nm5163: so okay we're doing the medical market place and we've all read Roy 
Porter
sf5164: no
nm5163: you haven't read Porter oh what you have done then
sf5164: i've read er the ones that are on the back of it i did try but it 
wasn't in the original yesterday and i was writing this yesterday
nm5163: okay so you had to do what you had to do okay 
sf5164: yeah
nm5163: okay you but namex you've read the Porter and you 
sf5165: yes
nm5163: okay right okay
sf5164: okay er it will be a bit longer than ten minutes because i've got a 
really long quote but if it is not allowed for more than ten minutes i'll 
nm5163: no we'll forgive you we'll forgive you
sf5164: a bit irrelevant but i liked it anyway er 
nm5163: okay
sf5164: okay er the medical marketplace was concerned with the purchasing of 
medical services and goods the eighteenth century economic conditions offered 
the possibility of social mobility resulting in commercialisation and 
consumerism medicine was one of the many commodities that began to be marketed 
on a wide scale interest in how medicine in the body grew in the eighteenth 
century as is illustrated by the increase in the number of medical texts and 
commentaries and the frequent references to health and personal resources ill 
health was frequent in the eighteenth century and could easily spiral into 
death and was a major worry this all contributed to the buoyant market in 
medicine i shall consider why the market place emerged in the eighteenth 
century who practised medicine in the services on offer the consumer demand and 
advertising and the fashion of medicine by considering the patient practitioner 
relationship and why was the medical market place aiming to emerge in the 
eighteenth century during the eighteenth century health and medicine became a 
much more prominent and central part in people's lives it was able to do this 
because of changes in interpretations of what meant to be ill and because of 
changes in economic circumstances the Enlightenment changed the traditional 
pessimi, pessimistic Christian view of the world and began to replace it with 
more rational positive interpretation championed by [giggles] the Christian 
wealthy who held that illness is a cross to be born while Morris Stevens 
suggested that ill health was a positive thing because it encouraged people to 
turn inwards and concentrate on the next wor-, world the philosophs rejected 
this and offered a view in which people were able to control their lives 
without the aid of divine grace they believed people needed to be fit and 
healthy to fill their potential and suggested that people were able to control 
or at least influence their health themselves coupled with this change in 
outlook was a growth in the knowledge of medicine and in consumerism as it 
develop-, as a development or reflection of the Habermasian bourgeois public 
sphere printing increased the potential market and interest in the knowledge of 
medicine at the same time medical iss-, issues featured prominently in books 
and journals of the period and can be seen in the growing popular interest in 
science but namex's term and use of the expression recriproc-, reciproci-, 
[giggles] you know what i mean
nm5163: reciprocity
sf5164: yeah and exchange of ideas services and products creating and 
environment which allowed for the creation of large scale medical market place 
more people were selling goods and labour for money rather than for other goods 
or favours and the money was then used to buy services and that included 
medical ones there was an auto-diological context to producing goods and God's 
influence on human lives coupled with the increasing demand and the 
availability of medical goods and services which resulted in the growth of the 
medical market place that's all from Brockhurst and Jones chapter six part c 
now who practised medicine and what services were available there are three 
orders of orthodox medical practitioners physicians surgeons and apothecaries 
physicians were usually university educated and most qualified to practise 
physic which was concerned with internal medicine much of their university 
education was from books although oxford and Cambridge required their students 
to complete a period of apprenticeship before they were awarded their M-D this 
is not necessarily the case in universities on the continent they gave advice 
on how to prevent illnesses during times of good health during the eighteenth 
century an increasing amount of their time was spent giving advice to the sick 
they diagnosed and prescribed often calling in surgeons or apothecarys to treat 
their diagnosis under their supervision eighteenth century diagnosis is very 
different to modern diagnosis the physician would firstly diagnose an illness 
by its symptoms and name it however unlike modern medicine the naming did not 
give did not point to a specific course of action the illness could have 
occurred because of any number of combinations of six non-naturals which are 
air diet evacuation exercise sleep and mental and emotional stimulation the 
doctor had to identify by reason the course of the illness by the imbalance of 
the non-naturals which could change in each case the physician then needed to 
maintain the balance of the pa-, patient's body recommend and to restore 
internal health to keep it in harmony with the external world in order to treat 
patients physicians had to know about the patient's lifestyle the healing 
powers of nature and the actions of drugs and physical remedies like bleeding 
the doctor may have prescribed medicines in the form of lotions syrups pills or 
powders and remedies of pulses alternatively he may have suggested fresh air 
and exercise or a trip to a spa town spa towns could be found throughout the 
country and on the continent and many healthy and ill people either bathed or 
drank the waters which were thought to have healing properties if neither of 
these approaches were appropriate a surgeon may have to be called in in the 
case of charlotte Banbury wife of the eighth Earl of Banbury the symptom was a 
headache in eighteen-twelve the most suitable treatment was deemed to be 
bleeding followed by the placing of five leeches on each of her temples
nm5163: surgeons 
sf5164: surgeons dealt with the external body their concern external diseases 
for examples skin diseases lumps bumps and broken bone in London the surgeons 
were limited to setting bones healing outward sores and applying topical creams 
carrying out bleeding and undertaking operations such as amputations and 
cutting of the gallstones surgeons were empirically trained in positions on 
their own theory having learned their trade by apprenticeship like workmen 
physicians acknowledged that this was the most appropriate way for surgeons to 
be trained because they dealt with specific problems such as broken bones and 
not with individual cases dependent on the number of factors leading to the 
knowledge and education of the physician there were some highly trained 
surgeons in London Edinburgh Paris and other large cities who disassociated 
themselves from the work-based surgeons and stressed their book learning and 
detailed anatomical knowledge gained by dissection surgeons were also present 
at difficult births since the 1730s account by a Yorkshire gentleman who'd 
wanted to become a doctor after about two in the afternoon my dearest A G the 
most tedious and dangerous labour she was not feeling well before June the 
fourteenth about half an hour past three in the afternoon the child a boy was 
dead and lay across the birth with its arm forward which made it necessary i 
suppose his death not being perfectly known to turn it in order for a more 
natural posture but unfortunately in the operation the charge flew up so high 
and continued from then to run away perpetually that the surgeon could not 
possibly lay hold of it again with any firmness and after three several efforts 
to no purpose which my poor dear bore with a patient resolution and resignation 
that that was truly truly surprising i prepared and sit down once more by the 
help of his instruments tear the child in pieces and bring it away in a natural 
manner the event beyond expectation after a tedious and terrible operation in 
which the surgeon seemed tired in afflicting her and she was in suffering he 
rose from his knees to refresh himself and then returning to his business broke 
into the abdomen of th-, of the child with his instruments and then extracted 
the bowels and other viscera and broke parts o-, and broke off parts of the rib 
this evacuation made room in the uterus for him to insinuate his arm between 
the belly of the child which was the size of the collapsed womb by which means 
he got hold of the feet of the child which had turned quite upwards almost as 
high as the diaphragm with as much violence as he dare use for fear of breaking 
the child in the back which was much weakened by the course of the mid but 
happily under the providence of God he extracted the remains of this mangled 
carcass except the arm which first presented itself and had been cut off as 
soon as the child's death was perceived these measures were taken in an attempt 
to save the mother that women were traditionally present at birth was 
increasing during the eighteenth century women who could afford to hired a male 
midwife as males in the job training increased the women not been capable of 
successfully completing it women were also considered incapable of handling 
many instruments such as forceps and were legally not allowed to do so the 
quote al-, also shows the place of God alongside the ne-, preferred new science 
the apothecaries the apothecary trade developed in the physi-, physic physician 
by dispensing drugs and continued to do in the eighteenth century but were 
practicing medicine and prescribing themselves as well in eighteen-o-six the 
eighth Earl of Banbury's son was constantly attended by an apothecary whilst 
suffering from a hefty bowel complaint the apothecaries charged less than a 
physician treated less weal-, less wealth patients than an apprenticed trained 
specialist the number of practitioners specialised as dentists midwives 
opticians hermiologists or herbalists the rise of medical literature opened up 
a new possibility of treatment for the first time doctors and patients could 
interact when not face to face medical books gave basic advice so people could 
make judgements about about medical practitioners and some illnesses they also 
provided home-made remedies the scale and degree of medical independence of the 
readers made them more critical of practitioners in reality providing a line 
between different medical occupations was much clear cut as this description 
suggests and was becoming more blurred as the century progressed in both 
England and France although there were clear definitions of what physics 
surgeons and apothecaries could do surgeons and apo-, apothecaries frequently 
encroached on the physician's territory and many surgeons and apothecaries knew 
a great deal of medicine gained from experience and practised generally 
although originally on low-, lower ranked patients 
nm5163: is that the end of a section are you coming to the par-, 
sf5164: not quite
nm5163: okay you can do it till there and then we can talk about that and then 
we'll get back to you
sf5164: okay right er okay er what did i just say i've lost where i was er 
there yeah 
nm5163: you were just finishing about the self help
sf5164: okay in English common law anyone could practise medicine as long as 
they had patient consent however if the patient died and it was found that the 
practitioner was unlicensed he could be charged with a felony patients were 
relatively free to choose a medical practitioner the eighteenth century offered 
a range of healing resources but access to them was not unrestricted the sort 
of healing you sought often depended on where you lived if you lived in the 
countryside traditional healing made it a more likely port of call than a 
physician medicine on the rural areas on the type of medical treatment you 
sought was likely to result in an ideology prevented the use of some medical 
treatments more influential was probably whether you could afford the 
prescription that a treatment prescribed alongside university trained 
physicians there was still a predominantly a market for traditional healers 
gained the reputation for being skilled healers within their community a bit 
about the Paris faculty which isn't totally relevant to that but it's more 
relevant to 
nm5163: yes but that that would be a good spot for us to sort of like er 
discuss where we are er so far so you're sort of painting a picture of you know 
there is there is a medical market place and is fairly dynamic in the 
eighteenth century and then you are sort of like taking us through the 
different sort of corporative er groupings any er yeah er any kind of er how's 
the other's work er any questions or points about 
sm5166: yes i i just just like marked this out the er the sel-, self help 
aspect er because frankly im aware of this because it's in Porter's he mentions 
the the self-help er for the people the the consumer of the medicine were they 
were they were read up about medicine they had huge medicinal chests and 
because of this this gave rise to a a growing market er they didn't just accept 
what the er doctor or the quack wanted to tell them the-, they would they would 
shop around because of this this knowledge they had er 
nm5163: yeah so that's right so print is actually quite important in in helping 
people in helping people to form their own views if you like yeah
sf5165: different views that we have of doctors today because credibility was 
not there completely and the word of the doctor was questioned and was compared 
with other doctors and was talked was talked around so it was not just the law 
of the doctor that people followed
nm5163: yeah so there's lots of there's a range of practitioners that this is 
what what yeah yeah this is what er hiya yeah yeah come on in do you wanna just 
grab a seat er a range of practitioners which er sit in here now er it just 
ruined the continuity here you know ha-ha ha-ha er we're just talking generally 
about the sort er of different types of practitioners and particularly then 
sort of relating it to self-help er so a range of practitioners that people 
turned to does that mean that you'd just sort of turn to anyone at any time 
depending on what your illness is Frankie
sf5164: er generally er the wealthier people tend to go to the er physicians 
because they're sort of the hi-, they consider themselves the highest rank of a 
medical practitioner and they would call in apothecaries or surgeons they 
deemed appropriate
nm5163: so the-, so there is a hierarchy of medicine yeah yeah
sm5166: i just very much er Porter seems to be to infer that tha-, that's may 
be not completely what the truth of the case that er that er the richer the 
people er the quacks also got to them as well if they had some sort of er 
famous famous cure and they often the quacks often worked by er patronages as 
well they got the patronage of the higher classes and then that enabled their 
kind of er product to flood the market
nm5163: yeah i think there's two er er break that down to a sort of er 
association between the rich and physicians i mean clearly physicians charged 
usually h-, quite high fees and although they occasionally do things out of 
charity out of the goodness of their heart usually [sneeze] excuse me usually 
they are looking to er make the-, their living basically aren't they so they 
are always gonna be your know charging fairly hefty er fees so that's gonna put 
them out of the of the range of most er poorer people okay on the other hand 
and so they'll look for other types of practitioners and some of those may be 
er licit ones you know things like surgeons and apothecaries or they may go 
down the road of you know some of these wandering sort of remedy sellers or you 
know or buy up things from from remedy shops or whatever but on the other hand 
it doesn't mean that if you're wealthy you only go to a physician in fact 
that's what i think Porter's pretty good on is showing that er you know people 
might go first to the physician if you like as they expect him usually to be 
you know the best source of form of medical philosophy of course if you're sick 
or you're dying or you're suffering or you're in pain er if the physician 
doesn't work then you might as well try something else really an-, and i think 
studies of wealthy patients show tha-, suggest that you know people go for a 
physician but then they hit the switches you know try anyone you know if you if 
you are suffering basically so it is er as i think as you're presenting this 
picture of a more a fairly open medical market place i think that's 
particularly true of of of England moreover which you've you-, you-, you've 
concentrated on so far than than some of some of the other place on the the 
continent mm er yeah any other points Iris
sf5165: well only the fact medicine itself was in such an early stage that er 
it was still experimenting and so er doctors in this case were as er credible 
as quacks in some aspects and so we don't have the whole truth in our hands
nm5163: so so you think that if you're ill you're as likely to get a decent 
remedy out of a quack as from er a physician because
sf5165: we-, we-, well
nm5163: yeah because medical science is so ropey what do you think
sf5164: it might it might be just as likely to work in many cases but i think 
the er general opinion would be that the more traditional er medical treatment 
would be a bit more sort of er 
nm5163: what do you do you you
sf5165: yeah i think there's a first approach as you said 
nm5163: yeah
sf5165: after failure they go out and se-, and look for something else
nm5163: yeah yeah now what is changing in the eighteenth century because in a 
way you're you're sort of hitting the the er range of practitioners like the 
physicians surgeons apothecaries and self-help i mean er that's been there 
through the ages hasn't it so why is the medical market place in the eighteenth 
century more intense and if so why now you've brought a couple of factors in 
there didn't you one was a sort more of secular view of health that you know 
people aren't so don't have a sort of Christian world world view where they 
sort of accept ill health well i think i can overplay that but you know are 
they sort of more thinking of the here and now so sort of attitudinal changes 
towards health what were the other factors you brought up
sf5164: varying er roles wasn't there and er basically increase in medical 
commodities as well 
nm5163: yeah so a bit of it's a bit of supply and a bit of demand you're saying 
there are these sort of medical entrepreneurs who are out to you know sell 
health you know this is what some of these quacks these charlatans are doing 
are sort of er sort of er using sales techniques to sort of you know get their 
message across but also that wouldn't work i guess if there wasn't a growing 
level of demand for medical services as well so people aren't concerned about 
their health and er you know have a more sort of consumerist attitude towards 
it as well yeah how does fit in with what you wrote in the er Porter
sm5166: yeah there is self-help er and there is demand ther-, ther- is demand 
certainly it came from i and they are sitting in the context of eighteenth 
century in the growing consumer in the eighteenth century i don't know still 
doesn't seem to answer where the market came from apart from automation the 
change in the the religious worldview of people the shift went from the bo-, 
from the soul to the body the people wanted to maintain their body now and and 
provi-, and they wanted providence and providence began to come out of the 
equation
sf5164: i read somewhere that it's something to do with the increase in 
separation of the public and private spheres and as women were pushed into 
their home they were given er more leeway to decorate it and to make it nice er 
nm5163: so they had a medicine chest on the wall
sf5164: they started to buy sort of pictures and ornaments and you know er sets 
of things just grew and there was more emphasis on women sort of being pretty 
and beautiful so they had to buy more clothes and make up and stuff and i-, 
this came from there
nm5163: yeah well where is that coming from why why the people you know that 
that i mean in a way that's sort of describing rather than analysing isn't it 
although may be that's all we can do i don't know it is very difficult to jud-, 
judge where these things are coming from
sf5165: i think the supply is creating demand in this advertising is creating 
demand and creating need for this new medicaments and instruments and all 
nm5163: yeah so when when Porter looks at the you know his chapter on sex he 
says are you is it meeting a demand for you know sexual medical services or in 
fact are you selling your sk-, your your your wares by creating anxiety anxiety 
ie equals demand for more er sexual medical services if you like so yeah i 
think there's sort of it's a sort of chicken and egg thing as well i guess we 
should-, i mean consumerism we should not miss out that capitalism is 
developing in the eighteenth cent apace and that that means that there are more 
commodities coming in you know there's more exotic commodities coming in these 
are establishing themselves in people's everyday lives things like tea and 
coffee you just to look at the number of tea pots and coffee pots and you know 
in fairly lowly homes to see you know that people are changing their attitudes 
towards material er goods but also things like the markets are are getting 
tighter and more active if you like so communications are better er marketing 
arrangements are better you know you could you could produce something 
somewhere and know that you'll find a market on a much bigger scale may be that 
you could a hundred years before so i think i think i'd wanna tie in economic 
change er to it quite closely i don't know if that's answering your
sm5166: what's the level of er communication changes as well because one of the 
things was that er before if you lived out of a big city you had to be reliant 
on the local practitioner whereas with the the emergence of literature 
advertising newspapers was that then people all over the country ha-, could 
suddenly be made aware of er medical products 
nm5163: yes no i think i think that's right i think you want to tie in print 
into the establishment of the market because parti-, as you say particularly 
for medical goods if you if you're ill you know you think of you know people 
down the road or you know in your own household or people you've heard about 
really as as where you'd go for medical care but if you are receiving 
newspapers in which it says do you have you know gallstones or something like 
that have you tried i noticed Jones's friendly pills were cited at one stage in 
Porter's i must try those actually er er then you know that obviously is 
increasing er the market so that means entrepreneurs can produce knowing that 
they've got a bigger market out there which they can reach through print you 
know so in other words not just books although books are important but the 
eighteenth century is the great period of the periodical the newspaper and if 
you look in the bottom of the pages or the back page or wherever of course on 
the Times classically on the front page advert you know so it's a world of 
print and advertisement are definitely important there any other thoughts Cathy 
you know why is there a sort of er denser more active er medical market in the 
eighteenth century do you think
sf5167: well i'm actually so sure that there is er i mean i think people had 
always been concerned about health er and involved on various levels i mean 
particularly the wealthy woman at home who was was always important there were 
sixteenth century gentry women who would go out amongst the community and help 
er the Lady Grace Marmite for example produced her own remedies er on an 
enormous scale so er i think in the sixteenth and seventeenth centuries it was 
also quite normal er to sort of pick and choose depending on the reputation of 
the practitioner
nm5163: yes yes oh yeah sure
sf5167: or perhaps just by chance which one you came across i mean obviously 
there weren't advertisements in the papers in the same way er but er i just 
wonder also whether we put too much emphasis on the role of the consumer and 
whether that's er really a twentieth century notion
nm5163: right so you are saying basically the volu-, ther-, there's there's no 
massive quality of change between the eighteenth century and before 'cause 
people always wanted to be healthy and so they always shopped around if you like
sf5167: i think so
nm5163: obviously they're shopping in a bigger market and there are more of 
them i guess in the eighteenth century 
sf5167: so perhaps there's just a er change in infrastructure and communication 
rather than a change in perceptions of health and dealers er 
nm5163: yes yes and of course i mean the point we we were saying earlier or you 
brought up Frankie that that p-, people move from a religious view to a more er 
secular view actually if you look at people who are intensely religious in the 
eighteenth century when they were ill they wanna get better you know they they 
they do say you know they usually say you know in well in God's hands et cetera 
but they're the ones who write for the remedies as well you know so may be may 
be we make too much of a distinction between a sort of religious world view 
which accepts ill health or prospect of death and a more secular one which er 
which doesn't so how about how about the second point you think may be consumer 
is a twentieth century term rather than er maybe being sort of sort of slightly 
anachronistic to to to sort of see it in the eighteenth or nineteenth century
sf5167: well i just wonder if er really yeah a lot of the stuff about the 
patient practitioner relationship emphasises very much how different that was 
from now and how great the role of the patient was in their actions in sort of 
picking and choosing and i just sort of wondered really whether we tend to put 
too much emphasis on that and forget that there was all sorts of limitations on 
the choices of individual people at the time i mean there was this great 
feeling of offering a variety of different approaches and different remedies 
but perhaps we sort of say too easily that every or most ill people then would 
have sort of actually sat down and thought about which one they were going to 
see perhaps they would just go to see the one that was most the nearest or er 
and not everybody would have necessarily needed to pick and choose and go to 
three or four healers before finding something suitable er any more than they 
do nowadays after all most people accept their doctor don't they i mean you go 
there and do that basically Frankie what what do you think on that
sf5164: er well actually i do a whole section on it later so 
nm5163: oh right so we-, we'll hold back on the discussion here and er can i 
just throw in just one other thing about er i mean i'm not totally persuaded by 
this but it's a sort of interestin-, i think it's an interesting angle er if 
you think about the pattern of diseases up to the seventeenth century sort of 
like late middle ages to the early eighteenth century wha-, er and look at 
patterns of those population pat-, demographic patterns what strikes you is 
that er there are crises of mortality normally and classically caused by the 
war famine or disease which you know kill people in large numbers so people are 
dying of starvation less in England in the seventeenth century but certainly 
all over continental Europe in the seventeenth century and into the early 
eighteenth century eighteenth century that patterns starts disappearing 
population goes up if you like and mortality crises are killing off fewer 
people in that in that way so this means longevity is a bit longer average life 
expectancy not just at birth but say at twenty which is you know when people 
have lived through the toughest phase in fact of their life in terms of 
sickness and er threats of death this means that ther-, people are surviving 
but because they are not being killed off they're actually unhealthier er than 
they were in the in the previous century i know this seems strange but 
basically by not being killed off that means you are living with ill health in 
a way which you haven't done before now i think that's that's a-, sometimes 
called the epidemiological transition which people er say you know from say the 
eighteenth century through to the twentieth so you look at look at patterns of 
mortality in the seventeenth century probably i think it's like half or 
something like that that of people are killed by big infectious diseases which 
hit as epidemics could be plague could be small pox could be typhus could be 
typhoid fever you know a whole range of them er look at de-, and patterns of 
mortality in the late twentieth century most people die from cancers or 
parasitic diseases which they live with for quite a long period in other words 
they live with chronic disease so it's a very different disease pattern between 
the seventeenth and twentieth century what might be arguable i sort of play 
with this one a bit i think is that basically that that i-, that shift is 
becoming apparent in the eighteenth century and in other words there's more ill 
health around people are aware of ill health of living with ill health in a in 
a more you know in a bigger way just in terms of volume than they did before so 
you know Porters talks about hypochondria the eighteenth century being an age 
of hypochondria well i think you know you might be able to tie that in a bit as 
well so i er wouldn't rule out that you know just you know the sort of 
development of capitalism development of communications and i think also as i 
say shifts in disease patterns might be taken into account as well the 
operation you described sounded absolutely ghastly
sf5164: yes [laughter] 
nm5163: so you can see why people would shop around i-, if if they are being 
told they're gonna suffer from an illness i mean that was the extraction of a
sf5164: a child yeah
nm5163: of a dead baby yeah er the but if they are threatened by that sort of 
incredibly horribly invasive er and extraordinarily painful er surgery they're 
gonna you know look around for for other things i mean do you think that's
Student?: i don't know in a situation like that you'd have to grab the nearest 
surgeon wouldn't you 
nm5163: yes in that particular basically you're not gonna live if if if er you 
don't cut the baby the dead body out sort of thing yeah that's right er er 
sf5164: otherwise you're gonna depend on reputation wouldn't you
nm5163: yeah
sf5164: with people who have lots of successes you're less likely to die
nm5163: yeah there's there's an absolutely sort of gut wrenching description of 
a breast er er breast surgery of Fanny Birning in the late seventeen-nineties 
which again makes you believe in the progress actually and you think thank God 
i'm living than the twe-, late twentieth century rather than late eighteenth 
century 'cause 'cause of course operations are done without anaesthetic without 
antiseptic
sf5164: so no anaesthetic at all 
nm5163: no you know they there's you know people sort of play with the idea 
about opium and opium is used a bit but because its no-, there's no there's no 
sort of first of all it's not very pure because it's only really in the early 
nineteenth century that they start chemically purifying distilling er drugs er 
and also they don't really realise they use a bit of a bit of opium and bit of 
and some sort of would be painkillers so if you have toothache they stress 
cinnamon they give you cinnamon and cloves to chew and things like that er 
basically you have to deal with the pain you have to deal with you know just 
the horror of it so you know th-, the patient has to be caught first literally 
you know and chased around the operating theatre er with er a sort of you know 
cutting cutting edge so you know it's really pretty ghastly stuff really shall 
we go on to the next section have you er have you got one ok
sf5167: i don't 
nm5163: i've got a here's one okay a spare one yeah okay so we're down the 
bottom of the first page okay go ahead then
sf5164: ok during the eighteenth century disputes arose between the Paris 
faculty and what it termed charlatans which was classed as anybody without 
faculty training and approval the Paris faculty dominated the practice of 
medicine in Paris until the eighteenth century they insisted that only those 
who'd been trained by the faculty could legally practise in the cap-, capital 
this opened up the market of wealthy aristocrats and nob-, nobles to a limited 
number of prac-, practitioners but there was one exception to this the members 
of the king's medical household were automatically allowed to treat anyone in 
France including Parisians regardless of where they obtained their training or 
whether they'd even been trained at all increasingly during the last decade of 
the ancien regime practitioners were using entry to the royal medical household 
as a way to bypass the faculty of the medical market due to patronage and 
fashion members of the king's medical household would prefer Paris faculty 
graduates not within the household but the most fashionable of the wealthy 
aristocracy this increased competition for patients and also brought greater 
degree of diversity in the country or for example or the use of medical 
electricity began to challenge views of the Paris faculty among influential 
people the important point is that the faculty's monopoly of both medical of 
acceptable medical acceptable medical ideology in treatments and the 
fashionable clients were being depleted especially with the creation of the 
Royal society of medicine in seventeen-seventy-six which effectively formalised 
court medicine because a lot of them shared membership and that's from your 
article
nm5163: that's my article yeah that's right what i was arguing there really was 
er this medical market place which people like Roy Porter and others had sort 
of s-, mention you know as being there in England in the eighteenth century 
they often make a contrast you know they say whereas in continental Europe 
there is a less open market and er the structure of medical authority is very 
much more accepted so people accept that you know there's the physician at the 
top and then you know the others are below and and they and they're very 
respectful of of er the sort of rights and privileges of the-, of these groups 
and you know people sort of accept the whole sort of shebang you know and what 
i was trying to say was actually if you look in a big city like Paris it looks 
like the medical market place to me er so so in other words there are a lot 
more similarities if you like in eighteenth century France and er er than er 
many of the people who work on England have suggested and i think if you went 
out and looked at other urban er settings you you know you'd see a similar sort 
of sort of pattern er really okay carry on
sf5164: okay consumer demand and advertisers it's difficult to discover which 
came first although its probably safest to accept that the two fed each other 
um right yeah okay yes) so the consumer medical market place was first tapped 
by those with little or no formal medical training who were more prepared to 
adopt the latest theories electrical machines mud baths hot springs mesmeric 
tubs and celestial beds for example Colin and Jones identified the tactics of 
the medical entrepreneurs they'd make a discovery advertise it heavily using 
posters handbills or in newspapers and periodicals and sell the product if they 
were lucky they would have successfully treated a famous individual and benefit 
from the patronage and testimony of that followed their success illustrated a 
change in medicine you could now become successful with or without royal 
patronage or official support a change in his great chain of buying Colin Jones 
illustrates a change in the market place and the degree to which medical 
advertising were around in the er the degree of medical advertising around in 
late eighteenth century F-, France he studies or he affiches i don't know how 
to say it which weekly advertisers is bought by subscription he estimates the 
total readership at between fifty-thousand to twenty-thousand their most 
successful and functions the readership was compiled of large numbers of 
bourgeois public er physicians and traders and med professions shop keepers 
domestic servants and women who were all among the readers the advertisements 
were aimed at those who were willing consumers rather than those who were of a 
particular status they contained large numbers of medical adv advertise 
advertisements they publicised medical courses in anatomy and midwifery and 
told of medical successes and they reported on the health of the Royal family 
and on public health measures like small pox inoculation they advertised 
medical books and engravings anatomical objects like skulls skulls they 
advertised surgical equipment like scalpel saws knives and probes they promoted 
electrical contraptions as well as more familiar medical equipment like 
tourniquet drugs and medicines they also appealed to a more cosmetic side of 
medicine offering post artificial limbs as well as potions to prevent and bad 
breath similarly Todd?s suggested the largest number of advertisements in this 
period were for medicines and cosmetics he cites examples of a venereal disease 
as well as medicines epilepsy rheumatism sciatica headache gallstones dysentery 
tape worm scurvy dropsy paralysis prevention of miscarriage prevention of 
flatulence medicine bowel complaints and coughs and chest syrups there were 
also advertisements for miracle cures and many different sorts remedies for 
hernia of advertisement brought responding to demand for medical services and 
treatment and increasing in demand as well as shaping the of the consumer 
that's your
nm5163: yeah yeah that's that's the can we finish on that section for a bit and 
then perhaps have a discussion of that cos i mean er you know this sounds like 
terrible i'm getting you just to read my work you see but in fact [laughter] 
we're supposed to be talking about Roy Porter which you didn't get er so er but 
er i mean the others have read Porter so you can you can see the see the angle 
and again just i mean i think you're you're you're picking up first on the 
article well look at Paris it looks like a medical market place it looks much 
more like a market place than perhaps historians have argued who er argued on 
sort of on the economic backwardness of France but then i sort of picked up on 
this affiche where you sort of look at the advertisement there's an awful lot 
of medical stuff there and this creates this is a network a network that's your 
term this er of er of you know which which in other words is establishing a 
medical market place throughout urban France and actually even in to the 
countryside but basically within urban urban France so print is the crucial 
feature in in constructing the consumer if you like in getting this whole range 
of goods and services across and if you looked at that sort of set of er things 
you know like i don't know whether any person had all of these things at one er 
time but basically again we're talking about true it's not as if corns or er er 
cramp is discovered in the eighteenth century these are sort of traditional 
sort of things which everyone would have [laughter] had at some stage or you 
know you stand a good chance of getting but now the idea is that you you don't 
just rely on local expertise given by word of mouth but you also have another 
line of sort of resort a line of resort if you like for for for particular 
illnesses yeah so this fits in with the Porter stuff doesn't it the world of 
advertisement Iris any anything on this
sf5165: yeah definitely well er to make a similar point about er the creation 
of a demand because of there so of so much being out there in the market place 
and and people relating all those affiches all those things they see outside 
with their particular lives they just want to be part of that and and purchase 
purchase and try and see how er these things work really 
nm5163: mm mm yeah 
sm5166: yeah mm don't you think that the different with the French market place 
and the English market place with Porter you get the idea that Porter he's like 
the champion of the little man established of the little man you know rather 
than the established sort of orthodoxy and so i don't know with Porter it came 
out a lot more as with with Porter demands on the consumer with the consumer 
the actual person doing the buying with the French case the emphasis was more 
on people who were buying the products 
nm5163: yeah the entrepreneur yeah that's probably right namex any any thoughts 
on the medical advertisements angle
sf5167: er really i remember reading some articles er by p brown about some er 
iron pills
nm5163: bath isn't it yeah he did it in bath didn't he
sf5167: yeah he advertised and the great thing about them used by women to 
cause abortions and under that a great deal of adverts for that sort of thing 
prolific
nm5163: and i think that's an interesting thing about the print world isn't it 
that and of course it was about abortion until you know two 0years ago that you 
know if you go to your doctor's for certain types of remedies you're not gonna 
get them you know because they act as a sort of authority figure if you like 
which will refuse certain things to you er and certainly in the eighteenth 
century no doctor would legally allow abortions or anything like that so some 
of the you know there is the obviously there's gonna be a demand for things 
like that from women and print is open opening up a new a new market really and 
of course that's how entrepreneurs work best is you know find a niche in the 
market and go for it really so someone like er as you say the er the er who who 
is the person can remember who was actually where who produces these pills
sf5167: Cooper Jones but there are a few of them a few big names
nm5163: yeah 
sf5167: of them big names are a bit like Tom Sallowells pills and i think they 
made a fortune 
nm5163: yeah yeah so basically that's right and entrepeneur has picked up on 
this and you know finds a form of advertising obviously you have to be careful 
about how you express it you know
sf5167: it's expressed as a menstruate to regulate you and and cos rather than 
but it's interesting cos sixteen th-, seventeenth century as being used for the 
same purpose but i don't know perhaps it wasn't so widely known 
nm5163: yeah yeah see this again would be your angle wouldn't it that you know 
these things have been out there before ah yeah but basically what's happening 
in the eighteenth century is that you know the the information flows are just 
getting so much wider that you're getting into a bigger bigger market and 
obviously you know putting the idea there in the heads of people perhaps who 
hadn't thought of it before and of course that's the other thing i mean you 
could say well you know there's perennial demand for for abortion methods if 
you like from from women but certain conditions actually are create created out 
of nothing if you like er i mean hair loss i mean what do p when do you think 
people started worrying about baldness and the er actually Morag Martin i think 
she's quite int-, i think she does quite a lot about the a whole theory about 
baldness in the early nineteenth century
sf5164: it wouldn't have been an issue while they were still wearing wigs would 
it
nm5163: but of course wigs make you sort of like you don't have to even think 
about it that's right so presumably if the move away from wigs is gonna create 
a crisis of bald [laughter] of baldness you know for er for people so er yeah 
you know pick up on this use it or something like halitosis which again you all 
these sort of personal condi-, conditions if you look at any sort of small ads 
or any sort of magazines now which has these adverts they are classically 
things which are personally embarrassing you know like flatulence wind trapped 
wind and something like that this is the this is the niche that you you create 
not by saying you're not you're not just accepting a er sort of demand that's 
already there you're actually creating anxiety creating an anxiety which you 
can claim to administer to and that's that sort of rhetorical pattern you know 
like play up anxiety and then oh you got the answer is comes out of a lot of 
the sort of er adv advertising er style of of of of the eighteen-, eighteenth 
century i don't know if you picked up the point that Porter makes about 
compares late seventeenth and eighteenth century advertisements d-, does anyone 
remember that
sm5166: was it to do with the amount of text
nm5163: it is partly about the amount of text yeah yeah
sm5166: what i mean well one thing one thing related to er that advertising was 
there perhaps because of the increase in literacy
nm5163: yes yes you have it was all part of the same pattern absolutely
sm5166: he said that advertisers in the eighteenth century they crammed as much 
text into the advertisements as possible which is in stark contrast to what we 
are used to know as advertisements and then he says when these handed bills of 
advertisements were handed out to people took er them just to have something to 
read
nm5163: yeah
sm5166: may be they couldn't afford a book and then he said perhaps even when 
they'd read them they'd put in their 
nm5163: yeah
sm5166: yes there's a lot of suggestion) to have something to read medical 
advertising caused a rise in literacy
nm5163: no i absolutely agree i think you've got to tie up to that end cos 
print doesn't work unless you know the technology and unless you've got the 
people who receive it anymore than er virtual reality works unless you've got a 
way of accessing it you know so literacy is if you like one of the essential 
tools of consumer demand isn't it yeah er the other thing i was thinking of but 
that is a very good point that he brings out is if you look at seventeenth 
century hand bills they are often like panaceas you know like some fabulous 
substance which will create everything you know cure plague hair loss you know 
smelly feet you know absolutely everything can be sort of wiped out this idea 
of a panacea is quite a big one from in traditional medicine whereas the 
eighteenth century angle is you know the niche marketing more you know let's go 
for something which has a sort of more specific more delimited range of er 
complaints and and play up rhetorically er to that so it's a much more subtle 
and sophisticated if you like er style of advertising than the than the than 
the eighteenth century one which is as you cruder sort of more like a 
blunderbuss where even the handbill itself looks like you know amazingly over 
written er text very little illustration in these things as well i think it is 
certainly the old the old writing some some few illustrated Cathy
sf5167: is there any way of er a mean of sort of i well i suppose i don't know 
sort of how much the quack versus the elite doctors is coming on in the 
eighteenth century but i wonder if sort of these charlatans selling these 
tonics or pills or whatever were writing these hugely long texts er in a way to 
appeal to certain kinds of persons as being intelligent a sort of more elitist 
cure er were pontificating about it rather than er having a sort of a simple 
picture and a slogan that would appeal to the lower orders 
nm5163: so so er what is er how is the rhetoric sort of pitched how's the er 
consumer imagined do you sort of play up to the person's er you know sort of 
aspirations of you know walking into the Royal enclosure at ascot or something 
like that or do you sort of play into the sort of the image of the person going 
into the dirty duck for a sort of half pint of Guinness at er sort of 1030so er 
so the rhetoric about where you're pitching it i think is quite important and 
would you get a sense of from the Porter what is the sort of optimum the 
optimum consumer if you like is it the duke or is it the dustbin man or where's 
that sort of model consumer
sf5164: the individual wealthier people who could afford to keep trying and 
trying and trying until they found a cure but as a whole group of middle the 
more 
nm5163: yeah Iris
sf5165: it's a combination i think since they don't have a clientele they need 
to sell lots and lots of things to make a living so basically their ideal 
customers are anyone who can buy their things who can it's a matter of amount i 
think
nm5163: yeah
sm5166: i've got i mean basically but also the people would like a name 
attached to them because it l it lent their products credibility and they can 
they can use that credibility to sell to other people 
nm5163: yes that's a good classic classic technique for this type of 
advertisement as you say as you know agreed by all or tested on the er you know 
Duchess of er Marlborough or something like that and they have a long stream of 
credentials behind it so i mean i think the thing about advertisements you if 
you're if you're a salesman you wanna reach as many people as possible but 
you're aware that you're actually selling not just the product you're selling 
desire so you don't sort of like pitch it for how people actually are you want 
to pitch it for how people would like to be or think they they might be you 
know so you normally aim above the niche basically cos you assume people wanna 
do better in life than they're actually doing so i mean i think a lot of 
English stuff comes out a bit altered you know gentleman or ladies you know so 
it's not your average washer women or you've got corns have this corn remedy 
although actually some of them might be like that but more normally will be 
sold through the trappings of politeness and gentility really and obviously we 
have to be careful how we read that you know because that doesn't mean that 
it's just dukes and duchesses or whoever buying it once because the rhetoric is 
to sort of pitching it that i particular way i think actually you know it would 
be daft to pitch t too high wouldn't it you know because you know everyone 
would realise you know you're aiming for a very small market that people who 
imagine themselves being you know prince consort or something like that buy 
it's the middling sort that you can sell to with sort of you know the idea that 
they're just a bit higher in the social social scale i think in the crucial 
ones you're you're getting on to charlatans aren't you so shall we /shall we 
get you back on stage
sf5164: it's important to know that most early advertising originated from 
outside the official medical line of the Paris faculty and the Royal society of 
medicine trained physicians aided by abided by the that it was immoral to 
advertise their business however they were soon forced to respond and advertise 
as charlatans gained more business there were times when it became increasingly 
difficult to tell the qualified practitioners from the charlatans that were 
advertising practically established physicians that creating and patenting a 
medical treatment was a good way to financial success and enhance their 
reputation and started to mimic the practice one of well known English 
physicians James and Radcliffe patented they also started to advertise their 
service and the treatment style of advertisement placed by respectable 
practitioners charlatans work somewhere both tended to legitimise themselves by 
stating their qualifications whether they were real or fake their past medical 
successes any new treatments they'd found they also published commercial works 
to keep their work and practice in the public eye the qualified practitioners 
had to respond to demand and allow themselves to be influenced by the market in 
faculty criticism of charlatanism was a response by respectable practitioners 
trained by apprenticeship stating that their empirical training was more 
appropriate in achieving better results in education in seventeen-seventy-two 
Joan Manuel i don't know how to say it in French
nm5163: 
sf5164: a Montpelier trained physician argued that medicine was so poorly that 
even trained practitioners could do harm he was careful to point out that the 
untrained could do even more harm there seemed to be truth in these allegations 
to for example for example treatments of venereal diseases faculty broke with 
the tradition of using mercury and seemed to cure without the side effects 
associated with mercury questioning the ideology and the radical and the method 
of traditional medicine in favour of empiricism is in keeping with developments 
in other scientific fields it also illustrates that the established order the 
medical world medical success can now be achieved by public acceptance without 
relying on traditional medicine fashion develops historians have attempted to 
discover to discover whether the new market in medical commodities fitted with 
the eighteenth century commerce and consumerism also need to be active and 
understand how to divide the has been summarised by Lawrence by suggesting that 
by eighteen-hundred doctors were complaining that the society was hypochondriac 
and that medicine had become a unit of cultural currency and suggest [cough] 
demand led and the social and cultural fashion that was driving it i shall 
consider this with regards to the relationship between the patient and the 
practitioner firstly it is important to point out that decision of whether to 
hire a practitioner was dependent on the costs skills on offer for the 
development of patient's illness and reputation all practitioners whether they 
were qualified or not were dependent on their reputation it was stressed in 
advertisements by the practitioner advertising his qualification and 
publications and dropping the names of famous individuals that they had cured 
and and stating medical developments they were responsible for report on parts 
of the medical world in seventeen-ninety-eight the eighth earl of Banbury wrote 
to his sisters about his wife's imminent confinement mister Berkeley of having 
lost three or four women in ten days committed to his care not so much about 
charlatans Banbury's consideration apart from geographical location reputation 
from midwife and practitioner similarly when Carolyn Fox wife of the English 
politician Henry Fox elder son due in December seventeen-forty-six she called 
for a local apothecary but she still wanted the opinion of to suggest that the 
choice of practitioner was based on medical reputation not necessarily disagree 
with the suggestion that medical reputation was influential in making a 
practitioner fashionable we've seen the case of childbirth it was to seem 
necessary for a medical practitioner of some description increasingly midwives 
to be present so it could not be considered as a whim of fashion it is however 
difficult to suggest 
nm5163: a male midwife 
sf5164: yeah even before that it was going to be someone there you know if 
necessary inc-, increasing [giggles] it is however difficult to suggest a 
circumstance this advice was thought to be necessary hypochondriacs in the 
eighteen-hundred century society increased market place the important point is 
that patient whether a hypochondriac or not not medical medical care was 
necessary for the health and it is possible to suggest that fashion may have 
influenced the choice of practitioner
nm5163: can you go a bit slower
sf5164: yeah or if we twist that round and say that it was a demand that was 
creating the need there and tell how cosmetic or how medical problem could be 
now cook suggests that the patients controlled the medical market the he 
believes that medical books increased the medical knowledge of the public and 
that this could threaten the idea that we learn and practise at the medical 
council medical knowledge threatened medical practitioners often medical 
practitioners were of a lower social rung than their clients so despite their 
superior knowledge had to defer to the wishes of the patients many patients 
also wanted a second opinion that there were the medical networks and 
regulations in Britain that prevented a second opinion from embarrassing or 
contradicting the original practitioner if the patient was dominating the 
practitioner or suggesting treatment in practice the argument that fashion was 
leading medicine as an example of Caroline showed that at least some patients 
were willing to defer to medical advice despite personal regulations fox 
library held a large number of medical texts which Caroline took particular 
interest in including two French texts measles poisons and small pox Jones' 
essay diseases and baryon digestion plus miscellaneous medical tracts a book on 
sea water bathing diseases of the arm and dispensaries guides to continental 
spas and [laughter] 
nm5163: this is Charles James fox's no it's his mother) mother yes so okay namex
nm5163: yeah right okay then yeah
sf5164: despite perhaps because of her wide medical reading and interest in 
medicine Caroline allowed her allowed her eldest child to be given mercury 
sulphite with ox and squills a syrup concocted 
nm5163: er er what
sf5164: a mercury sulphite with ox quills
nm5163: i thought you said ox of squirrels
sf5164: squills [giggles] 
nm5163: extraordinary
sf5164: concocted of vinegar and boils as well as ground up woodlice the 
reputation of her doctors and the high esteem they held them in resulted in 
Caroline defying their suggested treatments despite her reservations her 
primary aim was the health concern and 
nm5163: hmm
sf5164: one interesting example of a charlatan and the influence of fashion on 
medicine is that of doctor graham a notorious English quack he used electricity 
and milk baths and sexual techniques to encourage fertility in woman and er to 
deal with impotency in men i infertile couples paid fifty pounds a night for 
use of his celestial chamber complete with orchestra
nm5163: mm
sf5164: a cylinder pumped a magnetic fire into the room educated opinion named 
him as a charlatan and his patients as gullible however society including the 
duchess of Devonshire and lady Carlisle approved of him he earnt enough to 
practise from the Adelphi where his temple of health and harmony was situated a 
successful newspaper campaign undermined him and he went bankrupt in seventeen-
eighty-two this example highlights the limited fashion of medicine a people 
hiring his services conceive once it was accepted that his services were 
fashionable attempted to do so though the fickle use of doctors and medical 
treatments of doctors may have been fashionable but it also served a more 
practical purpose people relied on their interest in contemporary medicine in 
the comfort to them and gave them hope and allowed them an active role in the 
defeat of illness the same desires had been served in the past by local healers 
and white witches from a much more and more localised scale in the medical 
market and more scientific er angle of medicine but probably more accurate 
nm5163: yeah so you downplay the scientific er aspect yeah
sf5164: er only only in terms of its actual existence even full of a scientific 
medic medicine there was still a demand people still wanted to
nm5163: yeah yeah that's er i mean no that's your argument that seems to be er 
it's inte-, it's interesting yeah ok so we spread about now to patient 
practitioner relations quacks and non quacks yeah Matt er do you wanna kick off
sm5166: yeah this er is a bit what touches on about the er conflict between and 
empiricism and the er the books that were traditionally read er which i found 
interesting selections and er perhaps explains or it may explain the success of 
the the quacks and quack medicines in the sense that there was in science as a 
whole there was that wider trend towards empiricism rather and that the book of 
the ancients and and that yet in medicine you still had the orthodox medicinal 
practitioners relying on the rules of the ancients not approving any practice 
which goes against this training on the other on the other hand you had the er 
quacks er charlatans appearing appealing to empiricism and they they seemed to 
have success while they do this wide trend in the eighteenth century i think 
could possibly demand this i don't know me mesmerism going into hypnosis
nm5163: yeah that would be that would be an example yeah although that hypnosis 
doesn't really doesn't make it into the medical you know set of set of 
techniques until much later but yeah but that would be a good example yeah
sf5164: inoculation
nm5163: inoculation would be the very good example of that yeah you know 
something that starts with a sort of Turkish folk ground appeal essentially and 
then and it's massively attacked by the doctors when it's brought back to 
England in the early eighteenth century as hypnosis you know women's' stuff 
folklore old wives' tale and it's foreign as well you know yet because it works 
and establishes reputation in the public the doctors actually catch on and they 
accept and and they pick up on this and i think we can sort of paint too too 
crude a line sometimes between you know the old type of medicine and the new 
type of medicine because i think a lot of doctors are more opened to this new 
type of empirical medicine and and sort of go along with some of the er some of 
the er of the stuff if it if it seems to work er you know er so if it so er 
they might not be able to explain it if you like into pure Galenic terms but if 
it but if it l but if it works like inoculation does though that remains 
actually still contested right through the century er but a lot of people do 
accept it and and buy it yeah so i think that's this question of medical 
authority i think it's a very important one yeah highlights this problem in 
within the medical profession
sf5164: well really with the faculties they had been quite faculties they had 
lower prices and were prepared to deal with lower classes i can't hear her the 
experience or the reputation cos they'd really rather see a physician who 
nm5163: yeah that's right so the the the charlatan or the quack not only brings 
you know what they cl-, claim as sort of med medical salvation but they are 
also bring it at a cheap price yeah whereas the physicians are essentially as 
you say pricing themselves out of the market would moan you know when people 
who see they see as quacks or charlatans are sort of invading that that massive 
and growing market place and in the eighteenth century namex
sf5165: so it's basically the market the one that is changing practice or is it 
two sides this one and also an imitation of what is happening to science you 
know that from within scientists start looking at empiricism as a new way of 
making science er in opposition to to the knowledge of the ancients i mean is 
there also a stream of medics who is er recognising empiricism is valuable or 
it's only because the market is asking for this sort of of er new healing 
nm5163: yeah namex what do you think
sf5164: i don't know i think with this we're obviously inside science but we're 
seen it as a thing of i in itself isn't it there was often medicine that was 
perhaps leading the other ideas of science i don't know it's a bit vague i 
suppose
sf5165: also are doctors questioning the the way they practise th-, th-, that's 
my 
nm5163: yeah i think they are yeah i think that's right i think although a lot 
of people criticise the medical establishment if you like it's it's worse in 
the sort of institutional establishment like the Paris medical faculty is very 
stuck you know stick in the mud as a corporate grouping when they get together 
when you look at the individuals they're actually very diverse very open and 
you know not all of them obviously but a lot of them are and very much sort of 
em accepting the possibilities of you know experimentation and all the rest of 
it so when in France they get this thing like an academy of medicine in the 
seventeen-seventy late seventeen-seventies doctors leap on this because they 
say well this is our academy you know we'll be able to test out medicines we'll 
be able to establish our authority [sneeze] excuse me er and so yeah there 
there is an openness there on the other hand you know the medical community is 
broken itself broken up you know some are you know sort of sticking their their 
heels even deeper into the mud and others are sort of going with the flow what 
i think port one of the things Porter shows is how you know this line between 
you know quacks who are out there in the market place selling remedies and 
doctors who are sort of like purer than purer and above market considerations 
breaks down when you look at some of these remedies because they have very 
often originated or certainly endorsed by you know physicians so er doctor 
ward's you know drops or dr Ja you know these are real doctors who are er 
actually authenticating and legitimating this er particular things so 
commercial medicine if you like the market place just growth of consumerism is 
allowing doctors to diversify if you like and to get out o into the market 
place into a much more pro-active and dynamic way than perhaps they'd done er 
before er that's happening earlier in England that's happening more importantly 
probably in London than anywhere else it's something which generally perhaps 
happening in many of the urban centres of Europe this is happening as well 
sm5166: takes account of the actual consumer in the sense that if the 
eighteenth century medical consumer was one who was very interested in in 
products and wanted to know what worked and why it worked and wanted to make 
these choices if they relied on the orthodox medicine which relied on the books 
of the ancients they couldn't rely on that because they could not read them may 
be they didn't have access to them they took too long whereas on the other hand 
the quacks would show came along they could see that's actually working for so 
and so this worked for so and so for so and so so it would ma it auth authentic 
authenticated their knowledge
nm5163: yeah and i think that's right and i think you're picking up on another 
you know classic thing that's happening in the eighteenth century although it's 
clearly there before which is texts of medical vulgarisation if you like 
reaching between you know the medicine you know up there of the faculty or of 
the ancients or whatever and trying to bring the sort of best of medicine in 
distilled form and sort of more you know attainable and reachable format for a 
bigger bigger audience namex is one of our research students is looking at 
these health manuals in the eighteenth century there are examples which go 
right back but obviously there is a massive boon in these things going on from 
about seventeen-fifty onwards so you know reaching out to that sort of 
perceived need of consumers for sort of more more medical advice which is 
entuned to their needs if you like er and and their social situation er namex 
any thoughts on this
sf5167: er only that sort of principle of medical attention the medical ideas 
that are happening earlier popular from his work which is in fact for making 
all their secrets known so i guess that what i'm just saying is that it was 
just happening on a bigger scale but it had existed before 
nm5163: yeah yeah yeah so a lot of i mean that's interesting being one the 
things that's coming out of our discussion yeah this is not a necessarily a 
quality of change that's happening so much but things like communication 
markets literacy er a bit of extra entrepreneurship these are sort of like er 
developing together from not out of nowhere but from established patterns if 
you like which go back so there's medical vulgarisation before er you know 
there is advertising before obviously in terms of the hand bills but now the 
possibility and the range and the volume are the things that are really 
changing can i ask you about one other cos you brought up about the patient and 
practitioner relationship and the suggestion is that basically the practi-, 
sorry the patient is to a certain extent in command in the eighteenth century 
as you're you're citing Howard cook's work i think
sf5164: i don't i necessarily agree with er the fact that i think obviously 
that people as they er gained more medical knowledge they were able to they 
were able to pick and choose but and they wanted but she did have a regular 
practitioner that she that she kept with so er we don't know how many 
practitioners she'd been through before stuck with them and how er choosy she'd 
been originally but she was responsive to what they said
nm5163: right right namex patient - practitioner relations Jewson you know this 
stuff 
sf5167: Jewson
nm5163: j-e-w-s-o-n it's a sort of classic article of his i thought that you 
probably er would know that er what is it decline of i've forgotten what it's 
called decline of medical cosmologies or something decline d the er basically 
what he argues is he says in seventeen-nineties things change okay up to well 
you know slower after that but if you look for a moment as things change in 
seventeen-nineties prior to seventeen-nineties physicians are in a situation 
where they depend for their livelihood on patronage so you need basically to m 
establish links with the high and mighty because you're gonna get most of your 
income er from them so to a certain extent you're you're subservient to them 
you know cos your living is coming from a relatively small number of people and 
then you are you know dependent on them okay ah and there are a number of other 
things there which er he highlights and one of them is the importance of the 
patient narrative if you're in a situation where basically you believe in 
Galenic theory and human theory the the patients' own description of their 
health or lack of health is gonna be a crucial ingredient in understanding 
what's going to in the body so the first thing that a doctor does with the the 
a patient is sort of listen to what they say looks on the outside looks at the 
colour of their eyes colour of their skin or looks at their urine or whatever 
but basically the patient narrative is the crucial thing okay and they speak 
the same language okay about the body and the medical condition you know the 
doctor you know has a bit of Latin and knows but but but basically they talk in 
the same sort of language Galenic theory what happens in the late er in the 
well the birth of the clinic sort of seventeen-nineties is that medicine 
changes completely so that medical science is grounded not in that type of 
exchange er but in terms of er medical knowledge which is found in the body of 
the deceased or sick person and which can be opened up by the medical 
practitioner ok and you've got the birth the birth of the clinic here new 
hospitals were established in which the medical profession can build up 
knowledge of bodies by systematically comparing the bodies of sick people with 
those of the dead you know cos they dissect and all the rest of it so basically 
now you've got a new structure of medical career and new structure of medical 
authority coming in er in which there is a language which only the doctor 
speaks okay and the patient narrative is not really gonna be helpful you know 
okay it's gonna be how are you feeling today er mr Smith or something like that 
but it won't be the description of a lifestyle with all those sort of you know 
accepted you know conventions of familiarity of both sides of of a description 
of the of the of the of the sickness it will be basically the doctor knowing 
how bodies work inside which is not not gonna be obviously available at all to 
the er to the sick person so that this is when er the stethoscope comes in you 
know for example so basically you you can you know listen to the body and and 
you know the individual will have no sense of what is going on in their body so 
it's the doctor who has the knowledge and the idea would be therefore that this 
patient the relationship between patient and practitioner is shifting massively 
in the late eighteenth century from a er sort of situation in which the patient 
narrative was crucial in which the patient you know because the patronage 
system had a very wide range of powers to one in which a new pattern of medical 
authority is established in which the patient is very often the the object if 
you like the bearer of clinical symptoms which only the medic can understand 
you know from a sort of position of you know great height and all the rest of 
it er what cook is adding to that is that he says well you know patient power 
if you like exists in the eighteenth century for all these things but also 
these remedies are again offering a whole range of possibilities to to to the 
sick person so they don't have to rely on a medical authority of the doctor 
they can sort of shop around if you like and interestingly you know we said 
earlier about the sort of seventeenth century and the eighteenth century 
consumer in some ways the argument would be well in the late twentieth century 
where you know medical authority is breaking down a bit you know because you 
know we said before of a more wider established patterns of complementary 
alternative care and all the rest of it and people do shop around i mean the 
thatch that's the legacy of the Thatcher and Reagan years we all shop for 
everything including our health and we go back like almost a cyclical thing to 
the eighteenth century to a period before you know medical authority was 
established in the way which it was you know for one-hundred-fifty years 
seventeen-hundreds to what we said nineteen-eighties where if you if you wanted 
to know about health you you asked the doctor you know er i mean you know like 
these er magazines that used to have this thing a doctor says you know that 
private eye always sort of satirises where they say you know what's my problem 
well I'd consult your doctor the doctor is the source of all medical knowledge 
it's your route into health care if you like er now are in a much more 
consumerist period which funnily enough the idea would be a sort of replicating 
but obviously in a different way in all sorts of ways the sort of more 
consumerist more sort of patient led type of medicine of the the eighteenth 
century so yeah
sm5166: sorry i just wh-, i know just because like we shop around now we 
shopped around in the eighteenth middle of the eighteenth century does that i 
don't know if that necessarily means that you control the market the market 
place
nm5163: no
sm5166: yeah
nm5163: no no good point yeah
sm5166: because i mean if you're talking in the eighteenth century like image 
that you talked about advertisements 
nm5163: yes Wellcome and Roche can play er control the marketplace yeah that's 
right 
sm5166: yeah who's got best advertising techniques and the best the best 
distribution systems yeah it seems almost like an illusion that you're 
controlling the marketplace
nm5163: yeah no i think that's a good point yeah but i think so i think there's 
a because the question of where power lies is as you say is much more you know 
problematic but i think that certainly the structure of medical power that sort 
of emerges in the 19th century is actually rather different from that of the 
eighteenth century that would be the the difference er the crucial difference 
so i take you on your point i mean namex what do what do you think about thi-, 
these models
sf5164: yeah i really agree with that i think that the er the eighteenth 
century doctors haven't necessarily got an influence over their patients and 
originally i think that er a wealthy individual would abide by what they said 
and only if it didn't work would they then start trying other things
nm5163: so you think that medical authority does count that the patients don't 
have it all their own way
sf5164: obviously you have individuals who are gonna pick and choose and not 
everybody is going to do as they are told but i think to a certain extent if 
the practitioner has a reputation and he has success and then originally at 
least 
nm5163: namex
sf5167: hmm no i agree with namex i'm just thinking some of that subject namex 
working on at the moment or in surgeons in the seventeenth century particularly 
and she's found or discovering that er m they would actually turn away clients 
that they thought that weren't suitable and they would refuse to treat them 
that changes the whole thing so you think so the the idea that th-, physicians 
do have more authority they have more medical more reputation i think that 
that's the crucial thing 
sf5164: not just physicians even sort a even a quack or apothecarist or a 
surgeon and they had the reputation and people would be willing to try them 
nm5163: i guess that would be a crucial thing for us to think about it how 
medical reputations are made wouldn't it i mean and and how that changes over 
the eighteenth century how do you you you know is it different how are er how 
are how you have how you establish a medical reputation say in in the late 
seventeenth century and late eighteenth century
sf5164: the physician is still very much dependent on er patronage isn't it er 
in London you'd have a select group of physicians who were dealing with society
nm5163: so hunter or whatever says you know cared cared for the prince of Wales 
so patronage is is still very important but it eh yeah is it more varied than 
you think the market does has opened up other
sf5164: oh yeah definitely but i think it's still an important issue
nm5163: yeah
sm5166: er yeah i'm not sure if it's just a case of reliance on reputation i 
think it's may be a case of who can deliver the best message across then wins 
the day and then you saw i mean in the eighteenth century rise of like medical 
showman coming into town in brightly coloured stage and props the best 
techniques to deliver the message across it didn't matter what his reputation 
was 
nm5163: yeah but don't you don't you deliver reputation but you know in a 
fairground manner if you like i mean but you know so it's about er having a 
reputation but a different type of reputation a reputation grounded in self 
sm5166: in self-promoted reputation
nm5163: yeah yeah so
sf5164: they are creating the reputation which might originally create a market 
if they were to er fail in the er treatments of the their er patients they then 
are not gonna maintain it
nm5163: so that's very fragile if you build up a reputation solely in terms of 
your curing because you are bound to you know to have some flops and that's why 
i guess a lot of these people always move on don't they [laughter] you know 
they're always on the next market you know so they sort of slash and burn 
approach to find a market you know and then onto onto the next one
sm5166: yeah there was the case of the the er eye surgeon 
nm5163: John Taylor
sm5166: yeah
nm5163: he's great he's a really interesting example John Taylor yeah
sm5166: the argument was that by the time the patients had peeled off their 
bandage to see what their eye was like that he would have he was already long 
gone
nm5163: [laughter] excellent hi-ho silver away yes that's right it's the lone 
eye surgeon that's right but er yeah that's right so on the other hand i think 
actually there's a lot of bad stuff about Taylor i think he's really 
interesting er i think that is one of the interesting things about you talking 
earlier about you know more empirical medicine being sometimes led by empiri-, 
i think oculists er dentists i think as well but you know some of these people 
had a very particular range of expertise people who cut for the stone these are 
the ones who are really making the er you know on sort of canvas sort of 
cutting edge type of er surgery and very often you know with this very limited 
set of expertise so so chevalier Taylor everyone hates his guts if you're a 
medical a trained radical man you know an orthodox man you'd hate Taylor cos 
not only does he look like a charlatan and comes in his flashy wear and all the 
rest of it but also kings and queens of Europe all are rushing to be you know 
to be cured by him to have their eyes sort of cut out you know he he is 
established reputation on the market place essentially but funnily enough he's 
done it by melding that with the old thing of rep repute by you know the 
quality of people you're actually looking after you know so it's his reputation 
isn't just oh he has you know cured you know the Duchess of Saxe-Coburg or 
whatever but also his reputation comes from the fact that we all know that 
because he tells us endlessly you know he's endlessly advertising in the er the 
newspapers and so the best sort of you know reputation in the eighteenth 
century is someone who keeps the old forms if you like in other words you know 
the high place practitioner but on the on the other hand can deploy the sort of 
advertising possibilities the self promotional possibilities which the new sort 
of market place has opened up with new advertising technique better literacy er 
and all the rest of it and i think the fact that someone like chevalier Taylor 
is you know half in the sort of medical establishment is interesting cos many 
of the people in the seventeenth century and before you know if you someone 
like him the fact that he was and the fact that he was not a proper medic that 
would be very bad news for him you know he would not get any sort of credence 
from within the medical establishment if you like but i think by the late 
eighteenth century because medical establishment is a bit more comfortable if 
you like within the medical market place someone like him can manage to do 
something so i think yeah this idea of how medical reputations are constructed 
and formed i think and how those vary you know how the successful person is one 
who sort of plays a lot of you know i guess this is true of all of 
entrepreneurs isn't it they they don't just go for a single idea otherwise as 
you say they go for a single idea they're probably gonna you know ride in for a 
fall as well the guy James Graham that you mentioned er he falls off his 
celestial bed eventually doesn't he and he sort of goes bankrupt and the rest 
of it so he's he's just played that one out you know it's flopped you know 
fashion has moved on yeah er but so you need a a range of possibilities there 
yeah
sf5164: i think trying to destroy reputations as well yes the morning herald 
didn't it ran a whole lot of arguments against him to bring him down but er 
nm5163: yes so you put yourself in the market place you you you still open 
yourself to attack don't you and so so so that that again it's gonna be a 
problem with er with reputation how you establish reputation you're gonna be 
very very dependent on your cures i guess then aren't you
sm5166: so what's the basis for questions about patients controlling the market 
place if if he's just if he's demolished on the basis of newspapers rather than 
patients 
nm5163: yeah but i guess the newsp-, yes i know it's how you look at it though 
presumably is defeated or goes bankrupt because no-one turns up for er to be 
cured
sm5166: but why why
nm5163: which is but on the other hand you are right their their opinion is 
being presumably shaped by by the media if you like not just by the personal 
experience would that be fair do you think
sf5164: er yeah not necessarily in the case of graham because i think like the 
duchess of Devonshire's mum wrote her and warned her about er his practices and 
that she wasn't to take anything internally that he gave her and i think when 
the duchess had been there she didn't think very highly of him so it was like 
in that sort like the actual treatment the success of the treatment as well the 
emotion of that and his reputation had been er the duchess of Devonshire's 
mother had used influenced against him which
nm5163: right
sf5164: although the duchess of Devonshire had also been advised by other 
client that he was offen-, 
nm5163: do you think that you know when we were looking at mesmerism last week 
we suggested that may be you know the sexual connotations of of mesmerism were 
a bit dangerous a bit risky if you like o-, on the public sphere i mean do you 
think Gra-, Graham's failure might also be you know cos he's in a way it's 
caused for his popularity i guess to start with you know but people with sexual 
again that's one of the big things if you look in the small ads and any 
newspaper there's always something about sexual dysfunction er you know so but 
on the other hand you know to play with sort of sexual things in the seventeen 
and 80s and when it's getting a bit more prudish you know domestic ideology 
blah-blah angel in the house that sort of thing
sf5164: yeah well i think those people who were desperate to conceive went to 
see him the duchess of Daventry was desperate for a male heir wasn't she she 
already had two daughters
nm5163: but how that would be seen in terms of reputation that he's dealing in 
sexual matters
sf5164: i don't know people still go to see him i think that perhaps their 
desire would override his reputation they wanted their children so i think i 
don't know it was probably it was more legitimate probably than sort of sexual 
connotation from mesmerism and that would probably help a bit 
nm5163: interesting to do that do a comparison actually between you know 
mesmerism in graham and the sort of sexual elements there in th -, er in Iris 
any er points we ought to be
sf5165: yeah i think we can find another comparison between eighteenth century 
er medical market place and what we had now and is i think the emphasis the 
quacks ha imposed on self health and self care and the doctor at home you know 
these things and and the cure by oneself instead of going to to an established 
practitioner and and the sense that we have today that that living a healthy 
life basically saves you all the trouble and just following the simple rules of 
of health just basically do it and also the idea that any external or er 
artificial medicament you put into your body is is no good i m you you should 
first try the natural the natural ways to get healthy 
nm5163: so it's yeah so er eighteenth century medicine to a certain extent is 
more about like lifestyle you know leading a good life if you like a nat-, a 
natural life and all the rest of it and it and b and in the late two 0th 
century we are sort of picking up on that as well and in between you've had 
biomedicine saying if you know you've got a medical problem we can spot it and 
cure it we've got the technology you know we can get rid of it and er now 
whether a reaction or sort of extension or whatever of that we we've perhaps a 
more a tendency towards a more holistic view of of of health 
sf5165: i think in the eighteenth century it was not as clear because obviously 
there was still lots of killing sicknesses that you just had to fight them but 
er the argument that the quacks made about the possibility of people of curing 
themselves not going to the doctor or trying to cure themselves before hand is 
something similar to what we have today may be not with the natural element but 
yes with the full who think it has a natural a natural essence in that first 
try remedies that come from herbs or that come from er less dangerous er 
substances than what the doctor would give you
nm5163: mm namex what do you think
sf5164: er i think there certainly is tradition of the old herbs however there 
isn't any evidence i think also they would not have had this sort of 
genetically er create
nm5163: modified [laughter] i quite agree yeah
sf5164: they didn't the drugs the sort of k-, i almost lost what i was thinking 
there we are very artificial drugs that we have mentioned and they had to be 
based on herbs and 
nm5163: yeah i think it's less actually in the medicines it's more in the 
emphasis on er you know lifestyle in particular emphasis through Gaylon on you 
know what you you say on the non naturals you know don't eat too much you know 
don't drink too much you know have rest you know don't get over excited about 
things have a moderate amount of sexual activity and all the rest of it so the 
the the good life is that mean if you like that you've gotta keep and and 
imbalances in any of those are gonna cause upsets within you if you like which 
are now we don't see it in colla-, well i i know it's true actually some forms 
of complementary health do stress that sort of thing but very much the same 
sort of idea you know with two the century twiddles on like don't sort of put 
sort of gm stuff inside your body and things like that but again the emphasis 
on lifestyle and preventive medicine if you like rather than medicine as you 
know the quick fix the biomedical technology which we sort of like channelled 
into a particular problem do the stuff and then then then get out Cathy ho-, ho-
, ho-, how do you think about this
sf5167: i agree with what Frank was saying about the remedies because i i do 
think there was a lot of opposition to all the new drugs er and the chemical 
ones 
nm5163: in the eighteenth century
sf5167: yes still er [coughs] i think it took a long time
nm5163: how how where where was the opposition coming from
sf5167: well i think even in the elite medical circles
nm5163: yeah
sf5167: er they were sort of they were slow to accept new ideas perhaps slower 
than the empirics would have been er so i think that that their remedies were 
based on some the traditional medical cures that had been used in the centuries 
and we still do use today
nm5163: yeah well i think Porter though suggests i don't know whether you you'd 
agree with this er is that er if we look at the language of quackery it va-, it 
is sort of parasitic on the established er er discourse if you like that is 
sort of people er paint themselves into the picture of of you know the super 
orthodox er physician if you like just using this ancient technique or this new 
technique or whatever but they're not sort of an oppositional force if you like 
but are sort of creating their reputation er and their positive response from 
the public by highlighting their similarities to the established medical er 
folk er and so what do you think do you think that works er yeah
sf5167: like er the physicians in Moliere when they adopt the er the robes and 
the er appalling Latin but to had the airs and and graces of the er 
nm5163: yeah so that's right so a charlatan isn't a sort of like whereas i 
think you know a lot of er complementary health now does the opposite it sort 
of distances itself you know er regular medicine does this we do this which is 
more natural whereas the charlatans that we we're looking at actually say we 
you know we can be physicians as well you know as you say in Moliere's er the 
guy who's sort of you know just a normal sort of Joe so who puts on the robes 
and then starts talking dog Latin you know which has heard people talk about 
before so so he's basically having this effect by imitating a sort of sincerest 
form of flattery isn't it the imitation of the of the medical doctor er who 
pretends to speak Latin and all the rest of it and if you look at the er 
adverts you know the handbills or whatever they do sort of play up to that so 
er what was it doctorate from some medical faculty you know may be a medical 
faculty that's never existed or you know that's in some sort of tiny place 
that's er that you only have to pay a couple of bob to to get or something like 
that er the speaking Latin actually that's interesting by the eighteenth 
century people aren't mentioning it that the Latin thing you know that hasn't 
become the badge if you like of being a physician in the way that it was in the 
seventeenth century a bit but not so much but what could people will tend to do 
is they'll call themselves like you know instead of herb cut cutter or 
something like that they'll say they are botanists botany is a sort of a little 
bit of theory look and you know and instead of saying it's a sort of shop for 
hairdressers or something like that you'll say like the academy of hairdressers 
i think that there are academies of hairdressers now now but you sort of give 
yourself some scientific cache if you like so so to a certain extent far from 
being an oppositional sort of force the charlatans are are you know so 
parasitic on dependent on imitative of travestying if you like er the culture 
of the medical establishment or is that fair or may may be the charlatans are 
more you know antagonistic critical of subversive of er the medical 
establishment than perhaps is suggesting what do you think
sf5164: mm yeah the obviously were once they were attacked by the physicians 
they certainly responded didn't they it wasn't that they didn't let them say 
what they had to say but the same time the er physicians were also adopting the 
methods of the charlatans as well weren't they so it wasn't one away
nm5163: yeah that's right so i think it's er it's er it's a blurring that's 
going on there you know in terms of er the the the divide is being crossed from 
both ways so much that one wonders whether you know i mean er well Roy has an 
interesting discussion about whether the term charlatan means anything apart 
from someone else's medicine that you don't like er m
sf5164: was it very different you could say looking from hindsight cos you know 
what works and what didn't 
nm5163: well actually i don't know i mean incredibly sceptical about all these 
things anyway i think er no-one has really done any sort of analysis of any of 
these sort of things in anyway er which er you know would be provable one way 
or the other what was good or and how how would you know certainly something 
like bleeding you know blood letting which is you know the staple of so much 
medicine in modern times we sort of see pictures they just let blood but 
actually how come that went went on for so long and people thought it worked 
presumably it must have worked it must have had local effect sometimes which 
you know helped in the medical reputation thing as well so actually saying you 
know what is scientific and what is not scientific what works and doesn't work 
i think it's actually rather difficult
sf5164: what i'm saying is though that at the time they wouldn't be able to 
definitely say whether it works so it's not a charlatan 
nm5163: so i see yes okay so the benefit of hindsight is an unfair thing is i 
agree with you absolutely to to so to sort of er to to to ascribe to this yeah 
yeah 
sm5166: oh just one thing i was just thinking i read in a completely unrelated 
that the influence of Descartes on on medicine in the sense that the 
mechanistic view of the body and this is perhaps why medicine became more 
specialised into compartments treating certain elements rather than the body as 
a whole 
nm5163: yeah yeah yes i'd funny enough i don't think i wouldn't have put 
Descartes as a sort of significant figure there because i think he's well into 
the nineteenth century before you get the idea that physicians a good physician 
can be a specialist the idea of medical specialism comes actually very late 
this is why what one of the reasons why physicians in the eighth seventeenth 
and eighteenth century are very critical of empirics because they say you can 
just do one thing you know that it that's another way and you don't know the 
conditions in which you should do it and how you should it and all the rest of 
it and the effect of what you're doing because you don't have the whole medical 
er philosophy so i think yeah i i don't agree with that you know so well if it 
is Descartes then it is Descartes at you know century and a half removed but on 
the other hand obviously the mechanistic view of the body i think you know he's 
obviously important in that that is the eighteenth century body after all isn't 
it yeah with this consume you've got something wrong with you try this 
commodity put it in it you it will make you feel better so yeah so that's shall 
we er shall we close now it's a wrap you've got to say i't s a wrap [laughter]