April 2011

Quacks and Anti-Quacks: Challenges to Irregular Medical Practice in Mid-EighteenthCentury London

Andy Kramer

It is difficult to resist the romantic allure of the eighteenthcentury quack. Contemporaries and historians alike have peered at medical charlatans with the lurid fascination often reserved for the highwayman and the other ruffians and fraudsters that have traditionally scandalised society. For a writer in the 1760s, quacks belonged among the Setters, Spungers, Sharpers, Swindlers, Smugglers, Shoplifters, and Street-robbers that plagued the streets of London.1 Imposture especially medical charlatanry, which threatens the physical wellbeing of a society as much as its social order holds a similarly subversive appeal for contemporary scholars.2 Since the explosion of research in the history of medicine that began in the 1980s, irregular practitioners have come to the forefront of the historiography of the London medical scene. The cacophony of the medical marketplace has drowned out the authoritative voice of the physician: it is impossible to conceive of a history of the early modern medical world today

1 2

R. King, The cheats of London exposed, (London, 1766), p.1. See, for example, T. B. Hug, Impostures in early modern England, (Manchester, 2009).

written through the old-fashioned lens of paternalistic physicians and passive patients.3 As Laurence Brockliss and Colin Jones observed in their magisterial study of early modern France, we are blessed with a wealth of scholarship on the history of medicine on this side of the Channel. Thanks to the double-fortune of the generosity of Sir Henry Wellcome, and the phenomenon that is Roy Porter, British and English medical history occupies an entrenched position within the historical discipline more broadly.4 And Georgian medicine the golden age of quackery is particularly well catered for. What, then, can another study of the eighteenth-century medical marketplace add to the mound of scholarship left by Porter? In the nine years since his untimely death, there have been relatively few advances in our knowledge of Georgian quackery. Perhaps one can detect a faint reluctance among contemporary historians to tread on the hallowed ground left by their great teacher and scholar: eighteenth-century unorthodox medical practice was one of a number of subjects intimately associated with Porter himself, and Vatermord has never been a particularly important engine of historiographical renewal in Britain.5 But certain important deficiencies with Porters interpretation have recently become apparent. Only the most dyed-in-the-wool Whig history still polarises the past in terms of confrontations between saints and sinners, heroes and villains, he asserted.6 In Porters work on the eighteenth-century medical marketplace, heroes and villains are clearly identified. The quacks are lionised, rescued from the awful condescension of posterity. James Graham, the pioneer sex-therapist; Sally Mapp, the bone-setter; Joshua Spot Ward, pill-vendor to the Royal Navy; and every itinerant
3

Roy Porters 1985 article, The Patients View: Doing History from Below was the starting point for this methodological revolution. F. Condrau, The Patients View meets the Clinical Gaze, Social History of Medicine, 20, 3, (2007). 4 L. Brockliss and C. Jones, The Medical World of Early Modern France, (Oxford, 1997), p.6. 5 See, for example, Simon Schamas reverential Foreword in R. Porter, Flesh in the Age of Reason, (London, 2003). 6 R. Porter, Health for Sale: quackery in England 1660-1850, (Manchester, 1989) p.vii.

quacksalver standing on an upturned crate in Covent Garden: these are the heroes of Porters story. It is the Royal College of Physicians, the corporative body legally responsible for regulating and limiting the practise of physic in London, which plays the villain. In fact, Porter has been so successful in championing the losers of the traditional medical historiography, (often written by retired physicians, keen to justify their professions status), that in an ironic reversal the members of the College of Physicians are the new overlooked losers. This need not be the case. While Margaret Pelling appears to share the same anti-institutional bias of Porter, her work on the College in the sixteenth and seventeenth centuries successfully incorporates both the activity within the Colleges walls in Warwick Lane, and the thriving and varied medical marketplace without.7 As Pelling shows, the Annals of the College shine a particularly useful light onto the practice of physic in eighteenth-century London, illuminating an aspect of Londons medical world obscured by reliance exclusively on the quacks handbills themselves. These Annals, the main source of data for this study, are problematic; most notably, they are sparser for the eighteenth century than the seventeenth in some months in the 1740s, nothing was recorded as having occurred at all as the College fell into soporific decline. When the College fined Edward Barry five shillings for failing to return a library book on time in October 1765, it was the first fine imposed for over a quarter of a century.8 In this period, the Colleges attitude is often best gauged through tracts published independently by fellows, and there are too few records in the Annals to conduct much meaningful statistical analysis, as Pelling was able to do in relation to the records from the more active years before 1640. This essay therefore offers an intellectual and cultural history of the College of Physicians, seeking to scrutinise and account for the descent into utter apathy that took place between the years 1730 and 1770. It is composed of three main sections. The first
7 8

M. Pelling, Medical Conflicts in Early Modern London, (Oxford, 2003). Annals of the Royal College of Physicians, London, 1 October 1764, xii, 116.

section will examine how the College and the university-taught physicians sought to delimit and define the borders of medical orthodoxy. Porter has convincingly demonstrated that it is impossible to define quackery on any objective criteria. For Misoquackus writing in The Grub-Street Journal, Joshua Ward was a murderous quack. To George II, he was an excellent physician.9 Undoubtedly, the division between orthodox and unorthodox was a discursive creation, but the strategies used by the London medical faculty and collegiate physicians to police this border have not hitherto been satisfactorily considered. The old-fashioned, Galenic, dogmatic rational education offered by the English medieval universities became the essential precondition of medical orthodoxy as regular physicians sought to open rhetorical space between their camp and Quack Street. Quacks therefore became those of poor stock, unmannerly, unlearned, and unconducive for social stability. Worse, they were often female and foreign. By contrast, the regular elite medical practitioner was a gentleman-physician. Inspired by Steven Shapins notion of the social construction of truth, and the discursive creation of the gentlemanly-scientist to aid the dissemination of empirical knowledge in seventeenth-century physical science, I will argue a comparable process occurred in mid-eighteenth-century physic. In the second part, I will seek to examine in more detail the fall of the College into institutional stupor and the protracted psychological crisis of confidence afflicting Warwick Lane. Its impotence in the face of unlawful, unlicensed practice was obvious even to the physicians themselves. Yet the descent into apathy was not a sudden revolution, but a gradual decline, taking place throughout the 1730s-60s. The College declined from a regulatory corporation, exercising its quasijudicial powers to fine and imprison, to mere consumer rights protectors, arbitrating between patient and practitioner a low and unbecoming calling. The final section will attempt to demonstrate how this phenomenon arose from a gradual and continuous series of
9

Misoquackus, Letter to Mr. Bavius, The Grub-Street Journal, 257, (28 November 1734), p.1056.

changes in the intellectual culture of the London medical community. From 1730-1770, the empirical turn in epistemology associated with Robert Boyle and the Royal Society slowly percolated through the institutional imagination of the College. The Colleges correspondence with the Lords of the Admiralty from 1740 to 1769 allows the historian to map the permeation of empiricism through its consciousness, countering Harold Cooks hypothesis that empiricism and English medicine collided in the 1690s.10 As the scientific revolution slowly reached the London medical faculty in these years, the boundaries dividing the orthodox from the quacks became increasingly more porous. The Colleges piecemeal acceptance of the tenets of empiricism rendered their attacks on empirics baseless, and paralysis set in. I From a medical and scientific point of view, the distinction between quacks and regulars is nonsensical. Even the greatest eighteenth-century doctors were more likely to kill their patients than cure them; it was prudence rather than dark humour that insisted patients entering St Bartholomews Hospital had to prove that they could afford burial fees in advance of treatment.11 Quacks and regulars are only valid as terms of historical analysis in a rhetorical sense: the categories only exist as contemporary labels and libels. The historical attempt to delineate the borders of medical orthodoxy on any objective criteria an implicit ambition within collegiate histories from Charles Goodalls in 1684 to George Clarks in 1966 is ultimately fruitless, for the two were like as two peas in a pod.12 Aside from sheer inefficaciousness, the egoism and ostentatious ritual habitually associated with the quacks these turdy-facy-nasty-paty-lousy-fartical-rougues, in Ben Jonsons memorable phrase were never in the exclusive
10 11

H. Cook, The Decline of the Old Medical Regime, (Cornell, 1986), p.254-5. E. Lorraine de Montluzin, Daily life in Georgian England as reported in the Gentlemans Magazine. (New York, 2002), p.51. 12 R. Porter, Quacks: Fakers and Charlatans in English Medicine, (Stroud, 2000), p.23.

possession of the irregulars.13 Augustan satire abounds with depictions of pompous physicians engaging in the same sort of swanking self-advertisement that they excoriated in those practitioners outside the faculty. Medical orthodoxys borders the distinctions between regulars and quacks were fuzzy, contested, discursive constructs. They are not lying beneath the skin of the Georgian medical scene, waiting for the historians scalpel to uncover; instead, they emerged from the discourses of anti-quackery and the binary opposition which pitted regularity against fraudulence. Who, therefore, was as a regular? The question is more complicated than it appears. Viewed from a legal and institutional standpoint, three traditional broad layers of medicine men (the gendered language is appropriate here) were apparent in London: at the top were the university-trained gentleman physicians, ostensibly regulated by the College of Physicians. Below them were the surgeons, trained in apprenticeships, and policed by a distinct regulatory framework. Lastly came the apothecaries, the most numerous members of the profession. All had their place in the medical hierarchy. But the imagined hierarchical model never accurately depicted the reality of the medical marketplace, existing only in the imaginations of those at the top. It excluded the hundreds of folk healers, uroscopists, dentrificators, charlatans, itinerant drug peddlers, men-midwives, womenmidwives, and the profusion of other types of practitioners that characterised the eclectic Georgian medical marketplace. Limiting this analysis only to the practice of physic, the London medical profession in contrast to the Parisian medical scene still appears as a mythical construct. There was no English unified, corporative body of practitioners. The College of Physicians of Warwick Lane, founded under statute by Henry VIII in 1518, was a club. Despite its members legal monopoly on practicing physic within seven miles of the centre of London, it never represented the majority of universitytrained doctors in the metropolis. In 1747, overseeing a metropolitan population of over 550,000, the College had only
13

B. Jonson, Volpone, or the Fox, Five Plays, (Oxford, 1981), p.60.

52 fellows and 24 licentiates. Fellowship was restricted to the graduates of Oxford or Cambridge who had paid the appropriate fees. Graduates of Scottish and foreign universities and religious non-conformists barred from Oxbridge quadrangles could gain Licentiate status, yet they received nothing in return for their annual payments, and justifiably resented their inferior position. The licentiates would besiege the College in protest at its failure to answer their grievances in 1768, the high point of intra-collegiate bickering.14 A great many regular physicians were able to rise to prominence in the eighteenth century outside the College environment: William Hunter, brother of the famous surgeon, had a thriving practice catering to the noblest aristocracy in London for two decades before he decided to honour Warwick Lane with his presence.15 In order to be a useful category of analysis, the term regular physicians must incorporate more than merely those who appeared in the register of the College. Perhaps the term regular physician is most usefully employed to distinguish the medical training that a practitioner had received, rather than his relationship to any medical corporation. When the quacks wished to stake their own claim to regularity, they used the same definition: the physician is truly characterized from the knowledge and skill he exercises in curing the sick, wrote an anonymous advocate of the quack uroscopist Theodor Myersbach.16 Regular physicians had studied physic, the art and science of healing. They were the Gentleman Dogmatists against which the prominent magistrate Henry Fielding railed.17 Medical science and curative technologies progressed very little in this period. The dogmatic and rationalist Galenism, which persisted even throughout the scientific revolution of the seventeenth century, remained fairly intact throughout the eighteenth. English doctors in the
14

G. Clark, A History of the Royal College of Physicians, (2 vols, Oxford, 1966), ii, 562. 15 H. Brock, Hunter, William (17181783), Oxford Dictionary of National Biography, (Oxford, 2004), [http://www.oxforddnb.com/view/article/14234, accessed 7 March 2011]. 16 The Imposter Detected, or, The Physician the greater Cheat, (London, 1776), Wellcome Library MS. 3246. p.20. 17 H. Fielding, The Charge to the jury: or, the sum of the evidence, on the trial of A.B. C.D. and E.F. (London, 1745), p.35.

eighteenth century may have dropped the language of humoral imbalances in favour of the language of natural philosophy, but there was little evidence that the new ideas of iatrochemicalism or mechanical philosophy (which reduced all phenomena to matter and motion) in any way impinged upon the classical qualitative understanding of disease in the English imagination.18 What can be the use of beating ones Brains, and destroying ones Health, to comprehend the Meaning of old musty Authors who lived some thousand Years ago? inquired Fielding.19 It was a pertinent question. Physicians certainly did not alter the tried and tested therapeutic techniques aimed at conquering illness. Bloodletting survived as the dominant medical intervention in response to most diagnoses. Bleeding, purging, inducing vomiting and sweating, and the limitless array of ineffective and frequently poisonous drugs comprised the sum total of the physicians armoury.20 William Harveys discovery of the circulation of the blood first announced in the Lumleian lectures to the College of Physicians in 1618 may have exploded the Galenic anatomical model of the circulatory system, but physicians and surgeons merely found new ways of justifying their old practices.21 Indeed, medical science as a body of theoretical doctrine only formed a part of the medical curriculum for university students; it was never divorced from a broader conception of natural philosophy. Examinations by the College of Physicians reflected and reinforced the theoretical orientation of the university curriculum: the tripartite examinations were on physiologica, pathologica, and therapeutica, but not clinical bedside medicine. These were the sciences which legitimated medicines claim to the status of scientific knowledge. Notably, the Continental development of medical science diverged from the English in the Enlightenment, as Padua and Paris adapted to the increasingly apparent shortcomings of a medical
18

A contrast can be made with France. Brockliss and Jones, Medical World, pp.441-2. 19 Fielding, Charge to the jury, p.36. 20 Lorraine de Montluzin, p.51. 21 D. Wootton, Bad Medicine, (Oxford, 2006), p.17.

education devoid of clinical experience.22 By contrast, the medieval English universities responded badly as Oxbridge lost its grip on medical education in England, challenged both by the expanding and modernising Scottish universities, and the clinical training increasingly offered by the London hospitals. As Thomas Broman has persuasively argued, medical education in the English universities remained wedded to the spoken and written word.23 Even as the faculty recognised these deficiencies, the culture of scholarship and criticism of ancient and modern medical writings were so fundamental to the social identity of physicians, so crucial to their superior credentials over the surgeons, apothecaries, and the rest, that they could not let it go. Although there was variety in the nature of the education in physic that a practitioner might have received, what differentiated the regular from his nemesis the quack was the theoretical study which had to a greater or lesser extent underpinned his medical education. But if there was heterogeneity among the regulars, it was infinitely less than that which characterised the quacks, the medical theoretical illiterates. Unorthodox practitioners ranged from the sublime to the ridiculous. On the one hand, William Read, a quack oculist, became sublimely successful. He treated Queen Anne and was knighted. Joshua Spot Ward, pill-vendor extraordinaire, supplied the Royal Navy with his pills and was granted the unique dispensation from George II to drive his coach-and-six through St James Park.24 Female irregulars could be equally successful: the bone-setter Sally Mapp treated the President of the College of Physicians niece, and became famous enough for Hogarth to include in his satire, The Company of Undertakers (1736).25 In 1740, Parliament decreed that Joanna Stephens hath acquired the skill of medicines, and

22

T. N. Bonner, Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750-1945, (Oxford, 1995), p.13. 23 T. H. Broman, The Medical Sciences in Roy Porter (ed.), The Cambridge History of Science, Vol. 4, (Cambridge, 2003), pp.465-8. 24 Porter, Quacks, p.58. 25 Sir Hans Sloanes Letter of November 1736, in G. R. De Beer, Sir Hans Sloane and the British Museum, (London, 1953) p.78.

awarded her the extraordinary sum of 5000 for her patent lithontriptic remedy.26 Yet the faint smell of the ridiculous persistently hangs over the image of the itinerant mountebank: those whom John Wilmot, earl of Rochester mimicked when in 1675 he went among the quacks of Tower Hill, in the persona of a foreign mountebank Alexander Bendo. Dressed up in an old overgrown Green Gown and fake beard so his servant was later to recall he started selling drugs made from just Ashes, Soote, Lime, Chalk, Clay, old Wall, [and] soap on an upturned crate, allegedly turning a handsome profit.27 Quack Street was as diverse as the Georgian society it served; quacks were as responsive, if not more so, to the varied demands of the medical marketplace. Not only was Georgian quackery varied, but it was also remarkably continuous, a feature which has remained remarkably unproblematized in the historiography of irregular medical practice. Roy Porters extensive corpus on what he terms the golden age of quackery demonstrates an evident lack of interest in its diachronism.28 But such an omission is perhaps justified: by and large, the Tudor and Stuart quacks in Margaret Pellings work bear a striking resemblance to the late Georgian ones in Porters.29 Of course, there were some long term developments: the early modern ideas of therapeutic magic are less prominent in eighteenth-century quack advertisements, and the mass promotion and distribution of nationally marketed, brand name products like Dr Robert James Powders (over one and half million sold), and Daffys Elixir was a peculiarly post-1700 phenomenon.30 It can be inferred that quack self-promotion remained largely unchanged from the Restoration to the beginning of the nineteenth century: a tract entitled The Mock Doctors Speech to the Credulous Mob in Covent Garden was in circulation from at
26

D. Pickering, Statutes at Large, from the Ninth to the 15th Year of George II, Vol. XVII, (Cambridge, 1765) p.290. 27 T. Alcock and Rochester, The Famous Pathologist, or The Noble Mountebank, ed. V. de Sola Pinto, (Nottingham, 1961) pp.28-9. 28 R. Porter, Health for Sale, p.222. 29 Pelling, Medical Conflicts. Porter, Quacks. 30 Porter, Quacks, p.58.

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least 1670, and was reprinted in various forms throughout the eighteenth-century. Its preposterous claims and pomposity clearly tickled the funny bones of Charles IIs subjects as much as they did George IIIs: I, Waltho Van Claturbank, High German Doctor and Dentifricator...Seventh Son of the Seventh Son of an unborn Doctor...lately cured Duke Philorix of a dropsy of which he died...For if a man chance to have his Brains beat out, or his head chopt off, two drops [of my tincture], I say two drops Gentlemen, seasonably applied, will recall the fleeting spirits...I restored Virility and the Comforts of Generation to above an hundred and fifty Eunuchs in the Grand Signiors Seraglio...31 Early modern and eighteenth-century quacks were execrated in largely the same terms. For an Elizabethan writer, quacks were a bunch of runagate Jews, the Cut-throats and robbers of Christians...prittle-pratling barbers.32 When, in 1804, the renowned Dr John Coakley Lettsom wished to vilify Dr William Brodum, he libelled him a a shoe-black...a Jew vendor of oranges &c. and a footman to a mountebank.33 Social (and, where applicable, ethnic) disparagement of irregular medical practitioners was a perpetual and recognisable genre of antiquack medical commentary. Aware of the precarious and irrational foundations of their legal privileges, collegiate physicians engaged in a campaign to open up the rhetorical space between the quacks and themselves. Quacks ignorance and their social inferiority were identified as the crucial distinctions. The importance accorded to the social superiority of the gentlemanly doctor, particularly the collegiate physician, cannot be overstated. It was not simply the means by which physicians secured for themselves the custom of the respectable classes. In fact, the control
31

The Mock Doctors Speech to the Credulous Mob in Covent Garden, WL, MS 5326. 32 C. S. J. Thompson, The Quacks of Old London, (London, 1928). p.268. 33 Professional Ancedotes, or Ana of Medical Literature, (London, 1825), ii, 188-9.

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mechanisms involved in the construction of high and low social statuses were the machinery by which credibility, reliability, and truth could be constituted and recognised.34 Pomposity and self-aggrandizement were always the hallmarks of the satirical attack on the quackery of the regular profession: they were not a distasteful adjunct to the creation of medical authority, but an integral component thereof. Henry Fielding composed a mock advertisement for the Library of an Eminent Physician. Its catalogue included such bitingly satirical entries as, Ars Practica, or the Method of getting Business and Reputation: Containing the Secret of Puffing, cajoling Apothecaries, &c. To which is added, by way of Appendix, a short Essay on the Countenance, Cane, Perriwig and Chariot.35 Countenance, cane, periwig and chariot the paraphernalia of the gentleman-physician were not only necessary for the physician to attract custom, but were fundamentally essential if he was to justify his claims to truthfulness and credibility. William Hogarths depiction of a doctors room in The Inspection, the third painting in his narrative series Marriage-la-mode (1745), similarly lampoons this visual and performative aspect of medical practice. Lord Squanderfield has returned to Monsieur de la Pilulles laboratory with his common miss to complain about the inefficacious pills prescribed for his syphilis. Pilulle, clearly caught unprepared, has his untidy hair hanging loose, and the young viscounts cane raised perhaps in a threatening manner points to the full-bottomed wig in the cupboard. Hogarth has scratched the thin veneer of Pilules claims to sagacity and prestige to show that it is only the cane and wig which distinguishes the orthodox physician from the quack.36 The irony is amplified when it is noted that the name Monsieur de la Pilule (with one l) was often applied to Dr Jean Misaubin, a French licentiate of the College, working in London
34

Hug, Impostures, p.2. Fielding, Charge to the jury, pp.25-26. 36 F. Haslam, From Hogarth to Rowlandson: Medicine in Art in EighteenthCentury Britain, (Liverpool, 1996), p.111.
35

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in the 1720s and 1730s.37 The distinction between quack and regular truly was a matter of presentation, hints Hogarth. In addition to having a gentlemans appearance, physicians claimed possession of the requisite character needed to dispense good advice; it is instructive to consider that the faults identified among the quacks were often personal, as well as practical: irregulars were boastful, bold and mercenary, traits considered lse-facult by the collegiate regulars.38 Were the physician to lose his social standing, or should quackish imposture flourish, medical anarchy, in JeanEmmanuel Giliberts definitive phrase, would result. This would be a particularly insidious form of social disorder Gilibert insisted, because it both harmed the nations moral and physical health, and subverted its stability: Quacks, properly so-called, have no knowledge of the areas of medicine in which they intend to practice...Acquiring money, thats their only goal; corrupting morality, thats their purpose; but what can one expect of such villains, dispensing untested drugs?39 Giliberts rage at the quacks social inferiority, moral corruption, and base pecuniary motivation fused with his denouncement of unlettered ignorance. Equally, the blurring of the distinction between quack and regular was a visceral fear for the London College of Physicians, in spite of its apathy regarding active prosecution. One of the few activities that could rouse the College from its stupor during our period was to send regular reminders to every one of its fellows or licentiates, directing him not to meet or consult in any case of Physick with such

37

R. L. S. Cowley, Marriage A-la-mode: a re-view of Hogarths narrative art, (Manchester, 1983), pp.88-9. 38 H. Cook, Victories for Empiricism, Failures for Theory in C. T. Wolfe and O. Gal (eds.), The Body as Object and Instrument of Knowledge, Studies in History and Philosophy of Science, Vol. 25, (Dordrecht, 2010), p.14. 39 My translation. J.-E. Gilibert, L'anarchie mdicinale ou la mdecine considre comme nuisible la socit, (3 vols, Neuchtel, 1772), i, 268.

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prohibited Person under the penalties of the Statute in that case.40 Where regulars were steeped in learning and scholarship, quacks were upstarts, whose experiential knowledge lacked even the most rudimentary theoretical underpinning. We are the inheritors of Hippocrates and Galen; they are frauds and imposters, the heirs to a tradition of superstition and backwardness, fayning themselves to have knowledge in Phisnomye, Palmestrye, and other abused Scyneces, in the words of the Elizabethan College.41 Thirty years before Lettsoms 1804 campaign against Brodum, he engaged himself in a war with the German quack Theodor Myersbach. It drew heavily on the scholarship/ignorance duality common in anti-quack rhetoric. Myersbach was a urine-caster, who divined diagnoses from examining vials of urine. When Lettsom presented him with a vial of cows urine, claiming it was from his wife, Myersbach diagnosed a disorder in the womb, a pain in the loins, and declared, she always be coughing.42 Publishing this expos in the following weeks issue of the Gazetteer, Lettsoms mockery of the uroscopist was merciless.43 As the pamphlet war between the supporters of Lettsom and the defenders of Myersbach rumbled through 1776-7 it would run to over 100 articles, scrupulously collected and annotated by Lettsom himself Myersbach was increasingly linked to primitivism, and traditional, irrational practice, in contrast to the university-educated doctors, literate in classical and contemporary science.44 Of course, superstitious mummery was in the eye of the beholder: eighteenth-century orthodox medicine contained much that would later be derided as superstitious, most conspicuously the retention of the notion of humoral imbalances.
40

For example, Annals, 12 October 1747, xi, 33 and Royal College of Physicians [hereafter RCP], London, Whereas divers persons do illegal practice... (London, 1706), p.1. 41 Hug, Impostures, p.48.
42 43

J. C. Lettsom, Fugitive Pieces, Vol. 2, WL, MS 3247, p.11.

A.B. To the Printer of the Gazetteer, Gazetteer and New Daily Advertiser, 29 August 1776, p.2. 44 These are collected in Lettsom, Fugitive Pieces, Vol 2.

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Many rejected the physicians claims to greater medical knowledge. Hippocrates, writing in the Morning Chronicle, penned a long and very funny piece of doggerel against Lettsom, opening with the quatrain, Dont you know, Dr. L. is a Man of such Knowledge, That Physicians all hail him - the Cock of the College? Dont you know, as a Scholar, he swaggers and hectors With Learning close coped from Cullinss lectures? 45 But for every wit intent on satirising Lettsoms pretentions to greater learning Hippocrates joined Galen in poetically lampooning Lettsom in the pages of the Morning Chronicle there were two authors supporting his campaign, and the ideology of public benefit which sustained anti-quack rhetoric. The anti-quack argument from learned authority was stronger than might be imagined: the motto of the Royal Society Nullius in verba (on the words of no-one) meant little for sick patients desperate to ease their suffering, and the English medical establishment was one of the last bastions of bookish scholasticism: Baconian New Philosophy and the dethronement of classical learning only slowly penetrated the English medical imagination in the mid-eighteenth century. Quacks were an epidemic, as threatening as plague and smallpox to the health of the nation. The ideology of public benefit which accompanied the regulation and limitation of medical practice may only have been a cloak for the monopolistic self-interest of the occupational and commercial lite, but it was vigorously pursued. Paternalism was the order of the day: Sickness humbles the pride of man; it forces upon him a sense of his own weakness, and teaches him dependence upon unseen Powers.46 If the sick were to be dependent on anyone, the regulars were determined it should be them. Quackery was incorporated within a psycho-social diagnosis of popular gullibility, on which predatory charlatanism fed. But the historiography of quackery has often taken this conceit at face
45

Hippocrates, To Galen, Morning Chronicle, and Daily Advertiser, 9 October 1776, p.1 46 R. Southey, Letters from England, (3 vols, London, 1807), iii, 284.

15

value quackery as merely one chapter in the history of popular delusions and failed to historicise it as a rhetorical strategy employed to associate medical authority and corporative regulation with public benefit.47 Steven Shapins notion of the social construction of truth is therefore an enormously useful lens with which to observe the active drawing and redrawing of the boundaries of medical orthodoxy which took place in the eighteenth century.48 For Shapin, the discourse of gentlemanly science arose in conjunction with the empirical epistemological ideas of Robert Boyle and the early Royal Society (less than half a mile away from Warwick Lane), because truth claims derived from these experiments could only be disseminated if those not present at the experiment trusted those who were. But it has been conventionally applied to the seventeenth-century hard sciences, not eighteenth-century medicine.49 Harold Cook has recently demonstrated its conceptual utility when applied to the seventeenth-century medical marketplace, but if anything the physicians insistence on their own status as gentlemen is even more evident for the eighteenth. There is an obvious irony, however, because the imagining of the gentlemen-scientist occurred hand-in-hand with the rise of empirical methods, yet the College, of course, continued to prize the rational and the theoretical over the experiential. It invested itself with the rhetoric and image of the gentlemanly scientist, without adopting his experimental methods, and reaffirming its own gentlemanliness took the place of persecuting irregulars as the Colleges main activity in the 1730s. II For an historian interested in institutional decline, the eighteenth-century College of Physicians offers rich pickings.
47

For example, C. MacKay, Extraordinary Popular Delusions and the Madness of Crowds, (London, 1841), Chapter 7: The Magnetisers. 48 S. Shapin, The Social History of Truth, (Chicago, 1994). 49 A lament expressed in Cook, Victories for Empiricism, p.27. S. C. Lawrence, Charitable Knowledge: Hospital Pupils and Practitioners in Eighteenth-Century London, (Cambridge, 2002) is an exception.

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Every long-lived institution must have its bad times...the eighteenth century was one of the worst periods of the College, sighed the official historian of the College, Sir George Clark.50 It is a judgement universally accepted. Roy Porter revelled in the eighteenth century as the golden age of English quackery in part because it was then that the College largely abandoned its former crusade against unlicensed practice and retreated into its shell.51 Certainly, the material facts endorse Porters judgement. In the period studied by Margaret Pelling, 1550-1640, the College prosecuted 1,273 quack practitioners; half of them were convicted.52 In the early 1730s it attempted unsuccessfully to prosecute three. And from 1735 until 1858, (when the new Medical Act removed the regulatory responsibility of the College) it did not haul a single quack in front of a judge and jury for malpractice or practising without a license. But Porters judgement sentenced the eighteenthcentury College to a decade of historiographical obscurity: the contours of the shell into which this learned body retreated remain largely unsurveyed. And the story of stupor, insularity, and exclusivity depicted in the Colleges admittedly scanty records is an interesting one, deserving more than a perfunctory dismissal. Rare bouts of innovation and activity punctuated the general sloth. Institutional decline it certainly was, but the descent into supreme apathy towards quacks was meandering and gradual, and on occasion as picaresque as the quack-doctors were themselves. That the College suffered the dual malady of an extreme bout of apathy alongside a tragic self-awareness of its impotence cannot be in doubt. Its failure to intrude into the lives of two Thompsons in the 1750s illuminates this particularly well. Thomas Thompson, an unlicensed physician practising in London, sued an apothecary Mr Saxon for libel for having questioned his abilities in Physick. In June 1751, Saxon asked the College to provide him with a certificate stating that Thompson had never been examined and was not licensed; the

50 51 52

Clark, ii, 483. Porter, Quacks, p.37. Pelling, Medical Conflicts, p.301.

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College obliged.53 Astonishingly, the College never investigated or summoned Thomas Thompson for unlicensed practice. This is truly remarkable. The President had expressly noted his intention to suppress unlawful, unlicensed practice only six months previously. Mr Saxons evidence to the College proved not only that Thompson was practising contrary to the law, but that he was incompetent as well, but it still did not rouse the College from its stupor. Perhaps in direct response to this episode, an anonymous London physician beseeched the President the following year no longer to stand by as an unconcernd Spectator of these growing mischiefs. It would be to no avail.54 Seven years later, the failure to summon John Samuel Thompson was even more striking. Susannah Bray complained to the board of censors that this Thompson, an unlicensed practitioner, had made exorbitant demands on her, having charged fees as a Physician [and] a Bill for Medicines. She presented these to the board as evidence. The Colleges response shows complete apathy regarding prosecuting charlatans: Thompson was told that unless he agreed the matter with her, that the College would prosecute him for practice.55 Suppressing quacks had become a mere threat a strategy to ensure it could continue in the easy passivity to which it had become accustomed rather than a sovereign duty exercised for the public good. So if the College was not persecuting unlicensed practice between 1730 and 1770, what was it doing towards those practitioners who fell outside the old medical regime? Summoning, indicting, and failing unorthodox practitioners were carried out irregularly at best. Of the 86 practitioners summoned between 1730 and 1770, only six suffered interdiction.56 And those unlicensed practitioners who were
53 54

Annals, 6 June 1751, xi, 109. Annals, 22 December 1750, xi,86. A London Physician, The modern quacks detected, (London, 1752), p.8. 55 Annals, 1 March 1758, xii, 64-5. 56 These were Drs Rathbone and Barclay in 1731 and Drs Joseph Fry and William Siney in 1765-7. Dr Isaac Schamberg and Dr Walker had their interdictions revoked in 1747 and 1765 respectively. Annals, 25 June 1731,

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summoned by the College especially those rounded up in the major summoning campaigns of 1765 (in which 37 unlicensed doctors appeared) and 1751 (involving 16 summons) generally all held university degrees, but just had not troubled themselves to gain Licentiate status. The majority were not quacks at all, merely still-unlicensed regulars, and the overwhelming majority of the practitioners summoned submitted to an examination and passed. Two of those summoned asked to be excused because they were still studying at Cambridge.57 But if practitioners wanted to excuse themselves from being examined for lesser reasons, the censors were almost comically lenient. Dr Homan asked to be excused the examination because it would put him to great inconvenience. He was indulged.58 Dr Turner simply did not turn up and remarkably he was not pursued (though admittedly the failure to chase non-respondents was rare indeed).59 Not a single request to defer examination was refused. Some, like Daniel Cox and David Ross who were summoned with six others in March 1747, repeatedly requested more time in which to prepare; it would be three years before the College finally lost patience and insisted that they submit for examination.60 If the College truly believed that it highly behoves us [not] to suffer any unskilful Person to undertake the Cure of Diseases...who upon due Examination shall [not] appear to have sufficient skill and ability, as the President professed, it appeared as though they did not show it.61 The decision to fail a candidate, like summoning them in the first place, was vanishingly rare: of the 86 summoned in this period, only 11 were told that they had failed their examinations. There is a strong argument to suppose that the censors decision to fail a candidate was often the result of an
ix, 141; 18 June 1765, xiii, 12; 6 March 1747, xi, 24, 61-2. 57 They were David Hartley, who would later become a noted philosopher, and Dr Hibbin, who never returned to take an examination: Annals, 5 August 1737, x, 65; 1 March 1751, xi, 95. 58 Annals, 26 April 1765, xiii, 9. 59 Ibid. 60 Annals, 6 March 1747, xi, 22. 61 Annals, 22 December 1750, xi,86.

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individual quack hunter within the censorial board. Porter identified the great Quack-Finder Generals as extra-collegiate early nineteenth century figures, such as Thomas Beddoes in Bristol, John Coakley Lettsom in London, and James MacKitterick Adair in Bath.62 But in the 1750s and 60s, the College of Physicians had its own anti-quack: Dr Anthony Askew. He did not write diatribes against quacks as those did, and all of his biographers since the great Victorian College prosopographer William Munk have focussed on his antiquarianism rather than his antipathy to the irregulars, but it is likely that he was a persistent force for intolerance towards irregular practice throughout his tenure on the censorial board.63 It should be noted that such a deduction is necessarily conjectural, because one of the side-effects of the mid-eighteenth-century decline in collegiate activity was a corresponding affirmation of the Colleges corporative, unified identity: the Annals rarely recorded the actions of individual fellows after the 1740s. But they do record that it was Askew who gave the Censors Committee a list of over forty people practising physic unlicensed in London, and insisted that they be summoned, causing the great spike in summons issued in 1765.64 More convincingly, it is chiefly during those years that Askew served on the censorial board, (1756, 1761, 1764-7) that candidates were told that they had failed their examinations, and were desired to come again when [they] shall be better qualified.65 The evidence is certainly circumstantial, but it seems likely that the rare waves of activity in the sea of stupor and apathy were more the result of individual temperament than widespread collegiate energy. Indeed, the very beginning of our period, which marks the last seriously hostile meeting of quack and College, is worth examining in some detail; these records contain a curious mixture of the vital seventeenth-century quack-bashing spirit
62 63

Porter, Quacks, p.18. W. Munk, Munks Roll, (London, 1861), ii, 185. See also M. J. Mercer, Askew, Anthony, Oxford Dictionary of National Biography, (Oxford, 2004); online edn., May 2005, [http://www.oxforddnb.com/view/article/799, accessed 2 December 2010]. 64 Annals, 5 October 1764, xii, 116. 65 Munks Roll, p.185. Annals, 5 March 1756, xii, 44.

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identified by Pelling, and eighteenth-century paralysis.66 In June 1730, two quacks were reported simultaneously. The Censors of the College recorded that, Mr Michael Warwick came to complain of one Ageron, a Swiss Quack, for an unreasonable Bill for Medicines and Attendance upon his wife and also of one Fabricius for another like Bill and Attendance upon the same Person; and desired this Board to interpose their Authority in this Affair; and give him what relief they could herein.67 The College Beadle, asked to summon Ageron and Fabricius for questioning, was told that Ageron was gone beyond the seas; and it was said that Fabricius had put himself under the Protection of a Forreign Ambassador, and so the cases were not pursued.68 In many ways, the briefest hints about Ageron and Fabricius left by the Annals conjure up both the Porterian image of the quack as a romantic, ridiculous showman, and the Colleges obvious distaste thereof. Their names obscenely Latinized are transparently calculated to appeal to an image of classical erudition. Even Agerons claim to be Swiss was in keeping with the sense of European exoticism common among quacks, whose handbills frequently boasted of his or her continental extraction.69 (We have had many such Practitioners sent us by the Kings of France and Spain out of pure Love and Kindness to their afflicted Neighbours, an anonymous fellow dryly noted.)70 The Colleges manifest derision, snobbery, and xenophobia towards these two characters seep from the Annals. The eighteenth-century Colleges role as fee arbitrators is evident too: the College, however reluctantly, found itself focussed on righting the wrongs suffered by Michael Warwick,
66 67

Pelling, Medical Conflicts, Chapter 3. Censorial Activity. Annals, 5 June 1730, ix, 124. 68 Ibid. 69 See, for example, the High German doctor, British Library C112, f9, p.2. and R. Porter, The language of quackery in England, 1600-1800 in P. Burke and R. Porter (eds.), The Social History of Language, (Cambridge, 1987), pp.89-90. 70 An account of the progress of an epidemical madness, in a letter to the President and Fellows, (London, 1735), p.18.

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and arbitrating in a financial dispute, not pursuing a quackfinding agenda. Part of the reason that the College stopped persecuting unlicensed practice is that their campaigns often ended in failure, as in the case of Nicholas Fivatt, who in 1735 became the last person to be labelled a quack by the College in the eighteenth century, and the last one they attempted to prosecute. Fivatt had taken fees from Lady Catherine Paul, bringing in an extravagant bill. Debating the issue irregularly for eleven months, the Censors eventually found him guilty of practicing without a license, and instructed counsel to prepare a case against him.71 The case never reached the court and Fivatt remained unpunished. It is symbolic that the plaintiff in the Colleges last attempted prosecution for generations should be titled; the Colleges retreat into its shell in the mid eighteenth century was a last ditch attempt to cling onto authority by girding itself with gentlemanly status. It is equally indicative that the Annals should mention the fees and the extravagant bill, because when the College surrendered its role as the suppressor of the quacks, the primary role that it assumed was the regulator of the medical marketplace, arbitrating between practitioners and patients in financial disputes, its profound antipathy to that low calling notwithstanding. Unlike summoning, interdicting or failing quacks, patient arbitration was a highly consistent area of activity for the Board; there was one case requiring collegiate mediation approximately every two or three years from 1730 to 1758. Looking forward towards the eighteenth century in his masterful study of the Stuart College, Harold Cook also recognised that the comitia censorum became more and more a body concerned with fee arbitration, but his judgement that the College became something rather new: a professional organisation is perhaps a little premature.72 Importing the concept of professionalisation of the nineteenth-century medical scene back into earlier centuries easily and justifiably provokes the charge of anachronism. It is clear that the College
71

Annals, 7 March, 4 April, 2 May, 4 July 1735, 1 August ,6 February 1736, x, 34-47. 72 Cook, Decline of the Old Medical Regime, p.254-5.

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was forced into this position, not out of choice, but because its pretentions to authority and credibility had begun to seriously crumble. This descent from quasi-judicial prosecutors, to mere consumer rights protectors, provoked an institutional psychological and cultural crisis of confidence. When Porter described the eighteenth-century physicians of Warwick Lane as a snug dining club, he was only half right.73 Snug it most certainly was: there can scarcely be a finer example of an institution crippling itself by insularity, parochialism, and an all-encompassing obsession with keeping the unclubbable out rather than the unlicensed down. But if it started the century a dining club, the middle of the century saw even the civic and social function of hosting dinners decline. In the 1730s, the Annals still recorded the occasion of the annual Harveian oration with the same gaiety that characterised the lectureships establishment in 1652: Dr Bourchier made the Harveian Oration, after which was an hansom dinner at which his Grace the Duke of Montague was present, the registrar cheerfully recorded in 1732.74 But by the 1740s, distinguished and noble guests had ceased to be invited, or if they were, they stopped accepting the invitation to Warwick Lane. And after 1750, the occasion was no longer marked by an hansom dinner, but by a dinner, as usual. Not until 1838 would these dinners become decadent once again.75 It is by such barely perceptible subtleties and banalities that the Colleges cultural decline its psychological crisis of confidence is measured. Its increasing exclusivity and the narrowing of its corporative vision is a symptom of the physicians failure to come to terms with the increasing diversity of the regular end of the spectrum of medical practitioners, of which they had hitherto been the only occupants. In keeping Scottish doctors out of the ranks of the fellowship, the College persisted in its delusion that the Act
73

R. Porter, Before the Fringe: Quackery and the Eighteenth-Century Medical Market in R. Cooter (ed.), Studies in the History of Alternative Medicine, (London, 1988), p.5. 74 Annals, 21 November 1732, x, 5. 75 Clark, ii, 692.

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of Union never took place, and that a system of medical regulation established in the reign of Henry VIII was fit to govern it two centuries later. It mattered little that the Edinburgh and Glasgow medical schools trained ten times as many doctors as the English universities, offered a more modern syllabus which incorporated practical experience, and produced some the greatest doctors of the eighteenth century, from William Buchan, to John Coakley Lettsom.76 Richard Russells anguish at this injurious state of affairs seems quite proportionate: I could never apprehend with what justice or propriety the Graduates of Oxford or Cambridge assume to themselves the title of Regular Physicians, exclusively of all others; and am apt to believe that all the stock of Rhetoric and Logic, with which they have Furnished themselves there, will hardly enable them to support that distinction.77 The Colleges preoccupation with Oxford and Cambridge graduates men of the requisite great learning, as the founding statutes expressed it was more than a reflection of the Georgian fashion whereby polite society wanted its physicians to be gentlemanly, as it has hitherto been assumed.78 Gentleman physicians from the English universities were the sole inheritors of the Hippocratic tradition possessors of the stock of Rhetoric and Logic and thereby had the monopoly on knowledge required to cure disease, in addition to their legal monopoly on practising physic. In the early eighteenth century, however, the numbers of physicians like Richard Russell educated in the quadrangles of Leiden, Paris, Edinburgh, Glasgow or St Andrews rather than Oxbridge practising in London increased. In the 1730s, the Annals record that only one of the twenty-one unlicensed
76 77

Bonner, Becoming a Physician, p.20. R. Russell, An Letter to Dr Addington of Reading on his refusal to join in consultation with a physician who had taken his degree abroad, (London, 1749), WL 45412/P, p.13. 78 Porter, Quacks, p.88.

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doctors summoned to answer before the College had studied abroad. In the 1760s, those who had done some training in Scotland or the continent outnumbered those who had not. The regular-irregular binary opposition was further broken down. Tis owing to this Inundation of Foreigners, that the Science of Physick itself is brought into so much disrepute, one anonymous conservative pamphleteer thundered.79 Another open letter to the President of the College insisted that, these Manslayers...have, I am informd, by some Means or other (I must leave your honourable Board to enquire what) procured a University seal, I think from Scotland, with which the better to cloak their Knavery.80 Although the College shared the opinion that physicians trained outside England were inferior, it failed either to regulate and include foreign practitioners within its remit, or to prosecute and crush them. Take particular care to preserve...the regard hitherto paid by the College to the Universities of Oxford and Cambridge, wrote the President to the committee charged with redrafting the Colleges statutes in 1765.81 When the question of whether the College would finally recognise Scottish medical degrees arose in 1751, the College decided to remain bedded to conservative exclusivity and take away all ambiguity, and make it plain in favour of the English universities.82 Reactionary to the last, the College utterly failed to engage with the problem presented by well-qualified practitioners who had not followed the orthodox Oxbridge route into medical employment.83 The mid-eighteenth century saw the College not stagnate so much as it actively became more exclusive and further detached from the realities of the medical marketplace. Moves
79

A.Z., An Address to the College of Physicians...occasiond by the late Swarms of Scotch and Leyden Physicians, &c. (London, 1747). p.15. 80 A London Physician, The modern quacks detected, p.7. 81 Annals, 14 January 1765, xii, 157. 82 Annals, 1 February 1751, xi, 94. 83 Annals, 30 September 1758. xi, 11.

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to push the College into step with the realities of the London medical scene were frequently rebuffed and successively resisted by the inertial traditionalism: in December 1761, a fellow managed to persuade his colleagues to peel off one of the layers of social snobbery crippling its effectiveness, and repeal the Statute restraining such persons as have ever been surgeons or Apothecaries, or have kept an open shop for the sale of any wares from being Candidates or Fellows of the College.84 But a fortnight later the repeal was overturned, and the question did not come up again. Indeed, in 1766 the College only agreed to approve Dr Peter Swinton as a Licentiate after he produced a certificate proving his disenfranchisement from the Apothecarys Company.85 Elitism reigned supreme; preventing the Colleges perceived social standing becoming contaminated by the socially inferior was more important than suppressing the intrusion of quacks into the field of medical practice.

III Why did the mid-eighteenth-century see such a decline in the persecution of irregular practitioners and such a crisis of confidence for the College? Clarks argument, that the cessation of coercing unlicensed practice was a consequence of the increasing difficulty in securing prosecutions, appears reasonable; Nicholas Fivatts failed trial in 1735 certainly lends support to this interpretation.86 Yet this observation cannot account for the suddenness nor the completeness of the Colleges turn to apathy. What changed decisively in the eighteenth century was that the revolutionary construction of knowledge on experiential grounds, whose germination Steven Shapin and Simon Schaffer so convincingly located in 1660s London, dissipated throughout the natural philosophical arts and sciences spreading from physics to physic and beyond.
84 85 86

Annals, 22 December 1761, xii, 114-116. Annals, 5 September 1766, xiii, 31. Munks Roll, Vol 2, p.277 Clark, ii, 507.

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The ostracising of irregulars on account of their empiricism was now increasingly anachronistic.87 It has long been historiographically assumed that the process by which the empirical natural philosophical principles of the Royal Society were applied to medicine occurred at some point during the long eighteenth-century, but little historiographical energy has been expended to concretely pin this process down.88 Harold Cook located the epistemological decline of the medical ancien rgime at the end of the seventeenth-century.89 Meanwhile, historians focussing on France have tended to locate this chronological caesura alongside the political tumult which characterised the end of the eighteenth.90 For Michel Foucault, it was during the French Revolution that the Parisian medical faculty stopped being the locus of an esoteric, bookish corpus of knowledge and instead aspired to become the temple of nature.91 But the Colleges record of activity suggests that it is possible to map the percolation of the seventeenth-century epistemological revolution through the London medical profession and penumbra: it was a gradual process most evident from the 1740s to the 1760, and was directly responsible for the concomitant wane in collegiate confidence. The lexical shift in the use of empiric to denounce quack practice is particularly instructive. But it is one which has been historiographically neglected, at least as far as the English case is concerned.92 Roy Porters otherwise forensic deconstruction of the language of quackery in a 1987 article entirely neglects this trend in anti-quack rhetoric.93 In John Lockes most
87

S. Shapin and S. Schaffer, Leviathan and the Air-Pump, (Princeton, 1985) p.7. 88 T. H. Broman, The Medical Sciences in Roy Porter (ed.), The Cambridge History of Science, Vol. 4, (Cambridge, 2003), p.465. 89 Cook, Decline of the Old Medical Regime, p.256. 90 Brockliss and Jones, Medical World p.1. 91 M. Foucault, The Birth of the Clinic, (London, 1973), tr. A. M. Sheridan, pp.84-5. 92 Some historians of France have touched upon the issue: Brockliss and Jones, Medical World, pp.668-70. But some have not: A. Lingo, Empirics and Charlatans in Early Modern France: The Genesis of the Classification of the "Other" in Medical Practice, Journal for Social History, 19, 4 (1986) pp. 5835. 93 Porter, The language of quackery.

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influential work, An Essay Concerning Human Understanding (1690), the father of British empiricism did not use the term empiricism at all, and the word empiric is employed only once. A regular practitioner of physic himself, he used it in a sense which his seventeenth-century contemporaries would have immediately recognised: an empiric was an untrained and dangerous quack, a charlatan who paid as little heed to theoretical medical science as to the fate of his or her patients. 94 Every Man is an Empirick, who by a pitiful Stock of Knowledge amuses and preys upon some ignorant People, an anonymous anti-quack pamphleteer lamented in 1747.95 In the first half of the eighteenth century, the defamation of certain practitioners as empirics was a well-established trope of medical discourse. And before the 1730s, unlicensed practitioners coming into contact with the College were frequently denounced in those terms. Even before 1690 when the Annals of the College were largely written in Latin, the term Empirick was written in English and was applied to irregulars even more frequently than the old-fashioned term, mountebank.96 In the last quarter of the seventeenth-century, both of the irregular practitioners whose occupations are expressly mentioned in the Colleges legal records are disparaged in such like terms. In 1681, Christopher Packe, a Chemist & Empiric, was fined 100 for practicing Physick without the Licence of the College, just days after Thomas Salford, Empiric [and] Weaver had suffered the same punishment.97 Both practitioners were not solely empirics, but had a dual occupation. Salfords non-medical trade weaving should not surprise us in the context of an occupationally diverse medical marketplace. The unsystematic but frequent recording of practitioners non-medical occupations was a means by which their social and technical inferiority could be emphasised: empirics, for whom the therapeutic arts were a trade rather
94

J. Locke, An Essay Concerning Human Understanding, (London, 1690), p.354. 95 A.Z., An Address to the College of Physicians...occasiond by the late Swarms of Scotch and Leyden Physicians, &c., (London, 1747), p.6. 96 Pelling, Medical Conflicts, p.152. 97 RCP Env.97, p.138; Env.96, p.176.

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than a learned profession, could be unfavourably contrasted to collegiate gentlemen-physicians. 98 But Packes non-medical occupation that of a Chemist invoked a different threat to the College. There was a distinct intellectual overlap between the seventeenth-century proponents of new natural philosophical ideas in the realm of chemistry, and those who wished to reform medicine as it was traditionally practiced by the College. As John Webster had written in 1654, The next thing I shall remind [the physicians] of, as one of their greatest defects, is the that sublime, and never-sufficiently praised Science of Pyrotechny or Chymistry; which though it hath suffered much through the corruption of time... will produce more real and true fruit, than the studying Aristotelian Philosophy hath brought forth in many centuries.99 Innovations in medical theory either in the direction of chemistry or empiricism were equally unsavoury. In both the cases of Thomas Salford and Christopher Packe, the charge of empiricism was invoked to nullify the potential threats that unregulated practice offered to the Colleges monopoly on the dissemination of medical expertise. Yet by the end of the eighteenth-century, this pejorative use of the word empiric had become vanishingly rare within the medical professions vocabulary. Intriguingly, the College of Physicians was faster to drop the term in its institutional proclamations and internal records than in the pamphlets of individual doctors and medical writers outside of the corporative setting. The word empiric simply does not appear anywhere in the Annals from 1730-1770, nor any legal document or official proclamation. Quack, by contrast, occurs in the Annals in relation to three practitioners.100 But regular physicians and members of the College writing tracts addressed
98 99

Pelling, Medical Conflicts, p.150. J. Webster, Academiarum Examen, (London,1654), pp.70-1. 100 See above pp.17-18.

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to the laity were slower to respond to this change, and continued to use empiric and quack interchangeably into the mid-1750s. The anonymous London Physician, author of The Modern Quacks Detected (Porter attributes it uncertainly to Daniel Turner) shows a such degree of familiarity with the history, laws, and internal wrangling of the College that we can conjecture with some certainty that he was a fellow, yet the dedication to the president begins by noting the growing Boldness of Quack and Empiricks [and] the daily Mischief, thereby accruing to many of His Majesties good Subjects.101 Paradoxically, at the same time that furious pamphlets were deploying the full rhetorical force of the social inferiority associated with the charge of empiricism in their campaign against charlatans, the apparently soporific and introspective College had grasped the threat to their legitimacy offered by the empirical epistemological mode. The closeness of the Royal Society in Fleet Street and Royal College of Physicians in Warwick Lane similarly aided the injection of Baconian empiricism into the fibres of the College. Not only were the two institutions geographically proximate, but they shared a common intellectual culture, and a great number of common members as well: when the Royal Society was founded in 1660, collegiate physicians were excused the societys membership fee.102 Sir Hans Sloane was the prominent embodiment of the relationship between the two colleges in the early eighteenth century. President of the College of Physicians from 1719 to 1735, the last seven of which he was simultaneously president of the Royal Society, Sloane did a great deal to import the Societys empirical world-view into the eighteenth-century College. He preferred interrogating nature to interrogating empirics: in his private, unpublished correspondence, he spoke approvingly of several irregular nostrum-mongers including one Atkins, a Quack...who had a medicine for the gout, and he famously recommended Sally Mapp the notorious bone-setter, who allegedly cured his
101 102

A London Physician, The modern quacks detected, (London, 1752), p.1. T. Birch, The History of the Royal Society, (4 vols, London, 1756-7) i, 5-6.

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niece.103 In 1734, Sloane invited the members of the Royal Society into the gardens of the College, to witness an experiment: William Oliver, a professional viper-catcher, wished to suffer himself to be bit by a viper, to demonstrate the efficacy of olive oil in treating venomous bites. (Perhaps unsurprisingly, the physicians were not convinced of his treatment after both Oliver and his wife became exceedingly ill from their bite-wounds.)104 Though the eighteenth-century Royal Society had grown more secure since its earliest years, the identification of gentlemanly knowledge with matters of fact derived from experiments carried out by gentlemen remained. And as Susan Lawrence has convincingly argued, it was the appearance of medical case studies in the Royal Societys Philosophical Transactions from the mid-seventeenth century to the early-eighteenth century which provided a model for the dissemination of good medical knowledge.105 Though the bonds between the physicians and the natural philosophers were strong, it would take several decades for empiricism to thoroughly permeate the physicians institutional imagination. The piecemeal nature of this process emerges particularly strongly from the Colleges numerous and lengthy correspondences with the Lords of the Admiralty in the 174060s. The Navy wrote to the College on seven different occasions between 1740 and 1769. (For most of our period, naval-advising and navel-gazing incorporate the sum total of the Colleges activity.) The Royal College was not the only learned body to which the military leaders desperately turned during the Seven Years War. Political and military leaders from Robert Clive to Secretary at War Viscount Barrington solicited advice from medical experts, but the Lords of the Admiralty clearly regarded the College as a trustworthy source of medical counsel.106
103

Letter of 27 Match 1699. Correspondence of Sir Hans Sloane. WL MS 7633. 104 C. Mortimer, A narration of the Experiments made June 1, 1734, in Philosophical Transactions, (1735), 39, 313-360. 105 Lawrence, Charitable Knowledge, pp.230-234. 106 E. Charters, The Caring Fiscal-Military State during the Seven Years War, The Historical Journal, 52, 4, (2009), pp. 926, 938.

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In the summer and autumn of 1740, when the danger of French intervention in the War of Jenkins Ear constituted the first serious military threat to Britain for over a decade, the Lords of the Admiralty wrote three times to the College of Physicians, asking for their advice on particular medicaments.107 The responses that they received demonstrate that the physicians remained attached to their role of guardians of polite and pure learning, even if they were aware of empiricisms epistemological claims. Old remedies that had traditionally been recommended by the College were still deemed efficacious, regardless of new empirical research. On 2 July 1740, the Admiralty enquired whether vinegar would be effective as a means of preserving the seamen against the fevers of the West Indies.108 The College wrote back to their lordships, advising them that in their collective opinion, vinegar was an effective prophylactic for fever, as well as a cure. No reason for this judgement was adduced. Research published by the famous physician and medical historian John Freind in 1716 proving conclusively that vinegar harmed rather than helped in the case of fever was summarily ignored, much to the aggravation of extra-collegiate London physicians.109 When Dr John Tennant, author of a tract about the malignant Fever of the West Indies, met his friend Dr Horsman FRCP in a Holborn coffee-house and was told that the College had advised the therapeutic use of vinegar to cure fever, he was distraught. He immediately wrote to the College, but his request for a Copy of the Papers relating to the Vinegar being approved in that Case by the College of Physicians was refused, as he had predicted.110 Worse, the College simply refused to hear his complaint, or withdraw their recommendation, and their infamy spread. It was notoriously known both in Europe and America, that the College had given that Advice to the Fleet, snarled Tennant.111
107

P. Langford, A Polite and Commercial People: England 1727-1783, (Oxford, 1998), p.53. 108 Annals, 2 July 1740, x, 125. 109 C. Hutton, G. Shaw, R. Pearson, The Philosophical Transactions of the Royal Society...from 1665 to 1800, abridged. (London, 1809), iv, 423. 110 J. Tennant, Physical Enquiries, (2nd edn., London, 1749) pp.7-9. 111 Ibid. p.9.

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Such advice was all the more wounding, because it undermined efforts from within the military to encourage new methods of medical trials. At the same time that the Navys Sick and Hurt commissioners were repeatedly writing to the Admiralty to stress the importance of trials to test what contemporary medical theory suggested should work for the prevention of scurvy, the College was dissuading them.112 Within the walls of Warwick Lane at least, empirical evidence would not yet overturn established wisdom. A similarly unsubstantiated response was given the following month, when the Admiralty wrote to inquire whether it was wise to include elixir of vitriol (aromatic sulphuric acid) in the sea surgeons inventory. The College decreed that it was.113 Such advice was quite orthodox, but it was based on theoretical principles about acidity combating putrid diseases rather than clinical experience. Thirteen years later, James Lind would offer the same advice, but extol it based on experiential evidence from his time aboard the HMS Salisbury in 1747. As [a] Preservative against many [marine] Diseases...Vinegar, Spirit of Salt, Elixir of Vitriol, and many others have been severally recommended, and have been experienced, under proper Circumstances, to produce good Effects.114 When in September, the fellows of the College apologetically admitted that they can say nothing about the use of Spiritus Salis Dulcis (a distillation of salt, sulphuric acid and alcohol) to better preserve meat, because [they] have no experience of its use, their reference to experience indicated not that they had embraced empirical epistemology, but that they lacked theoretical knowledge thereof.115
112

E. Charters, The Intention is Certain Noble: The Western Squadron, Medical Trials, and the Sick and Hurt Board during the Seven Years War in D. B. Haycock and S. Archer, Medicine and Health at Sea, (Woodbridge, 2009), p.25. 113 Annals, 19 August 1740, x, 129. There is no evidence to support George Clarks assumption that the Admiralty primarily conceived of vinegar as a cure for scurvy. Clark, ii, 524. 114 M. Bartholomew, James Lind, Oxford Dictionary of National Biography, (Oxford, 2004) [http://www.oxforddnb.com/view/article/16669, accessed 2 March 2011]. J. Lind, An essay on the most effectual means of preserving the health of seamen in the Royal Navy, (1757, 2nd edn. 1762), p.37. 115 Annals, 20 September 1740, x, 130.

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As the Admiralty-College correspondence continued over the subsequent two decades, the College warmed to empirical means of examining unknown interventions. In 1745, the Lords of the Admiralty wrote again to the College, asking them to evaluate Thomas Lowndes patent salt, which he had offered to sell to the Navy for curing the flesh for victualling the Navy. The College responded enthusiastically: It is the opinion of the College from several examinations by the usual proofs of the goodness of Salts, that Mr Lowndes salt is in all respects a strong and pure salt...That it seems likely to answer in curing flesh for the Navy in long voyages; which being the Material Experiment wanting, They think ought to be recommended to their Lordships for trial.116 The same response was given by the College in relation to Joshua Applebys new method for the distillation of sea water eight years later.117 And though modern observers might justifiably be perturbed by the Colleges inefficacious advice to the Navy it was now not only metaphorically but also literally rubbing salt into sailors wounds perhaps more striking is the collegiate endorsement of experiment itself. Its reference to the usual proofs of the goodness of Salts indicates that the College aspired to create an impression of familiarity with Royal Society-style empirical investigations. But it is unlikely that the College of Physicians had been regularly performing tests on the efficacy of medicaments at this time: none are mentioned during the well-minuted monthly committee meetings, and there are no references in the Annals to experiments being conducted at any other times. Nor do the Colleges accounts from this period contain any entries relating to the costs of such experiments. More conspicuously, the allusion to the Material Experiment wanting cannot help but invoke the Newtonian concept of the experimentum crucis a term invented by
116 117

Annals, 27 August 1745, xi, 6-7. Annals, 16 January 1753, xi, 137.

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Robert Hooke and popularised by Isaac Newton to refer to the material or critical experiment which would determine the ultimate validity of a hypothesis in question. Itself an homage to Francis Bacons instantiae crucis, the experimentum crucis became a metonym for empirical natural philosophical endeavour during the eighteenth century. It seems reasonable to infer that the Royal Colleges self-conscious use of the term Material Experiment in a formal letter to the Admiralty - an even more august institution than the College, if ever there was one stems from an implicit decision to associate itself and its image with the seventeenth-century developments in science. In fact, in response to the Admiraltys expressed wish to investigate the best waters for brewing beer an odd request, perhaps, in the middle of the Seven Years War the College became a proselytising force for empiricism, recommending an experimental design and exhorting their Lordships to carry it out.118 A final proof of the Colleges assimilation of empirical natural philosophical ideas in the mid-eighteenth century is detected in its warm embrace of inoculation in 1755. This is not to say that the College was innovative in its adoption of the practice: the portly, lumbering College never led the vanguard in any revolutionary medical advances at all. Inoculation had been common in England from its introduction in the 1720s. Had Inoculation been practisd in France, at that time, lamented Voltaire in 1733, twould have savd the Lives of Thousands.119 But while French resistance to the practice was institutionalised by the Parisian medical faculty, the physicians of Warwick Lane were happy to publicly endorse it; and though the College may well have had one eye on the increased custom that could be gained by performing inoculations on little earls and countesses at great expense, importantly for our analysis, it legitimated its approval by reference not only to its popularity but to epidemiological observation:

118 119

Annals, 19 October 1761, xii, 113. Voltaire, Letter XI: On Inoculation, Letters Concerning the English Nation, (Oxford,1994), p. 48.

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The College being informed that the success of inoculating the small pox and its reputation in this country have lately been misrepresented among foreigners, came to the following resolution: That in their opinion the Objections made at first to it have been refuted by experiences, and that it is at present more generally esteemed and practised in England than ever, and that they judge it to be a practise of the utmost benefit to mankind.120 Empiricism was slowly becoming another weapon in the Colleges rhetorical armoury. Where once the College would stifle debate by reference to a statue of the College long since made, and often confirmd, after the 1750s it could draw on the argument (epistemologically more rigorous, and rhetorically more effective) that unacceptable practices had been refuted by experiences.121 The College was attempting to beat the empirics at their own game. IV If empiricism was a rhetorical weapon for the College, it was a double-edged sword: it harmed the credibility of the Physicians. In 1745, Fielding was premature when he declared that, Physick is now established on its proper Basis, being neither Dogmatical, nor Galenical, nor Chymical, nor yet Mechanical, but purely Experimental, or Empirical.122 Were he to have made the same diagnosis of the science of physic two decades later, few would have been able to refute him. Like the Royal College of Physicians, Fielding could see which way the wind was blowing. His notorious diagnosis was that a new Society [should be] erected, with the Title of the

120 121 122

Annals, 22 December 1755, xii, 42. RCP, Whereas divers persons do illegal practice... p.1. Fielding, Charge to the jury, p.39.

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Royal College of Empiricks.123 This was a humorous rendering of the great fear of the College not that quackery would increase, about which we have seen it was surely ambivalent, but that its privileges and authority would be taken away, about which it cared very deeply. Its power was invested in the belief that Physick was Dogmatical and Galenical: collegiate physicians had hitherto retained their gentlemanly social status and attendant higher fees because they were thought to be the most qualified medical practitioners in the marketplace. As its correspondence with the Admiralty ably demonstrates, the College slowly began to acknowledge the role that experiential knowledge would play in medicine: there would be no role for a corporative fellowship in this dystopian future. Unlike the early Royal Society, the mid-eighteenth-century College was unable to mould the empirical epistemology of the New Science into a legitimating discourse.124 Paralysed with fear, it retreated from anti-quack persecution in these years, becoming what might be termed a glorified consumer rights organisation, reluctantly occupied with low and unbecoming fee arbitration. Anti-quack pamphlet writers filled the gap left by the College, fighting their battles for medical supremacy with sharp tongues in pamphlets and newspapers, rather than with legal instruments in the courtroom. Perhaps, therefore, the medical marketplace in the middle decades of the eighteenth century provides an ideal testing ground for the application of recent historiographical ideas about the long term consequences of the scientific revolution. Steven Shapins claim for the construction of deliberate social conventions surrounding empiricism and epistemological innovation, with which this study has been particularly concerned, has hitherto existed in a philosophical idealistic plane, somewhat detached from material realities.125 Yet as much as I have been primarily interested in the cultural and intellectual world of Georgian medicine in London, it is impossible to divorce that from the competitive nature of the
123 124

Ibid. p.41. Shapin, The Social History of Truth, Chapter Eight: Invisible Technicians: Masters, Servants, and the Making of Empirical Knowledge. 125 Cook, Victories for empiricism, p.27.

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marketplace. New ways of justifying truth claims, which Shapin locates as having emerged from the polite world of the midseventeenth-century scientific laboratory, were literally and metaphorically embodied in the commercial mid-eighteenthcentury medical marketplace. The Royal College of Physicians active persecution of quackery was to be the first casualty.

Bibliography
Manuscript Sources British Library, Collection of 231 Advertisements, 551.a.32; Collection of 185 Advertisements, C112.f9; Medical facts and advertisements, 551.a.20.(7); Daniel Lysons, Collectanea, C.191.c.16. Royal College of Physicians, London. Annals, Bk. ix, 1721-32; Bk. x, 1732-44; Bk. xi, 1744-53; Bk. xii, 1753-65; Bk. xiii, 1765-71. Bk. xviii, 1807-11. Proceedings against improper use of medical titles, 1608-1920. Wellcome Library, London. John Coakley Lettsom, Fugitive Pieces, (3 vols), MS 3246-8; Mock Doctors Speech, MS 5326; Correspondence of Sir Hans Sloane, MS 7633. Printed Sources Primary Alcock, T. and Rochester, The Famous Pathologist, or The Noble Mountebank, ed. V. de Sola Pinto, (Nottingham, 1961). An account of the progress of an epidemical madness, in a letter to the President and Fellows, (London, 1735). A. Z., An Address to the College of Physicians...occasiond by the late Swarms of Scotch and Leyden Physicians, &c., (London, 1747). Birch, T., The History of the Royal Society, (4 vols, London, 1756-7). Fielding, H., The Charge to the jury: or, the sum of the evidence, on the trial of A.B. C.D. and E.F., (London, 1745). Gazetteer and New Daily Advertiser, (1764-1776). Gentlemans Magazine, (1731-70).

38

Goodall, C., The Royal College of Physicians of London...And an historical account of the Colleges proceedings against empiricks and unlicensed practisers, (London, 1684). Gilibert, J.-E., L'anarchie mdicinale ou la mdecine considre comme nuisible la socit, (3 vols, Neuchtel, 1772). The Grub Street Journal, (1732-6). The Imposter Detected, or, The Physician the greater Cheat, (London, 1776). Jonson, B., Volpone, or the Fox, Five Plays, (Oxford, 1981). King, R., The cheats of London exposed, (London, 1766). Lettsom, J. C., Observations preparatory to the use of Dr Mayersbachs medicines...,(London, 1766). Lind, J., An essay on the most effectual means of preserving the health of seamen in the Royal Navy, (1757, 2nd edn. 1762). Locke, J., An Essay Concerning Human Understanding, (London, 1690). A London Physician, The modern quacks detected, (London, 1752). Morning Chronicle, and Daily Advertiser, (1769-1776). Philosophical Transactions of the Royal Society, (1730-1770). Pickering, D., Statutes at Large, from the Ninth to the 15th Year of George II, Vol. XVII, (Cambridge, 1765). Royal College of Physicians, Whereas divers persons do illegal practice physic about this city of London..., (London, 1706). Southey, R., Letters from England, (3 vols, London, 1807). Tennant, J., Physical Enquiries, (2nd edn., London, 1749). Voltaire, Letters Concerning the English Nation, (Oxford, 1994). Webster, J., Academiarum Examen, (London, 1654). Secondary Bonner, T. N., Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750-1945, (Oxford, 1995). Brockliss, L. and Jones, C., The Medical World of Early Modern France, (Oxford, 1997). Blum. L., An eighteenth century health care provider and medical entrepreneur, Bulletin of the New York Academy of Medicine, , 60, 9, (November 1984). Burke P. and Porter, R., (eds.), The Social History of Language, (Cambridge, 1987). Bynum, W.F. and Porter, R., (eds.) Medical Fringe and Medical Orthodoxy, (London, 1986).

39

Charters, E., The Caring Fiscal-Military State during the Seven Years War, The Historical Journal, 52, 4, (2009). Charters, E., The Intention is Certain Noble: The Western Squadron, Medical Trials, and the Sick and Hurt Board during the Seven Years War in D. B. Haycock and S. Archer, Medicine and Health at Sea, (Woodbridge, 2009). Clark, G., A History of the Royal College of Physicians of London, (2 vols, Oxford, 1966). Condrau, F., The Patients View meets the Clinical Gaze, Social History of Medicine, 20, 3, (2007). Cook, H., The Decline of the Old Medical Regime, (Cornell, 1986). Cook, H., Victories for Empiricism, Failures for Theory in C. T. Wolfe and O. Gal (eds.), The Body as Object and Instrument of Knowledge, Studies in History and Philosophy of Science, Vol. 25, (Dordrecht, 2010). Cooter, R., (ed.), Studies in the History of Alternative Medicine, (London, 1988). Cowley, R. L. S., Marriage A-la-mode: a re-view of Hogarths narrative art, (Manchester, 1983). Cunningham, A. and French, R., (eds.), The Medical Enlightenment of the Eighteenth Century, (Cambridge, 1990). De Beer, G. R., Sir Hans Sloane and the British Museum, (London, 1953). Foucault, M., The Birth of the Clinic, (London, 1973), tr. A. M. Sheridan. Foucault, M., Power/Knowledge, ed. C. Gordon, (Harlow, 1980). Haslam, F., From Hogarth to Rawlandson: Medicine in Art in Eighteenth-Century Britain, (Liverpool, 1996). Holbrook, S. H., The Golden Age of Quackery, (New York, 1959). Hillhouse, J. T., The Grub-Street Journal, (Boston, 1928). Hug, T. B., Impostures in early modern England, (Manchester, 2009). Hutton, C., Shaw, G. and Pearson, R., The Philosophical Transactions of the Royal Society...from 1665 to 1800, abridged, (London, 1809). Jordanova, L., The Sense of a Past in Eighteenth-Century Medicine, The Stenton Lecture, (Reading, 1997). Kottek, S., Citizens! Do you want childrens doctors? An early vindication of peadiatric specialists, Medical History, 35, (1991). Kuhn, T. S., The Structure of Scientific Revolutions, (2nd edn., Chicago, 1971).

40

Lingo, A. Empirics and Charlatans in Early Modern France: The Genesis of the Classification of the "Other" in Medical Practice, Journal for Social History, 19, 4 (1986). Langford, P., A Polite and Commercial People: England 1727-1783, (Oxford, 1998). Lawrence, S. C., Charitable Knowledge: Hospital Pupils and Practitioners in Eighteenth-Century London, (Cambridge, 2002). Lorraine de Montluzin, E. Daily life in Georgian England as reported in the Gentlemans Magazine, (New York, 2002). MacKay, C., Extraordinary Popular Delusions and the Madness of Crowds, (London, 1841). Macmichael, W., The Gold-headed cane, (2nd edn., London, 1828). Mortimer, I., Diocesan Licensing and Medical Practitioners in SouthWest England, 16601780, Medical History, 48, 1, (2004). Munk, W., Munks Roll, (London, 1861). Park, K. and Daston, L., The Cambridge History of Science, Vol 3, (Cambridge, 2006). Pelling, M., Medical Conflicts in Early Modern London, (Oxford, 2003). Pelling, M. and Webster, C., Medical practitioners, in C. Webster (ed.), Health, Medicine and Mortality in the Sixteenth Century, (Cambridge, 1979). Porter, R., (ed.), The Cambridge History of Science, Vol. 4, (Cambridge, 2003). Porter, R., Flesh in the Age of Reason, (London, 2003). Porter, R., Health for Sale: quackery in England 1660-1850, (Manchester, 1989); illustrated edn. as Quacks: Fakers and Charlatans in English Medicine, (Stroud, 2000). Porter, R., (ed.), Patients and Practitioners: Lay Perceptions of Medicine in Pre-Industrial Society, (Cambridge, 1985). Porter, R., The Patients View: Doing Medical History from Below, Theory and Society, 14, 2, (1985). Porter, R., (ed.), The Popularization of Medicine, 1650-1850, (London, 1992). Professional Ancedotes, or Ana of Medical Literature, (London, 1825). Romanell, P., John Locke and Medicine, (New York, 1984). Russell, R., An Letter to Dr Addington of Reading on his refusal to join in consultation with a physician who had taken his degree abroad, (London, 1749). Shapin, S., The Social History of Truth, (Chicago, 1994). Shapin, S. and Schaffer, S., Leviathan and the Air-Pump, (Princeton, 1985).

41

Sienna, K. P., The "Foul Disease" and Privacy: The Effects of Venereal Disease and Patient Demand on the Medical Marketplace in Early Modern London, Bulletin of the History of Medicine, 75, 2, (2001). Thomas, K. V., Religion and the Decline of Magic, (London, 1971). Thompson, C. S. J., The Quacks of Old London, (London, 1928). Wahlberg, A., A quackery with a difference New medical pluralism and the problem of dangerous practitioners in the United Kingdom, Social Science & Medicine, 65, 11, (2007). Wallis, P. and Jenner, M. S. R, (eds.), Medicine and the market in England and its colonies, c.1450-c.1850, (Basingstoke, 2007). Wootton, D., Bad Medicine: Doctors Doing Harm Since Hippocrates, (Oxford, 2006). Website Oxford Dictionary of National Biography, (Oxford, 2004), [http://www.oxforddnb.com].

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