Fat is a manifest tissue

Steven Shapin

  • Obesity and Depression in the Enlightenment: The Life and Times of George Cheyne by Anita Guerrini
    Oklahoma, 304 pp, US $25.95, February 2000, ISBN 0 585 28344 3

Physicians have historically walked a fine line between expertise and common sense, between innovation and tradition. If what they said to their patients was unintelligible, they ran the risk of being ignored. If, on the other hand, it was believed that doctors’ knowledge and advice were little different from common sense, what was the point of listening to them? What doctors know and what they can do have changed enormously over the past centuries. So has lay knowledge about health and disease, and it is a truism that much common sense on these matters is now shaped by the pronouncements of medical expertise. In the part of the culture I inhabit it counts as common knowledge that an LDL-cholesterol level over 160 means that you should go easy on the butter and the beef; that a blood-pressure reading higher than 140/90 is a sign that you’ve got to take some tablets and do something about your way of life; and (if you’re a late middle-aged male) that a Prostate Specific Antigen level of more than 2.5 augurs a biopsy and maybe worse. All this is testimony to the medicalisation of the common culture (especially in the United States), and to a vocabulary shared by modern doctors and their more medically literate patients.

Roll back history three centuries and the culture held in common between physicians and those able to afford their services was different. Among the things that a physician might have told you (and that you might very well have seen the point of) were that roasted meats were no good for your atrabilious temperament; that you needed to be bled in the spring when you tended to plethora and your pores were dilated; that frequent intercourse opened the passages and was therefore good for the stone; and that if you had a pain in your cods you should avoid chills. Common sense about these sorts of things did not necessarily have to filter down from medical experts to laity, since such knowledge might be an authentic possession of lay culture.

In early 18th-century Britain no physician positioned himself more precisely on the cusp between common sense and scientific expertise than George Cheyne. Born in Aberdeenshire in 1671, and trained at the rising medical school of Edinburgh, Cheyne in 1702 sought his fortune in the seething medical marketplace of London. The metropolis then was, as Roy Porter has said, ‘a world of quacks’. It was also a world of orthodox medical princes. And sometimes it was hard to tell the difference. The properly credentialled physicians who rode about in their coaches-and-six, and lashed out at the unprincipled commercial competition of vulgar ‘empiricks’, often peddled their own proprietary nostrums. The great Dr Richard Mead hawked a rabies powder under his own name; Dr Hans Sloane marketed medicinal chocolate; Dr Nehemiah Grew took out a patent on Epsom Salts.

How to make a medical reputation in such a world? How to make a medical living? A satirist advised the upwardly mobile young London physician ‘to make all the Noise and Bustle you can, to make the whole Town ring of you if possible: So that every one in it may know, that there is in Being, and here in Town too, such a Physician’. One way to make such a noise was to be seen in the fastest and most fashionable medical and literary circles, hoping for a reflected aura, or, at least, for crumbs of patronage to fall from the tables of the great. Within months of his arrival in London, Cheyne secured election to the fastest philosophical club of all, the Royal Society. A great talker, and, at the time, great trencherman and drinker, Cheyne cruised the coffee-houses and taverns, where he ‘found the Bottle-Companions, the younger Gentry, and Free-Livers, to be the most easy of Access, and most quickly susceptible of Friendship and Acquaintance’. As his fellow physician Bernard Mandeville observed, you could with application ‘drink yourself into Practice’.

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