Roy Porter. Disease, Medicine and Society in England, 1550-1860.

Cambridge
University Press, 1999.
Reviewed by: Haraszti Lilla PPKE-BTK (English-Arabic)

Issues concerning health, diseases, treatment have always been a delicate and long

disputed problem. On one hand, layman tended to regard medical issues as being expulsive,

addressing only a limited number of people as it was too difficult to understand. On the other

hand, professionals, not willing to change their language formed a somewhat closed and

priviledged circle. For this reason the ordinary people avoided reading medical issues and for

instance new scientific developments could not be applaused by the masses. Luckily enough,

Roy Porter’s book seems to be changing this course. It has an amusing style, clear language, it

can be easily followed and understood. From a social viewpoint his book examines the impact

of disease upon English people, and responses to sickness, lay and medical alike. It covers the

era between 1550 and 1860 and gives detailed information about the change of relation

between people and the medical profession. Although the title may appear somewhat „dull” at

first sight, Porter’s book is an appealling work even to those who may be totally uninterested

in the issue, since it can catch the attention of every lay reader.

In the first place Porter claims that the survey covers England and not Britain as a whole.

These he says are „the regrettable gaps [which] mirror the uneven state of current research.”

(p.4)

To start with, the book tells about how severe was the threads of disease posed on the

population at large. Deterioration in the climate, poor harvests, frequent dearth and chronic

malnutrition put a great pressure on society. Worse still, medicine plainly had no answers to

the fatal dieases that time and time again occured. In early Stuart England the life expectation

was probably under thirty-five years, amond which women and children were the most

vulnerable. Also, Oxford and Cambridge were underscored in providing medical education by
the fact that nearly all top English physicians has studied abroad, aminly in France and Italy.

In any case only a small percentage of medical practitioners had actually attended university

and those learned clustered in London where the Court, City and Parliament provided well off

patients and so the richest pickings. For those who could afford it treating illnesses relied

totally on the medicine of Antiquity, particularly that of Hippocrates and Galen. Orthodox

medicine laid great emphasis on the management of a healthy life through regulation of diet,

exercise and the pursuit of moderation. The idea was to expell toxic substances from the body

by purging, sweating, vomiting and bloodletting. It aimed to restore balance and to fortify the

body’s regular constituion. But very few of the recepies that physicians prescribed and

apothecaries dispensed ’worked’ in the sense that, say, antibiotics work, that is by destroying

the micro-organisms which caused people to die from pneumonia for example. Traditional

surgery could offer little more. Surgeons was to dress wounds, manipulate dislocations, lance

boils, pull teeth and not least, let blood though in the days before the need for scrupulous

cleanliness was understood. He undertook little internal surgery (it was too dangerous and

painful) and the only bodies surgeons were accustomed to cutting open were dead ones.

Medical men (and women healers) were in great demand, though they were bitterly critisised

by alternative healers, satirists and fundamentalist preachers.

When rich fell sick they has an access to an „integrated pyramid of

practitioners”(p.11). Highest in rank was the physician whose job was to diagnose the

complaint, prescribe the treatment and provide attendance and advice. A physic attended

university, dwelled in the capital and joined the Royal College of Physicians which enjoyed a

monopoly of practice. Other physicians living outside the City practiced in chatedral cities

and wherever a better class of patients could be found. Humbler in status was the surgeon. His

was a rather maual craft as he was to treat external complaints, set bones and perform simple

operations. Beneath the surgeon was the apothecary or the druggist. He ran his own buisness

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and he was educated through a few years’ apprenticeship. The apothecary dispensed what the

physician prescribed, consequently there was a great scope for rivalry between the two.

Knowing more than physicians about drugs, apothecaries often sought to prescribe on their

own authority. In London of Shakespeare’s day, some 50 physicians, 100 surgeons, 100

apothecaries and 250 additional ’irregulars’ were practising. Even where regular doctors were

far and few between , ther was never any shortage of other people experienced in caring for

the sick. Every village had its nurses who dabble in herbs and white magic. Among families.

Another type of medical practitioner was the street corner quack or empiric who had no

formal training. Thousands of other people this time made their livings from medicine. On the

contrary, lay medicine was sometimes attacked by regular practitioners, though it was

perfectly legal. Thus, although there were probably fewer professional doctors, popular

healers were meant that few needing medical attention would have gone without. In London

few medical instituions survived the Refomation, except St Thomas’s Hospital, St

Bartholomew Hospital and Bethlem Hospital (popularly called Bedlam: long England only

public madhouse.) Yet within the framework of the Elizabethan Poor Law „parish paternalism

frequently involved no small outlay of ratepayers’ money on the sick or infirm.” (p.15)

How did people cope with diseases? Well illness and death loomed large in people’s

minds. Illness was considered a deeply significant life-event, inegral to the sufferer’s whole

being, spiritual, mora and physical. This view partly stemmed from the contemporary

assumptions about what caused illness. They though that sickness was the outcome when the

body balance was disturbed, which could be maintained by good health, proper diet, exercise,

adequate sleep and the like. Thus life was not in the doctors’ hands but in your own. In this

way people in traditional societies tried to cope with the fact that doctors were not miracle-

workers and treatment was a matter of personal responsibility. Among the causes of dieases

were bad environments and unhealthy occupations, spells cast by wiches and the fallen estate

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of makind was also blamed for the universal empire of sickness, sufferinf and death. Above

all, sickness was regarded as the finger of Providence. Through sickness God revealed His

will to man. The medical culture of pre-industrial England thus focused on the individual, and

Gos’s purposes for him. No one thought therefore that professionals had a monopoly of

medical expretise. People often pondered their symptoms and attempted thir own diagnosis.

Very often, then they would turn to the assistance of friends, to Dr James’ Powder ( the

Gregorian equivalent foe aspirin), wise women, parson or the squire. In the long run, the

collective prestige of doctors would rise, the patent would be more firmly fixed under the

doctor, and consumers would lose some of their say. But that rise was slow and scepticism

about medical profession long continued. Popular proverbs (’one doctor makes work for

another’) endorsed this distrust, and echoed the Biblical: ’physician, heal thyself’. In the

world of traditional medicine sufferers and doctors could co-exist without tension, because the

limits of medicine’s powers were clear to all.

The rest of the book deals with the development of the medical profession from the

eighteenth century and their public roles in the nineteeth century, also about the role of

medicine in the English market economy and consumerism. These topics may be interesting

to an economic expert but we have already covered the most appealing parts of the book. The

writer points out how well practitioners meet the demand for medical services in a

commercialised economy. The rest may seem to be dry and colourless and thus will not be

discussed in detail.

To sum up Roy Porter gives a detailed description of the development of medical

treatment and the people’s reactions to diseases. Though at first glance the topic appeared

rather boring to me after reading it I have to adnit that even I became enthusisatic about the

issue, though the last twenty pages of the book was rather dry. I can recommed this work to

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all irrespective of their interest beacuse it has proven to raise the attention of the most

uniteresed.