr Johnson's Dictionary summarises both charges, defining a quack as:

1. A boastful pretender to arts which he does not understand. 2. A vain boastful pretender to physic, one who proclaims his own Medical abilities in public places. 3. An artful, tricking practitioner in Physic.

Not surprisingly, perhaps, medical historians such as L.R.C. Agnew have taken quacks in the same light:

I find it difficult to be objective about quackery – even quackery in seventeenth-century England. I do not like quacks; indeed, I despise them, and while I recognise that an occasional quack remedy or belief has been imported into orthodox medicine, I cannot evince the least sympathy for the breed, those crab lice that have feasted parasitically on the body medical since the very beginning of recorded medical history'.

Quacks are thus generally regarded as frauds. The problem with the 'fraud test', however, for separating out regular saints from quackish sinners is that, when it comes to the vast majority of individual cases, it readily breaks down. Take the likes of the Chevalier Taylor, James Graham or Ebenezer Sibly; it is difficult to deny that such operators, far from being out to dupe the public, had enormous faith in their own cures and skills; they were fanatics not frauds.

And similar difficulties arise with other criteria we might use to segregate the sheep from the goats.

Thus we might propose to define the 'regulars' as those who had received a medical training at university, whereas quacks had not. But what then of a man like James Graham who had studied for a year or two at Edinburgh under Cullen and Monro? Or what of 'Dr' John Hill, 'Dr' Ebenezer Sibly, 'Dr' William Brodum all sporting bona fide medical degrees? Admittedly, these degrees were purchased, from St Andrews University, but many regulars like- wise had got their MDs by the same route, from the same mercenary Scottish university. We might suggest that the acid test is that quack nostrums were worthless, or even deleterious, whereas regular physic cured, relieved, or at least, following the Hippocratic injunction, did no harm. But that test breaks down too. Eighteenth-century cures, whether regular or irregular, seem to have depended heavily upon nature's healing power or the placebo effect, and the relatively small number of genuinely effective ingredients – such as opium for dulling pain, mercury for syphilis, or bark or antimony as febrifuges – tended to be common to faculty and quack remedies alike (indeed one of the grouses of the medical colleges was that quacks pilfered from the official pharmacopoeia).

Was not then the real evil of quack medicine its secrecy (regulars, on the other hand, using preparations whose recipes were published)? But even this test fails. Certainly quacks were far more likely to cash in on secret nostrums. Yet many patented their nostrums, which entailed making the formula public. And of course it was not only quacks who patented nostrums – it was, after all, the highly respectable late Stuart physician and scientist Nehemiah Grew who took out a patent on Epsom Salts. And it was not just quacks who were nostrum mongers, for regulars thought nothing of promoting medicines either; witness this letter from John Hunter to Edward Jenner on Jenner's new tartar emetic:

Dear Jenner, – I am puffing of your tartar as the tartar of all tartars, and have given it to several physicians to make trial, but have had no account yet of the success. Had you not better let a book-seller have it to sell, as Glass of Oxford did his magnesia? Let it be called Jenner's Tartar Emetic, or anybody's else that you please.

And then what are we to make of Dr James' powders, the eighteenth- century favourite, yet most dangerous, fever remedy? These powders were patented, but the specification was made defective so as to conceal their contents. Yet they were the promotion, and made the fortune, of Dr Robert James, Oxford-educated, highly-respected author of the century's premier Medicinal Dictionary, and friend of Samuel Johnson.

If the mark of the beast setting quacks apart from proper practitioners is either fraudulence, or incompetence, the demarcation dissolves in confusion. Many of those called quacks were, in their various ways, well-intentioned and skilful. In any case, the Georgian regulars were not exactly spotless in these respects. Not a few anecdotes of leading physicians such as Dr John Radcliffe record them freely admitting in their cups that most of their medicine or therapy was useless (and yet they were happy to make vast takings out of it). And satirists and the sick both tended to view regulars and quacks as Cox and Box, tarring both with the same brush. If quacks were guilty of showmanship and mystification, what of the regulars with their Latin mumbo-jumbo, their ancestor worship of Hippocrates and Galen, their carriages and running-footmen? The public was often scathing about the impostures of quacks; but so could they also be about regulars. In his influential handbook, The London Tradesman, Robert Campbell offered the following disillusioned 'receipt to make a modern doctor':

To acquire this Art of Physic, requires only being acquainted with a few Books, to become Master of a few Aphorisms and Commonplace Observations, to purchase a Latin Diploma from some Mercenary College, to step into a neat Chariot and put on a grave Face, a Sword and a long wig; then MD is flourished to the Name, the pert Coxcomb is dubbed a Doctor, and has a License to kill as many as trust him with their Health.

Ambivalent though the Georgian public felt about quackery, they were sure the faculty had its own quackery too.

We cannot, as historians, simply cordon off the quacks as cheats and bunglers. We might argue that quack medicine is best seen as the Georgian manifestation of 'alternative medicine'. Eighteenth century quacks, mountebanks, and empirics could take their place in the roll of honour of the medical fringe down the ages, slotted in somewhere between the Paracelsists, Van Helmontians and Puritan medical reformers and that mushrooming of fringe medical sects, embracing alternative cosmologies and radical politics, which formed so dynamic a part of the Victorian medical scene.

Yet this placing does not seem to work either. That there were genuine expressions of underground Behemenism and Swedenborgianism, associated with religious dissent and embodied in spiritual healing is undeniable. But it would be a. mistake to see the culture of the quacks in this light. For the key point about the top Georgian quacks is that they were not absolute against orthodoxy, promoting radical alternatives. To risk a vast generalisation, the leading quacks and empirics of the eighteenth century attached themselves to the physic of the faculty as much as they attacked it.

In contrast to the assaults so much Victorian fringe medicine made against political oppression, social decadence, luxury and corruption, professional monopoly, and the diseases these all bred, eighteenth- century quackery emulated, assimilated and cashed in on the values of fashionable élite Enlightenment society. The labels of their medicine bottles read like a medical Burke's Peerage. Alongside Sintelaer's Royal Decachor you could try James Graham's Imperial Pills or Samuel Major's Imperial Snuff; then there was the Duke of Portland's Powder to treat that aristocratic disease, gout, and Lady Moor's Drops. Their proprietary names also show deference towards established seats of learning – you could buy Oxon Pills for scurvy (what else?) – and to top doctors and scientists. Dr Boerhaave's Aurea Medicina, for example could be had alongside Dr Radcliffe's Famous Purging Elixir. Similarly, the 'Chevalier' Taylor endlessly name-dropped the geniuses he had met on his travels – Boerhaave, Haller, Morgagni, Wimslow, Monro, Linnaeus and the Hunters – dedicating his book on the diseases of the eye (1749) to the Royal College of Physicians of Edinburgh. A show of up-to-the-minute science was clearly thought vital by Gustavus Katterfelto, who claimed expertise in the 'Philosophical, Mathematical, Optical, Magnetical, Electrical, Physical, Chemical, Pneumatic, Hydraulic, Hydrostatic, Proetic, Stenographic, laenical and Caprimatic Arts'.

In fact, Georgian commercial medicine traded heavily on the cachet of established values. Thus plenty of them conjured up the aura of religious healing, using such titles as the Pulvis Benedictus ('rather a miracle than a medicine'), the Anodyne Necklaces manufactured from the 'bones of St Hugh', and Fuller's Benedictine Medicine and most explicitly of all, Dr. Trigg's Golden Vatican Pill, at two shilings a box. And a high percentage appropriated the prestige of classical learning by weaving Latin and Greek into their titles, by-lines and advertising copy, as with the Elixir Magnum Stornachicum of Richard Stoughton, Dr Pordage's Pilulae Scorbuticae, Bromfield's Pilulae in Omnes Morbos, and Lockyer's Pilulae Radiis Solis Extractae.

As the messages of all such names might suggest, Georgian quacks did not want to shake the foundations of the medical and social citadels but rather insinuate their way into them, and these aspirations are evident in their ambitions, behaviour and achievements. For many Georgian quacks were remarkably successful in rising almost from rags to riches, fame, recognition, honours and even title. William Read – 'the most laborious advertiser of his time', according to Joseph Addison – began life as a tailor, turned himself into a successful oculist, made a fortune, treated Queen Anne (for which he was knighted in 1705), and became friend and host to the literati of his day. His fellow oculist, John Taylor, rose from a modest start as a Norwich surgeon's son to become the most feted and narcissistic operator in Europe, a sort of Casanova of the eye. Or what of Joshua ('Spot') Ward? From the profits of his Pill and Drop, Ward was able to turn himself into a respected philanthropist, endowing at least four London 'hospitals' for the reception of the sick poor; his medicines came to be designated regulation issue for the navy; and he won the gratitude and friendship of notables such as Lord Chesterfield, Edward Gibbon and Henry Fielding. Having successfully manipulated George II's dislocated thumb (the royal physicians had diagnosed gout), he won entree at court, gained the privilege of driving his carriage in St James' Park, and got unique exemption from having his preparations inspected by the College of Physicians. Quacks were often assailed by regulars as a 'vile race', yet they could easily win favour amongst fashionable patrons. If Georgian quacks were outsiders, they were outsiders not, like a true fringe, by inclination, and mostly they sought social acceptance and recognition.

Georgian quacks were not just ignorant frauds or a fringe avant la lettre. New socio-economic opportunities and pressures in the eighteenth century were important in shaping the whole range of medical practice under the Georges. William Hunter, who won fame and fortune out of his anatomy school, and William Battie, who made huge profits from the proceeds of a private lunatic asylum while serving as President of the College of Physicians, demonstrate that others besides quacks were up to their chins in the commercial developments of medicine. Of course, in the wider medical market place, regularly educated physicians and surgeons were more likely to have standard channels of advancement at their disposal, not least the grapevine and patronage networks of polite society, through which to maximise their economic opportunities, which were growing rosier by the year. The quack by contrast was initially less favoured. Necessarily a self-made man, he had to approach the open market in directly entreprenurial ways, winning a medical livelihood as the opportunities offered, through spectacle and showmanship, and the development of the business of selling medical commodities.

There seem to be four main reasons for the success of quacks in the eighteenth century. The first of these is the low therapeutic efficacy of Georgian medicine. The writings of contemporary doctors, and especially sufferers and their circles, the Bills of Mortality, and the findings of today's historical demographers agree in showing just how feebly Georgian medicine coped with the decimating diseases of the day: epidemic fever, puerperal fever, the gastro-enteric diseases of infancy, and, increasingly, tuberculosis. Today's nuisance like measles was a killer in the world we have lost. When diseases decimate and regular medicine is not reliable, people try anything – folk brews, proprietary medicines, quack remedies. Diaries and letters suggest that sufferers kept open minds. Many mocked quack remedies; some swore by them, as Horace Walpole with his 'superstitious reverence' for Dr James' Powders ('for cough – for gout – for smallpox – for everything'). But patients sometimes found regular medicine hard to swallow. As Dudley Ryder put it:

If one could get off only with the charge of the physic it might be tolerable, but to fill one's belly and load one's stomach with useless medicines is dangerous.

In such circumstances, therefore, quack medicine could vie with regular on terms somewhat approaching parity.

Such competition would have been of little practical significance in a medical polity in which regular medicine had the whip hand. Conventional medical histories sometimes depict the Georgian medical power structure in rather similar terms, noting not least that the College of Physicians and Surgeons were legally empowered to restrict their own membership and to limit to their own licensees the lucrative London trade, where after all the richest pickings were. Certainly the College of Physicians energetically enforced its rights to prosecute pirates throughout the Stuart century, and it would be most tempting to paint a picture of ancien régime practice as a closed, oligarchic world of Old Corruption about to be, wept away by the liberal, individualistic reformism, spearheaded by Wakley and the Lancet early in the nineteenth century, opening the medical career to the talents. Yet that is myth, indeed pretty much the reverse of the truth" for the real point about the practice of medicine in Georgian England is how free it was. Outside London, practically no restrictions applied; there was no medical register, no licensing system, no penalties for irregulars. And within the metropolis, though admission to the Colleges remained grossly restricted, turning them increasingly clubby, the Colleges in fact abandoned their role of medical policing, and thus left quacks to practise with impunity. This contrasted with France, where the Société Royale de Mâdecine energetically exercised its right to analyse and regulate nostrums, or with German principalities, where medical police bureaucracies hammered quackery. Samuel Hahnemann, the founder of homoeopathy, found it necessary to go on his travels, and Mesmer was more or less driven from Vienna and Paris; but in laissez-faire London, no one interfered with the early Mesmerists, with James Graham in his Temple of Health at the Adelphi, or with any other quack.

Indeed, by a curious quirk, quacks could actually bask in official approval of a kind, much to the faculty's fury. For foreign mountebanks could obtain royal licences to practise in England. And increasingly during the Georgian period, quacks took out legal patents for their nostrums ('licences to kill', John Corry called them). In any case, all nostrums paid stamp duty: all these state interventions were represented by empirics as tokens of royal blessing, the highest of all testimonials.

The task was made easier by a force in the medical world to which Nicholas Jewson has drawn our attention, viz patient power. Jewson has rightly pointed out that before the remarkable transformations of diagnostic technology and medical specialism which the nineteenth century brought, before the emergence of united professional peer-group organisation and of institutions such as hospitals, regular physicians were to a large degree the clients of fashionable patients, dependent upon them, more than on their peers, for career advancement. In the old world where medical humoralism reigned supreme, regular doctors were still remarkably beholden to the patient for specifying his symptoms, his sickness and even his treatment. In these encounters where he who paid the piper largely called the tune, regulars could be as patient-dependent as we generally think quacks have to be. Where the lay customer exercises large powers of the purse and patron- age, distinctions between professional and irregular will count for little, and quacks will flourish who are adept at pandering to patients who want pampering. Little wonder that the golden age of the quack was the golden age of malades imaginaries, of hypochondria and nervous diseases, which made the fortunes of regulars (such as George Cheyne) and quacks (such as Graham) alike. It is an interesting testimony to patient power that in his pioneering Medical Ethics published in 1803, Thomas Percival felt the need frankly to advise physicians that if a patient was attached to a favourite quack nostrum, it was prudent to allow it to be prescribed.

It was an age of golden opportunity for cultivating the business side of medicine. Social and economic historians have recently argued that Georgian England witnessed the birth of the consumer society, a time when the middling classes from artisans upwards increasingly had spare cash in their pockets, and were eager, or grew conditioned, in a materialist, money-oriented society, to splash out on goods and services. The market responded. Vast improvements in communications, in wholesale networks and in retail outlets, in promotions and publicity, made commodities available in a range and quantity unheard of before. Particularly important was the emergence of nationally available brand-name items, such as Wedgewood ceramics. In this process, the marketing of medical services, and in particular nostrums, as commodities, played no small part.

Three aspects are worth emphasising. First quacks showed an eye to the main chance in exploiting new market opportunities, especially in orienting their appeal to the affluent and fashionable. The typical Tudor or Stuart quack was a one-man-and-his-zany outfit, an individual mountebank who threw down his cloak in the market place. The patter was low, because the punters were. Note the vernacular of a quack bill headed The Wonderful Doctrines (1677) which offered to cure 'the Glimmering of the Gizzard, the Quavering of the Kidneys and the Wambling Trot'. But during the eighteenth century a sprinkling of upmarket quacks emerged – James Graham in particular comes to mind – who were consummately skilled showmen, as deft at making an appeal to sophisticated and fashionable audiences as were Garrick or Whitetield on the stage or in the pulpit. Graham's Temple of Health at the Adelphi, where he gave his risqué sex-advice lectures – a treasure dome housing statues, lights, music, art, trompe l'oeil, with its centre piece, the Celestial Bed, guaranteed to ensure fertility – involved a heavy outlay, took large amounts of money, and was for a season the talk of the town. Secondly the course of quack medicine involved a trend from personal service to the permanent medical commodity. The sixteenth- or seventeenth-century charlatan performed in person, made up and sold his own medicines. Increasingly, however, the focus shifted from the operator to the medicine itself. A shelf-full of nostrums became house- hold names – 'Dr James' Powders', 'Anderson's Scots Pills', 'Hooper's Female Pills', 'Turlington's Pills', 'Daffy's Elixir', 'Stoughton's Great Cordial Elixir' (advertised as 'approved by about twenty Eminent Physicians of the College'), 'Godfrey's Cordial', Joshuua Ward's Pill and Drop', 'Velno’s Vegetable table Syrup'. These nostrums were given saturation advertising, and they seem to have sold in vast quantities. Dr Robert James, for instance, claimed that in twenty years he sold some 1,612,800 doses of his powders.

The emergence of these nostrums as nationwide brand-name best sellers presupposes publicity and marketing, the third dimension of quack commercial acumen to warrant notice. What Oliver Goldsmith called the 'advertising physicians' had great bravura in marketing, packaging and inventive hard-sell, soft-soft copy – no gimmick was missed: no cure, no money; bargain packs, free pamphlets with every purchase or a silver measuring spoon, sugar-coated pills, violin-shaped bottles, treatment gratis for unfortunates or soldiers returning from the wars, and so forth. What must be stressed is the sheer density of quack advertising after the Restoration. Initially advertising was by hand-bills, coffee-shop notices and wall posters:

... it is incredible, and scarce to be imagin'd (wrote Defoe in his Journal of the Plague Year) how the Posts of Houses, and Corners of Streets were plaster'd over with Doctors Bills, and Papers of ignorant Fellows; quacking and tampering in Physick, and inviting the People to come to them for Remedies.

But then the nostrum-mongers endlessly exploited the opportunities of that crucial new Georgian medium, the newspaper. Newspapers were vital to nostrum sales, providing not just publicity but also sales outlets. Newspaper offices acted as depots for their sale, and newspaper deliverers often routinely delivered parcels of nostrums. The links between quacks and the publishing industry were intimate, even insidious. Take the career of John Newbery, newspaper proprietor, patent medicine wholesaler, and pioneer commercialiser of childhood through the development of children's books. The most famous children's book he published, Goody Two-Shoes, possibly written by Dr Oliver Goldsmith, contains a quite explicit internal puff on its very first page:

How and about Little Margery and her Brother

Care and Discontent shortened the Days of Little Margery's Father. – He was forced from his Family, and seized with a violent Fever in a Place where Dr James's Powder was not to be had, and where be died miserably.

Without quack ads, many newspapers would have gone bankrupt; without the constant barrage of publicity newspapers afforded, nostrums vending could never have become big- business.

One consequence was that many quacks grew rich – Dr Myersbach, against whom John Coakley Lettsom battled, allegedly gained 'a fortune equal to that of a German prince' – and moved into high society. At a relatively modest level, Nathaniel Godbold, promotor of a successful 'Vegetable Balsam', started life as a baker, and eventually cleared £10,000 a year from the sale of his potion, buying a large country house near Godalming for £30,000.

Our grasp of the social history of medicine still remains patchy. We are beginning to get an integrated view of orthodox medicine's changing profile as it shifted from the traditional three-tier system into what by the late nineteenth century had become the now familiar world of GPs and consultants. We still lark, however, adequate vocabulary and categories for the many mansions of irregular medicine, and as yet we have little feel for its historical traditions, continuities, breaks and transformations. One key element of such an enterprise is to gain an adequate historical notion – neither judgemental nor anecdotal – of what quackery was all about. What was habitually labelled quackery should best be understood as the emergence of a flourishing market sector of medicine. In their relations to medical orthodoxy, Georgian quacks were less in collision than in collusion; or despite polemics and superficial polarities, the culture of the quacks was more a reflection than a repudiation of that of the regulars. And in regard to what later emerged as the medical fringe, it seems Georgian quacks were not the forerunners of Victorian alternative medicine, not the 'roots of Boots'. More likely we will find that Georgian quacks represented the pioneer stage of capitalist medicine.