In newspapers and periodicals, artistic expressions of political and social events are presented to us daily in various forms, from caricatures of prominent people to line drawings and thumbnail sketches that depict a particular situation.

In 18th and 19th century London, such satirical prints were very much in vogue. Satire was the language of the day, and no level of society was spared. Prints were the only pictorial records of life at that time, and the print shops were extremely popular. They provided amusement, but also powerful social and political criticism. In those times, society, politics, and economics were changing rapidly, and scientific knowledge was emerging. Managerial and professional classes were rising in power and status. Tall poppies were there to be cut down, and the caricaturists were always willing to do this with their pens.

The first publication in the United Kingdom of Punch, in 1841, and the British version of Vanity Fair, in 1868, saw the emergence of illustrated journalism.

In the 18th and 19th centuries, medical treatment was harsh and violent, and the cartoonists treated it and its practitioners in the same way.1-5 The aetiology of diseases was unknown, and conditions such as fever, ague (malaria-like acute fever) and gout were personified as monsters or devils. The doctors were depicted as pompous pretenders to fashion, with their wigs, cocked hats and gold-headed canes (Box 1).

Physicians prescribed medicines — many ineffective and unpalatable — including emetics, cathartics and clysters (enemas). Being ill was bad enough, but being “physicked” could be even worse. Surgeons lanced, cut, bled and amputated, their skill being judged by their speed.

Anaesthetic agents were non-existent until the mid 1800s, and the only relief would have been from opium or alcohol. Therefore, disease and doctors were to be feared. The standing of those practising medicine, in the eyes of the artists and the public, was not high, and disease and death were considered to be the doctor’s constant companions. The humour of the time was “black”. The misfortune of the patients and the attitude of the doctors were material for satire by the artists.

William Hogarth (1697–1764) is regarded as the founder of the English form of satirical art. He was not a caricaturist, but is better described as a graphic satirist and moralist. His works are a perfect representation of life in London in the first half of the 18th century, and examples would be such works as The March to Finchley, Southwark Fair and Gin Lane (Box 2). After Hogarth, other British satirists who applied themselves to recording life and events were Thomas Rowlandson (1756–1827), James Gillray (1757–1815) and George Cruikshank (1792–1878), and the period in which they worked has been referred to as the “Golden Age of English caricature”.

The social stratification at the time was reflected in the medical profession. The pecking order of those practising medicine would have been:

1. The physicians with degrees from Oxford or Cambridge, who considered themselves to be learned men and above all others.
2. The licentiates who had a qualification from some other university in England or abroad.
3. The surgeons.
4. The apothecaries.
5. The quacks.

However, success in the practice of medicine did not always depend on qualifications, but often on patronage and, in the case of the quacks, advertising.

Hogarth’s work, A consultation of physicians or The company of undertakers (which he presents as a coat of arms), satirises the standing of the physicians (Box 3). It shows 12 members of the College of Physicians examining a flask of urine. In the escutcheon, he presents three famous quacks of the time, (“Chevalier”) John Taylor the oculist, Sally Mapp the bone setter and Joshua (“Spot”) Ward of “drop and pill” fame. In Hogarth’s opinion, there was little difference, if any, between them.

Another Hogarth print, published in 1726, Cunicularii, or the wise men of Godliman in consultation, depicted the story of Mary Tofts. In 1725, Mary Tofts of Godalming had been reported in a Guildford newspaper as having given birth to rabbits, and the doctors believed it! The event even came to the attention of the king, who sent his anatomist–surgeon to investigate and report. Eventually, the situation was found to be a complete fraud, and Mary Tofts confessed. In the drawing, three “surgeons” are pilloried for their gullibility — Mr Howard, the midwife, who first reported the event; Nathaniel St Andre, the royal anatomist–surgeon; and Cyriacus Ahlers, a royal surgeon. It has been suggested that the accoucheur, labelled as the philosopher searching into the depths of things, was Sir Richard Manningham (Box 4).

Jealousies and enmity existed among the strata of the medical profession — physicians, surgeons, apothecaries and quacks. These reached the press, and even the law courts, providing more material for the print shops, who would represent them as battles.

The cartoon, Siege of Warwick Castle (1767), illustrates a fight between the licentiates and the Fellows of the College of Surgeons (Box 5). The licentiates had invaded the College after having been denied access to a College meeting and dinner at an establishment in Warwick Lane. The president is depicted as a skeleton and the weapons are urinals, clyster pipes and syringes, as well as canes and fists. The licentiates were finally dismissed with the aid of the College fire engine.

The physicians also battled with the apothecaries over whether the latter could treat patients. Eventually, this was settled by the court, which found in favour of the apothecaries. All levels despised the quacks.

Cruikshank satirised the board of examiners at Surgeons’ Hall in his drawing, The examination of a young surgeon (1811). A fierce-looking examiner asks the candidate to describe the organs of hearing. Of the motley collection of examiners around the table, two are deaf, others are bored or uninterested, another takes snuff, and a skinflint counts his money (Box 6).

Patients then, as today, sought cures to their ailments and improvements to their wellbeing in clinics and health centres. Bath was a popular place for the gentry and wealthy to visit to bathe in the hot springs, and to take the air and the waters. There was also a very important social side to the Bath visit, which involved afternoon teas, dinners and balls. Doctors were in abundance and available for consultation. Rowlandson satirised the situation in his series, The comforts of Bath, published in 1798.6 One of the main figures in the series is an elderly obese gentleman with a gouty leg. Cartoons show him being examined by a group of doctors; attending the pump room in his Bath chair; and visiting the marketplace where he appears to critically examine a large fish as well as the lady assistant’s attributes.

In another scene titled The gourmets, two gentlemen indulge themselves in the good food and drink that would suggest a contributory factor in the aetiology of their gouty legs and other medical conditions. Another satirical view of the Bath visit was the Bath races. Here, the decrepit visitors race down the slope below the Royal Crescent. Death was also in attendance, and in a couple of cartoons was shown driving a coach drawn by some of the visitors.

Lecherous doctors did not escape the artist’s pen. A Rowlandson drawing, Medical dispatch or Doctor Doubledose killing two birds with one stone, shows a portly doctor taking the pulse of a dying crone and at the same time putting an arm around the shoulders of a nubile maid (Box 7).

Innovations in medical treatment also provided material for the satirists. One of Gillray’s prints shows Jenner inoculating patients with cowpox exudate. As a consequence of the procedure, the patients have begun to sprout miniature animals from their arms and faces, etc.

A drawing by Gillray titled Scientific researches! New discoveries in pneumatics! satirises the effects of air or nitrous oxide treatment in a lecture–demonstration. The subject’s trousers are blown off, while members of the audience show shock and disgust.

Death was considered to be the doctor’s constant companion, and the skeleton was used as a symbol. One cartoon (artist unknown) illustrates a doctor carrying a bag of gold, with a skeleton riding on his back (Box 8). The doctor has pointed ears, which might suggest an association with the devil, and in the background, a funeral procession can be seen.

Metallic tractors were invented by Elisha Perkins in 1795. These instruments were supposed to produce galvanic electricity and were available (at 5 guineas a set) to cure all conditions. A Gillray cartoon of 1801 shows them being used to treat a brandy-loving patient’s large inflamed nose, with resulting discomfort (Box 9).

Boards of public health were established during the 1831–1832 outbreak of cholera in England; the Central Board was in London, and its members were employed on high salaries. (The present-day analogy would be “jobs for the boys”.) Although the board issued statistics, it had no effective measures to deal with the problem, and The Times stated that “Choleraphobia was profitable to the medical profession”. The members of the Central Board of Health were lampooned by the cartoonists, and in one drawing by Cruikshank, four distinguished members, indulging themselves with a sumptuous dinner, drink a toast: “May we preserve our health by bleeding the country” (Box 10).

The relationship between contaminated drinking water and cholera had not been appreciated at that time. In London, 130 sewers emptied into the Thames near the site where the Southwark Water Company drew its drinking water. A cartoon by Cruikshank depicted John Edwards, the owner of the company, sitting on a buoy in the filthy Thames while people on the bank called for pure water. It was not until 1854 that John Snow confirmed that the cholera infection was related to the quality of the water.

In the latter half of the 19th century, the satire became more sedate and the humour more subtle, a change from the black humour of the earlier years. Because of the advances in medicine, violent treatment such as amputation and other painful procedures were no longer a target. Doctors and patients became the main subjects, the former because of their pretensions to upper-class status and the latter, their gullibility. The doctors’ attire changed to the top hat, morning coat and striped trousers.

A cartoon in Punch shows the fashionable patient protesting at the medication prescribed (cod-liver oil) and the fashionable doctor’s solution to the problem (cream and curaçao). In another drawing, the specialist writes a prescription, which the patient can have filled or not — for it would make no difference.7

Diagnostic problems were illustrated, as shown by a few examples from Punch:

• The specialist physician searching for a diagnosis asks the patient, “What do you drink?” The reply, “Oh, Sir! — thank you Sir . . . I’ll leave it to you, Sir!”

• The beneficial effect of taking the patient’s temperature and the patient’s comment, “That done me a lot o’ good, Sir!”

• The doctor makes a diagnosis on the patient’s symptoms of “feeling wretched . . . no interest in anything, have no appetite, can’t sleep”, and his advice is “Why don’t you marry the girl?”

• Another cartoon (1882) shows an American physician and an English physician in discussion (Box 11).

Between the 1940s and the 1990s, Giles in the British Daily Express used members of the “Giles family” to put a humorous aspect on events of the day, medical and otherwise. The foils were usually Grandma and sickly, snivelling Aunty Vera, who always had her handkerchief to her nose and carried her bottle of pills.

In Australia in the 1970s, Larry Pickering drew a series of sketches on the activities of the medical profession,8 which included a doctor operating on his hobby antique car assisted by his son in the role of theatre sister, and another rather cynical set published in The Weekend Australian newspaper in 1979 lampooning doctors and their fees (Box 12).

The handwriting of doctors has always been criticised. A cartoon in Punch shows the annual pharmacists’ competition, in which they are adopting many bizarre positions in their attempts to interpret the writings of members of the British Medical Association. In the 1970s, the Australian cartoonist Larry Pickering produced a drawing on this subject in which a lady, leaving the pharmacy carrying a large purchased teddy-bear, complains to her companion that her doctor’s writing is not getting any better.

Fees have been a subject for satire throughout the years. An 18th century drawing shows Dr Gallipot weighing the guinea (at the time a precaution against “light guineas”).

Punch had its own examples, such as the specialist surgeon being asked by his colleague, “What did you operate on old Jones for?” “100 pounds.” “But what had he got?” “100 pounds”.

Another cartoon, in the 1920s, shows the patient expressing surprise on receiving the bill: “Good Lord, doctor, have I been as near death as that?”

Humour and jokes have often been used as a way to deal with adversity, and satirical humour could be described as a form of benign aggression. Disease and death have been mankind’s greatest enemies. Anything that interferes with life and makes it uncomfortable (which could include the doctors and their medicines) falls into a similar category. Being physicked, 250 years ago, was unpleasant, and going to the surgeon a painful and horrible experience. Those unpleasantries have passed but are now replaced by other inconveniences and irritations, such as waiting times for appointments and operations, and complicated and invasive tests and the fees they generate, all of which can act as grist to the mill for the satirist.

1 A Going! A Going!

Reproduced with permission of the Museum of the Royal Pharmaceutical Society of Great Britain.

2 Gin Lane

Hogarth, 1751 (engraving).

3 A consultation of physicians or The company of undertakers

Hogarth, 1736 (engraving).

4 Cunicularii, or the wise men of Godliman in consultation

Hogarth, 1726 (engraving).

5 Siege of Warwick Castle

Source: George MD. Hogarth to Cruikshank.1

6 The examination of a young surgeon

From a print in the library of the Royal College of Surgeons of England.

7 Medical dispatch or Doctor Doubledose killing two birds with one stone

Rowlandson, circa 1800.

8 The doctor’s constant companion

Anon. From the Stephen Don Print Collection, Royal College of Obstetricians and Gynaecologists

9 Treatment by metallic tractors

Gillray, 1801. From the Boston Medical Library.

10 “May we preserve our health”

Cruikshank, 1832. From the Manfred Kraemer Collection, Harvard Medical School.

11 An American physician and an English physician in discussion

“Now, in Vienna, they’re first-rate at diagnosis; but then, you see, they always make a point of confirming it by a post-mortem!” From Mr. Punch among the doctors.7

12 The Australian medical profession, by Larry Pickering

From The Weekend Australian.8