Scouring drops, worm cakes and mud baths

Earlier this year a series of television programmes offered a glimpse of what might be in store for us in the post-genomic world of the new millennium. One concerned an elderly American millionaire who, in his wish to extend his life indefinitely, had donated a large sum of money for research into the mechanisms of ageing. The camera alternated between shots of the old gentleman in the back of an enormous limousine, nervously looking at his watch, and several gung-ho scientists studying changes in genes that extend the lives of fruit flies or worms. Watching as the camera flashed cruelly between this expectant octogenarian and the high priests of modern science, it seemed that quackery is alive and well in the 21st century and has retained all the basic ingredients of its illustrious past: flamboyant practitioners with wares sometimes not far removed from those of conventional practice; a clientele desperate for anything to satisfy its needs; and a hyperbolic publicity machine to display what is on offer to a gullible public.

The difficulty in defining quackery and distinguishing it from the contrived and often exaggerated claims of members of the medical or scientific establishment is a recurrent theme of this new and richly illustrated edition of Roy Porter's fascinating work on this topic, first published in 1989. Well aware of the problem, Porter tackles it head on in his preface, and immediately runs into difficulties. In the event he decides to follow W. F. Bynum's dictum that "quack is as quack does", describing the wide spectrum of those who were pilloried as such because they transgressed what the medical establishment of the time chose to define as true, orthodox, regular, or "good" medicine. He adds that, although as a historian he is not in the business of looking into men's souls, if pushed, he might venture the view that those who were arraigned as tricksters were zealots more often than cheats.

In the 18th century, as today, advertising played a central role in the success of brand-name remedies, whether approved by the medical profession or by its non-regular fringe. In 1784, the Coventry Mercury listed: Radcliffe's Purging Elixir, Royon's Ointment for the Itch, Swinfen's Electuary for the Stone and Gravel, Storey's Worm Cakes, Specific Purging Remedy for Venereal Disease, by Wessels, Smyth's Scouring Drops, and many more cure-alls. While the names of these medicines smack of a lack of subtlety, the Georgian consumer was also exposed to the tricks of modern advertising. Buffs, or hidden advertisements, were not uncommon; even that monument to childhood innocence, Goody Two-Shoes , plugs Dr James's Powder in its opening paragraph.

Another reason for the success of quackery was the willingness of some of its exponents to delve into areas of public concern that were neglected by the medical profession of the time. This is well exemplified by the activities of James Graham, whose early travels in America had engendered an enthusiasm for medical electricity, and who later became what Porter pithily describes as the leading "sexpert" of his age. In his Temple of Health and Hymen, Pall Mall, with its grand Celestial State Bed, couples experiencing problems of sterility or impotence could, for the sum of £50, spend a night of magnetico-electrico bliss augmented with "medical" music, an experience guaranteed to have a fruitful outcome. Despite this exotic nonsense, and less costly efforts to achieve the same end by immersing subjects in mud, Graham's teachings on sexual health had a remarkably holistic and even puritanical ring about them.

Among other things, he preached the importance of a healthy life, personal hygiene and good conversation in a calm and relaxed family environment, emphasising the ills of unfaithfulness in marriage. Masturbation was the ultimate sin, responsible for all manner of diseases, a message that, it appears, was easily assimilated by a public all too ready to convince itself that it was suffering from nervous disorders of sexual origin. Indeed, the quacks of the 18th and 19th century, helped by the inability of conventional medicine to do much better, promulgated a series of myths of this kind that were to survive well into the 20th century, vestiges of which are still with us.

Porter rounds up his story towards the end of the 19th century, a time when the control of medical practice by a variety of regulatory bodies led to the decline of the more florid and colourful aspects of quackery. As witnessed by his intriguing account of the long battle between Wakley's Lancet and James Morison of "Morison's Universal Pills", who preached that all diseases emanate from bad blood, the quacks did not go down without a fight. Even with the arrival of more scientifically proven therapies, unconventional medicine continued to thrive, often in the form of highly organised movements or cults.

The hazy distinction between conventional practice and out-and-out quackery is further highlighted by the juxtaposition of some of the marvellous illustrations that Porter has collected. One set, which includes a series of coloured lithographs depicting the horticultural side-effects of Morison's pills, including an unfortunate patient with vegetables protruding from every orifice, also contains portraits of Edward Jenner, the pioneer of vaccination but also the creator of a dubious brand of indigestion lozenges, and John Radcliffe; it is left to the reader to decide whether the latter's look of innocent satisfaction stems from thoughts of the future benefits of his good works for the sick of Oxford or from the self-administration of his Purging Elixir.

What kind of legacy has the colourful world of unconventional healing left us? Today, there are some 30,000 practitioners of complementary medicine in Great Britain, offering more than 60 different therapies. These range from traditional forms of herbal medicine and manipulation, through reflexology, acupuncture and a variety of sensory treatments, to those that are primarily psychological, including humanistic psychology, rebirthing and trans-personal psychology. A variety of paranormal activities are also on offer, including radionics, exorcism, palmistry and iridology. As appears to have been the case in the past, these activities form a continuum, ranging from treatments that are well tried and not far from accepted practice, to naked quackery.

Their success still reflects the inability of conventional medicine to deal with some of our commonest ills, undoubtedly helped by the willingness of their practitioners to spend more time talking to their patients about their problems than many doctors of today. Rather than marginalise unconventional practice, as it has done for centuries, the medical establishment should be asking why it has been, and still is, so successful. It will find some of the answers in Porter's thoughtful analysis; the rest will come only if complementary practice can be persuaded to expose its treatments to rigorous clinical trial.

Modern clinical practice has much to learn from the lives and works of those dubbed quacks in the past. Both the medical profession and the community at large should read this wonderfully entertaining yet deeply serious book. In its preface there is a quotation from Henry Angelo's Reminiscences : "The history of quackery, as practised in England, I remember hearing old Mr Sheridan say, would make a useful and no less amusing book." Roy Porter has proved him right on both counts.

Sir David Weatherall is emeritus professor of medicine, University of Oxford.