A 19th-century doctor’s guide to etiquette

In the nineteenth century the medical profession had something of an image problem.  The archetype of the pompous or unscrupulous doctor was well established, and authors like Charles Dickens had much fun sending them up with satirical depictions which were painfully close to the mark.  In The Pickwick Papers, the young doctor Bob Sawyer uses a number of underhand tricks to increase the size of his practice – such as deliberately sending medicines to the wrong address, with a paper wrapper with the words ‘From Sawyer’s, late Nockemorfs. Physicians’ prescriptions carefully prepared’ on its label; the exotic name intended to gull the unwary into thinking that this was a medical practice of repute and sophistication.

In 1839 a London surgeon, Abraham Banks, wrote a book intended to improve the behaviour and reputation of the medical profession.  Medical Etiquette was an attempt to describe the worst behaviour of doctors: ‘All the imperfections of character alluded to are unfortunately taken from living practitioners’, he mournfully informs his readers.

In a section entitled ‘Affectation of Mystery’, he bemoans the tendency of doctors to obfuscate: 

We have heard physicians use such words as ‘secundum artem, ad deliquium, toastum boastum,’ &c, &c, when talking to a general practitioner before others, such can only impose upon the ignorant, and cannot fail to lower a man in his own estimation; the profession should be too proud to violate the laws of good taste and honesty, to bend to popular error… When any person unnecessarily uses technical terms in the presence of others who may not be supposed to understand them, we regard it as a direct insult to those persons; it is in fact laughing at them. Closely allied to this habit, is that of clothing medicinal preparations in false colours, such as mixing rose pink with linseed meal, vermilion with epsom salts, burnt sugar with goulard water, &c. &c. We know that strong excuses may be pleaded in extenuation; but we may be permitted to deplore that constitution of society, which renders such conduct almost necessary; we believe it to be perfectly incompatible with an ardent love of truth, and a glowing admiration of rectitude.

This is not all.  Mr Banks suggests that the profession is full of Bob Sawyers who are all too ready to resort to subterfuge in order to exaggerate their success and importance:

It is scarcely necessary to allude to that thoroughly beaten path, which has now become nearly obsolete from its palpable nature; such as being called out of churches during divine service, and other public places, and so contriving matters as to be riding hard by, when people are coming out, his horse foaming and sweating—poor animal! all in the cause of falsehood. But this has given way to other arts equally reprehensible, though of a more refined character, and not quite so obvious to public perception; such as singing very loudly over and above all the rest of the congregation, taking a conspicuous pew, and sometimes mounting on a hassock, in order to be well seen; giving the responses in very audible language, so as to excite the observation, ‘Who is that pious gentleman?’, making himself very officious, particularly in the charitable department, so far as the collecting goes, more especially if there is any chance of filling a medical appointment.

Such a dastardly medic loses no opportunity to drum up new business, it seems.

A petition for a charity forms an excellent plea for calling on the wealthy, and putting in a good word for number One—the more so, if nobody else will do it; bowing to every one he meets, though, perhaps, he has never seen the person before; assuming a very religious tone according to the character he has to deal with, as, ‘Well, Ma’am, we have maturely considered your dear little girl, and ordered such and such medicine, which, by the blessing of God, we hope will have the desired effect:’ all this hypocritical cant, if it be not criminal, is truly disgusting.

And then, of course, there’s the time-honoured tactic of name-dropping:

Another recent manoeuvre, which is sometimes practised, is putting up counterfeit medicines, and letting them lie about the counter in the surgery or shop, so as to give a false impression of business; talking largely, and contriving, if any excuse can possibly be obtained for so doing, to introduce the name of some nobleman or baronet into all his discourse, chiefly before strangers. We have witnessed instances where some unfortunate peer, who may have accidentally got his name upon an apothecary’s books, has had that name mangled most unmercifully, as, ‘John, has my Lord such a one had his medicine? be good enough to send that medicine to his Lordship directly; I will attend to you, Sir, as soon as I have ordered something for my Lord’ &c.

Today, a doctor’s mode of transport tells you a lot about how well they’re doing.  Some things never change.

We remember hearing of a man who could not open his mouth without letting people know that he kept a horse and chaise; a bet was made upon the strength of this, that he could not answer the simplest question without introducing these essentials of his establishment. The question was put direct enough; he was asked what o’clock it was? and answered, ‘When I, with my wife, passed the Horse Guards this morning in my horse and chay, it wanted,’ &c