Illustrating his lecture with an extensive collection of cartoons and portraits, Professor Porter began by mentioning the current image of the doctor, based on the daily experience of patients and the public. That image, while only occasionally dented by a mass murderer or blundering surgeon, was a product of image-making and maintenance.
Commenting on recent depictions of the medical profession in literature and on stage and screen, Professor Porter noted that, while politicians, scientists and psychologists had lost favour, the medical profession had retained a favourable image. Harking back to the Hippocratic oath, the medical men of Tudor and Stuart times, bolstered by the foundation of the Royal College of Physicians in the time of Henry VIII, had developed a lofty image of the profession. Caricatures of the time portraying bombastic practitioners had not been vicious. The ideal physician had been dignified and austere, as exemplified by a number of portraits shown by Professor Porter, all of which were similar in depicting individual wisdom and gravitas: a model of restraint and moderation.
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Professor Roy Porter
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In the 18th century, the physician had relied on intellect and judgment rather than "hands on" examination. The Quaker physician John Lettsom had claimed to have no time for leisure or relaxation, and other physicians had claimed similar austerity. During the Georgian period, the physician had shaken off the mantle of the academic in favour of the image of a gentleman to whom success had brought prestige and prominence, as shown by the portrait of Dr Richard Mead of Bloomsbury Square, governor of the Foundling hospital, who was said to have made £7,000 a year. Lettsom had earned £12,000 a year and had owned a villa and extensive grounds in Camberwell, south east London. The wealthy Georgian gentleman physician had emerged from bookishness to face the world. Outstanding physicians like Thomas Sydenham and John Radcliffe had favoured practical observation rather than intellectual study. Physicians of the Georgian period had enjoyed, along with the great literary figures of the age, the affluent atmosphere of the club and the coffee house.
There had been, however, around the turn of the 18th century, another contrasting development, said Professor Porter, with some physicians flaunting themselves in bad behaviour. Rivalry and disputes between physicians had been common. The rivalry between the Society of Apothecaries and the College of Physicians had resulted in 1696 in the opening of a dispensary by members of the college. An acrimonious war had followed, bringing about the publication of Samuel Garth's The Dispensary. This was a mock epic of grotesque war between the two bodies, armed with bed-pans, urinals, emetics and purgatives, with running jokes about the slaughter of patients by both groups. It had been reprinted throughout the 18th century. Other publications had referred to the drunkenness, callousness and sexual misdemeanours of physicians. Some physicians of the time had also become involve in religious scandal, with accusations of impiety and opposition to the orthodox establishment. It had seemed as though some senior physicians had been indifferent to to their hard-won exalted image. In literary works, authors like Henry Fielding had depicted meddlesome, vain and greedy doctors.
Professor Porter had come to the conclusion that, against the background of the metamorphosis of the physician from dignified scholar to prosperous man of the world, some London doctors had, in a mockery of professional ideals, defied the etiquette and the moral code and had displayed tactics of drunkenness, mercenariness and sexual misconduct. They had often encouraged authors and critics to satirise their own profession - a possible parallel with the behaviour of some present-day celebrities. Since this appeared to be a high-risk course of action, why had they embarked upon it?
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Dr Richard Mead, governor of the Foundling hospital, said to have earned £7,000 a year
(THE TRUSTEE OF THE WELLCOME TRUST)
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The answer, suggested Professor Porter, was to be found in the anxieties and opportunities existing in the early 18th century metropolitan medical situation: the physicians had become vulnerable. The judgment in the "Rose case" of 1704 had removed their exclusive right to practise physic and the public had become sceptical of medical monopolies. The physicians had been compelled to act as individuals in capturing public attention. In an increasingly secular and affluent society, demand for medical services had been bouyant and eminent physicians had been willing to take risks in pursuit of high rewards. It had been essential to self-publicise in any way possible. Perhaps some physicians had learnt their ways from the fashionable, foppish culture of theatrical excess that had developed following the restoration of the monarchy, Professor Porter concluded.
