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Bernard Mandeville's Assault on the Medical and Pharmaceutical Professions (or A Treatise of the Hypochondriack and Hystericak Diseases )
Although Mandeville was a medical doctor he had little use for many members of his profession and found that writing was more satisfying than attempting to cure the ill. Perhaps this was due to the lack of medicines that had a beneficial effect on those plagued with illness in his time. The two favored prescriptions involved either that based on the elements or of plant origin. A much less used pharmacology was that of animal origin. Thus; animal, vegetable or mineral had its basis. In his treatise he presents a dialog in three parts between his characters. The patient, his wife and daughter have long suffered at the hands of the doctors, druggist and pharmaceutical houses (to put them in modern-day identifies) and in the discourse explains the nature of the malpractices to the visiting physician.
To fully appreciate Mandeville's cause celebre, the treatment of the King of England, Charles II, on his death bed can be cited as all that was the best of clinical practice at the time.
Dialogue between Philopirio (a physician), Misomedon (the doctor's patent) and Polytheca (the patient's wife).
On how to be a prosperous doctor �
Philopirio, "...way of getting money. Self-interest now gives better lessons to young physicians. If you are not extraordinary in any of the branches I have named, rather than that you should spend your time before the squallid beds of poor patients, and bear with the unsavory smells of a crouded hospital, shew your self a scholar, write a poem, either a good one, or a long one; compose a Latin oration, or do but translate something out of that language with your name on it. If you can do none of these, marry into a good family and your relations will help you into practice: or else cringe and make your court to half a dozen noted apothecaries (pharmaceutical houses), promise �em to prescribe loads of physick (science of healing with medicine), never to forget the melodious sound of bolus (pills), and always make your bills (prescriptions), like chimes of the exchange, ring with a "let be repeated every third hour": nay, get but in favour with one that has great business (buy into a practice), and yours is done. Otherwise be a party-man, it is all one, Whig or Tory (Democrat or Republican), so you are but violent enough of either side; or if you can chat, and be a good companion, you may drink yourself into practice; bu if you are too dull for what I have hitherto named, and in reality good for nothing, you must say little and be civil to all the world, keep a set of coffee-houses, observe your certain hours, and take care you are often sent for where you are, and ask'd for where you are not; but tho' in those several coffee-houses you are forced to sit idle and loiter away your time all day long, yet when out of �em always counterfeit a man that is in haste, and wanted in a great many places; as for the rest, study to be gracious, indulging, say nothing that is unpleasant to hear and smile upon every body; contadict no body, never open your lips without a smile, and give no peace to you hat (tip you hat to everyone)." pp 39
On the failure of botanist --
"... another branch of physick that seems to have deserted the art, for the use of which it certainly was first invented; which I mean botany. We have whole books wrote now, and by physicians too, that give us large catalogues of plants, without saying a word of their virtues, or so much as telling us, which of them are for medicinal use, and which are not. What is labour'd most in them is a curious exactness in the description of them, as to shape and colour, the time a plant blows at, what number of leaves the flower is compos'd of, what it bears, and which class it is to be rank'd in; and not a syllable of what it is good for." pp197
For headache �
Misom. Rx Rafur. Saffafr. Serpyll. Majoran. Betonic. Anam. Ifs. Flor. Rorismar. Lavendul. Pug. Ij. Infunde in s. q. aquae comm. & bujus colatureae 3iv. adde tincturae melampol. 3fs. Spir. Vitriol. Philosoph. Gt. V. Syr. de Staechade 3fs. M. s. Julap. Pro vehiculo Bol. Praescript. repetend. Quarta quaque hora." (Note some of the symbols are not available in the word processing program.) pp 266
On writing prescriptions �
"Phil. A good many patients are either too nicely squeamish, or else unreasonably scrupulous; and if the prescriptions were to be understood by every body, some might have a prejudice, others an aversion, against medicines, that yet are of great vertue; and therefore instead of making use of their plain Latin names, they are forced to wrap up several things, either in Greek or else a circumlocation; so they a call a toad phsalus, quick-silver zibach, and the Peruvian or Jesuit's-Bark, China Chinae, Pulvis Partum, &c.
Misom. That excuse may pass upon those that know no better; but what prejudice have people against white-wine, that in Bate's Pharmacopea it must be called Leucaenus. If the obscurity was only invented for the purpose you mention, it would be commendable, and I would not take it amiss, that they should call old cheese Palaetyrus, and Dog's-turd Cynocropus, because a great many people have an aversion to both but can you say the same for bran, or spring-water, that one must be call'd leptopityron, and the other hydroege, and twenty other things that are as innocent, and almost as cheap as either of them, and yet industriously disguis'd under hard terms, that a stranger to their cant, tho' he is the best Latinist in the world, can never understand, unless he is likewise a good Graecian, and something of a conjurer besides." pp300
On apothecaries (current day pharmaceutical houses) �
Polyth. ...Sure there are honest men among them, as there are in all other callings.
Misom. So there may, for ought I know; tho' no People of any other calling lie under so great temptation of being otherwise; for if an Apothecary's business be selling of medicines, and you commit a patient to his management, it is plain to me that he is left to himself to sell him as many as his conscience will allow of, and is not this to lead him into a vast temptation? Certainly the people that trust to their advice must be either fools, or thing the apothecaries are saints. Pray tell me what grocer, druggist, linnen or woollen draper, mercer, gold-smith, or other tradesman of the most reputable employment, you can name, would you put that confidence in, that he should sell you as much of his commodity as he though you wanted? It is a trust not to be reposed in mortals. They have a whole shop full of medicines, of which a great many too are in danger of being spoil'd, and would you imagine, they won't dispose of them, and vent as many as they can? Ought not every body to promote his trade?...
...an industrious apothecary never waits �till you are sick, if you are a good customer, and a well-wisher to physick; for either he makes a frivolous errand to enquire after what is his only grievance, your health, or else comes as if he thought you had lost your almanack, officiously to put you in mind of the approach of either spring or fall; and having no other design than to sell his ware, tells you perhaps some dismal accidents that befel such, as being in effect health, neglected at those seasons to disturb their bodies with violent medicine..." pp285.
Mandeville has his character, Mifomedon, speak many Latin proverbs which in the first edition went unexplained, but as he wrote in the second edition, "I have heard so many complaints of the Latin not being translated, that I have alter'd my measures, and made notes at the bottom of every page,to explain what is not English in the text of it. But as it is was not my business in this treatise to teach languages, I have been more sollicitous to set down the meaning of the Latin passages, than I have been about the words themselves, and I have had such a regard to all readers, that not to offend or make any of them uneasie, that I have soften'd the phrase, and deviated from the real significantion of the Latin in two or three places where I thought that a more just translation would have been too expressive to be read by or before every body... I have said in the notes that it is a proverb, or used proverbially, without having good authority for it; for the truth of which I appeal to the Adagies of Erasmus, where every one of those that are the least obvious may be found..."
So it is that Bernard Mandeville continued his campaign against societal practices of his time. Like "Defense of Public Stews " (why there should be government sanctioned whore-houses), Fable of the Bees (the basis for Adam Smiths writings on government where a bit of vice makes the wheels of society go round) and this A treatise of the Hypochondriack and Hyserick Diseases (where doctors and others involved in the treatment of the ill, line their coffers with money and line the coffins of the church with past patients) all were controversial at the time of their writing and continue to raise points of interest as little has changed since the early 1700's when the works appeared.
Collected Works of Bernard Mandeville , prepared in a facsimile ediion by Bernhard Fabian and Irwin Primer, Georg Olms Verlag, Hildesheim, New York, 1981. From A Treatise of the Hypochondriack and Hysterick Diseases , Bernard Mandeville, 1730 (second edition). The first edition titled, "A Treatise of the Hypochondriack and Hysterick Passions, Vulgarly call'd the Hypo in Men and Vapors in Women " appeared in 1715 and was enlarged by the author to this the second (and also third) edition. Variants in spelling from today's usage are those which appear in the editions. Capitalization was more heavily used in the press then, than is used today and the letter "f" representing "s" was used. Lower case and "s" is used in this essay.
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