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J R Soc Med. 2002 March; 95(3): 157–159.
PMCID: PMC1279491

Bodies Politic: Diseases, Death and Doctors in Britain, 1650-1900

How do you picture history? Conventional visual images from the past portray their subjects in an ostensibly realistic manner, but others convey more personal messages from the artist. Such messages may be coded, or transmitted with brutal directness. Individual people, events and places are transformed into stereotypes and metaphors to provide comment on more general social or political situations, usually with strong overtones of parody, protest or subversion. The subjects are to varying degrees remodelled to form caricatures, which range from the comical to the repulsive. Such images are often supplementary to or indeed directly linked with verbal images in the novels, plays, poems and pamphlets of the times and, to this extent, the visual and the verbal cannot be separated. Both provide valuable commentary on the historical contexts in which they are set.

Bodies Politic1 is one of a new series entitled ‘Picturing History’, and British medicine between 1650 and 1900 provides abundant material for Professor Roy Porter to develop several questions—notably, ‘How did the body and healing practices... supply metaphoric commentary upon the wider world of politics and the body politic?’. The emphasis inevitably falls on ‘the long eighteenth century’, on metropolitan rather than provincial practice, and on patients ‘of the better sort’ with time and money at their disposal.

Views of the body itself were inherently conflicting during this period—loathsome object or divine handiwork? Thus Gibbon disliked ‘... the naked frankness of Montaigne who exposes all his malady and the operation of each dose of physic on his nerves and bowels’, and he was painfully distressed by his own last and unpleasant illness—‘varnish the business for the ladies’. Gibbon's less fastidious contemporaries were, however, deeply interested in other people's bodily misfortunes. Publicity was guaranteed for giants, dwarfs and the malformed, and visits to ‘the Poore lunatiques’ at Bethlem hospital provided (according to taste) edification or raucous sport up until 1770. Mary Toft from Godalming, who claimed to give birth to litters of rabbits, was displayed in London in 1726, and was recorded by Hogarth. Rare but profound enjoyment was to be had from botched executions, and the case of Ann Green, hanged in Oxford in 1650, was widely reported. Anthony à Wood recorded that ‘she was carried away to be anatomized by some young physitians’ but they, finding life in her, hastily resuscitated their unlooked-for patient. She was ‘restored’, according to another source, ‘... her neck set straight and her eyes fix'd orderly and firmly in her head again’. More optimistic views of human bodies were implicit in the general pursuit of health. Dr George Cheyne, author of Essay on Health and Long Life (1724), was himself a spectacular example. Weighing 32 stone (230 kg) in his mid-forties and remaining in ‘a jumbled and turbid humour’—as well he might—he subsequently lost ‘16 or 18 Stone Weight of my rotten Flesh’ and later advocated a ‘thin’ vegetarian diet and daily rides on ‘The Chamber-Horse’. Cheyne's Essay sold widely but one may doubt how many of his readers followed his precepts to the letter. Regular visits to spa towns and seaside resorts were more diverting, offering at least putative therapeutic benefit in fashionable surroundings.

The huge numbers of visual and verbal images associated with urban doctors, particularly between the 1690s and the 1820s, were rarely flattering. The fashionable London physicians were depicted as ostentatious, avaricious, callous, given to sexual misdemeanours and often atheistical (‘Doctor, I talk with people who believe there is no God?’ ‘And I, Mr Robinson, talk with people who think there are three’). Above all, they were disputatious. Rows between individuals, and between the College of Physicians and the Apothecaries, were served up to a wider public in prints, plays and poems. The example and influence exerted by the great figures of the immediate past such as Harvey and Sydenham were ostensibly forgotten; but, Hogarth or Rowlandson to the contrary, the truly eminent and learned did still practise—the sort of men who formed part of Dr Johnson's circle.

Many 18th century patients, unless actually moribund, seem to have approached their ailments in a business-like manner, negotiating diagnosis and management with their doctors. Opinions were often collected. Garrick had eight physicians ‘yet I am alive and in spirits’. Stereotypes of patients became as familiar as those of their attendants—the docile, the argumentative, the dissatisfied and the impregnably well-informed. There were, however, surprises. An unfortunate boy, cut for stone, published The Grateful Patient in 1732:

‘The work was in a moment done,

If possible, without a groan...

And above all the race of men

I'll bless my God for Cheselden’

Another child, Mary Anne Schimmelpenninck was of sterner stuff. Having extracted four front teeth, her kindly dentist offered ‘... a packet of comfits as my reward. But I drew up and said, “Do you think Regulus, and Epictetus, and Seneca, would take a reward for bearing pain; or the little Spartan boys?” ’.

The choice of orthodox treatments was limited. Current pharmacopoeias were large but of little value. Charles II was alleged to have received 58 different concoctions in the last 5 days of his life, hideously described by John Evelyn and only surpassed by the less familiar details of his necropsy recorded by Bishop Burnet. Much attention was devoted to expulsion of toxins by blood-letting, blistering, vomiting, sweating and purging. Electrical treatment was sometimes advocated for insanity and for other disorders. Erasmus Darwin, faced by a patient with apparent biliary obstruction ‘... directed half a score smart shocks... to be passed through the liver’. It is reassuring to recall that it was at much the same time that Edward Jenner introduced vaccination for smallpox. Though Jenner himself was as far removed from the caricatures of the fashionable practitioner as it was possible to be, his work was ridiculed by Gillray. Porter points out that some details in Gillray's print are reminiscent of Hogarth's Etching of Mary Toft, except that a pregnant woman in now delivering a dwarf cow rather than rabbits. Is it relevant that the print is dated 1802, the same year that Jenner received £10 000 from Parliament?

The place of ‘chirugeons’ changed radically in the course of the 18th century. ‘I am a Practicer, not an Academick’ proclaimed Richard Wiseman, sergeant-surgeon to Charles II, and the distinction was maintained in gruesome visual and verbal images until the time of John Hunter. Like his pupil Jenner, Hunter was the antithesis of the prototypic fashionable doctor but his remarkable achievements were crucial in improving the intellectual and social status of surgeons and surgery. (‘Physicians worthily maintained their rank... and surgeons rose to it’ was one tactful comment.)

A striking feature of 18th century medicine was the large increase in unqualified practitioners. In The Company of Undertakers in 1736, Hogarth unkindly combines pictures of twelve fashionable physicians and three notorious quacks including Mrs ‘Crazy Sal’ Mapp, the Epsom bonesetter, and John ‘Chevalier’ Taylor, the oculist. (Dr Johnson described him as ‘The most ignorant man I ever knew, but sprightly’.) Porter cites many hilarious examples—Martin Van Butchell, for instance, the dentist, truss maker and inventor of ‘Springband Garters’ who rode about London on a white pony daubed with black and purple spots. Even more famous was James Graham who presided at the Templum Aesculapio Sacrum which, seemingly dedicated to his proposition that ‘the genitals are the true pulse and infallible barometer of health’, offered many curious devices such as an ‘electrical throne’ and the celebrated ‘Celestial Bed’.

No wonder that the material, considered here in only bare and selective outline, provided an inexhaustible source for contemporary artists and writers: Hogarth, Rowlandson, Gillray and Cruikshank spanned much of the period under discussion, each with distinctive viewpoints. Porter observes that many prints, particularly by Gillray and Cruikshank, have to be read as well as observed with their long captions, speech balloons issuing from the characters, and smaller amounts of text everywhere else—open books and papers on tables and poking out of pockets, notices on walls, labels on medicine bottles. Individual diseases are depicted either realistically or in more abstract and fanciful ways: gout, fever, headache were sometimes illustrated in both modes. Death was a frequent character. Purging, blood-letting, amputations and dissections were particularly favoured for prints and applied to a wide range of ‘patients’ to illustrate the national and international events. The roles of ‘doctors’ and ‘patients’ were assigned according to particular circumstances but regularly included the royal family, politicians (especially Pitt, Fox and Burke) and the country itself (John Bull and ‘the Mob’). The French revolution and the Napoleonic wars attracted much attention and inspired some particularly savage images.

The book ends with ‘Victorian Developments’ and the emergence of an entirely changed set of visual and verbal images. Fourteen years before the accession of Queen Victoria, Thomas Wakley founded The Lancet. There he fulminated against a good many activities, but most importantly he attacked the obsolete and schismatic way in which the various branches of medicine attempted to operate: radical legislation was enacted in the mid-century in relation to medical education, medical practice and the activities of the Royal Colleges. Changes in professional behaviour were quickly reflected in public images, in the weekly paper of Punch (1841) and the later respectful drawings by ‘Spy’ and others in Vanity Fair, and in many Victorian novels. Until the 1870s, ‘the doctor’ is male: he is dignified and soberly dressed and he appears gentlemanly, high-minded, sympathetic and politely dominant. Also still pompous and with an ineradicable tendency to obscurantism (brilliantly caught by Trollope: ‘... did you observe the periporollida? I never saw them so swelled before... the periporollida in such cases are always extended’). Patients, too, were changing and some of the Victorian images of the sick room and the death bed remain all too familiar. There were more working-class patients, whose ignorance was sometimes mocked unpleasantly—though comments such as ‘the label says “one pill to be taken three times a day” and for the life of me I don't see how it can be taken more than once’ seem entirely sensible.

Porter observes that the same subjects sometimes recur in prints published a hundred years apart. Having read this absorbing book you may well wonder which images from the past are applicable to us today.


1. Porter R. Bodies Politic: Disease, Death and Doctors in Britain (1650-1900). London: Reaction Books, 2001. [328 pp; ISBN 1 86189 094X; £25]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press