Q: The programme features a diverse cast of characters, from arrogant showman surgeons to physicians who self-medicate with cocaine. How many of these characters are drawn from history and what makes this era of medicine such a ripe topic for comedy?
A: There are many classic sitcoms that feature proud, bombastic individuals at their centre, and at this time in the medical profession there were lots of young, experimental, risky men and women who were trying to change things and shake medicine up.
They came up against an ‘old guard’ of physicians, many of whom had entrenched ideas about how healthcare should be given. There’s plenty of tension between these sets of characters.
There’s also humour in the sorts of treatment being tried out. Knowing what we know today, 19th-century treatments might be seen as slightly foolish or funny, but at that time almost anything went. People were trying many new, fanciful ideas.
For instance, there was a contention that anaesthesia – putting someone in an unconscious or numb state where surgery could be performed – might be able to be done through ‘mesmerism’ [a forerunner of hypnotism]. John Elliotson, a professor of medicine at University College London, was an advocate of mesmerism as a safe way to control medical treatment. In fact, there are examples of successful surgery being performed on patients who had been mesmerised: in 1842 in Nottingham, a surgeon reportedly amputated the leg from a labourer while the patient was mesmerised. It’s very different to our established ideas of medicine today.
Q: If we were confronted with such treatments today, some of us may be quite sceptical. What would people have thought at the time? Would they have believed it?
A: I think that the public at this time was still broadly sceptical about medicine in general, and wary of physicians and doctors in lots of ways.
There’s definitely a wariness of these ideas in the medical establishment; Elliotson’s theories and treatment around mesmerism are critiqued by Thomas Wakley who was the founding editor of The Lancet medical journal. There’s competition between different parts of the medical establishment at this time, as they’re warring over what should be changed or kept the same.
The public weighs in on these ideas too: Charles Dickens [played by Andrew Scott in the series] is one individual who was interested in the idea of mesmerism, though ultimately he takes the side of Wakley.
Quacks. (BBC/Lucky Giant)
Q: In the programme, Rory Kinnear plays a showman surgeon who boasts that he can remove a leg quicker than anyone else. It’s treated as a spectacular theatre event and surgeons are described as ‘the rock-stars of their day’. Would this have been the case?
A: Absolutely. That’s suggested in the words ‘surgical theatre’. In the early 19th-century, there would have often been ranks of seats looking down on to the area where the surgery was being performed. The public could purchase tickets to watch surgery performed, often with very theatrical demonstrations of skill and flair with the surgical blade.
The speed of the operation was directly associated with how good the surgeon was. There was one particular surgeon, Robert Liston, who boasted that he was able to remove a leg in under three minutes.
Q: What would the experience have been like for the patient at this time?
A: That’s one of the most difficult things to approach in any period of medical history: what’s it like for the patient, what’s their perspective? It’s a fascinating time as, progressing through the 19th-century, the patient goes from being aware of what was happening, to new ideas emerging around unconsciousness and how the surgery could be done better if the patient was anesthetised – thank goodness!
It was a really pivotal time for patient experience in other ways too. Certainly, in the second episode of Quacks, there’s an interesting question raised about where the power dynamic lies between the patient and the physician in terms of administering treatment.
Quacks. (BBC/Lucky Giant)
Q: As well as the changes happening in surgery and anaesthesia, the comedy also features a psychologist. What kind of developments were happening in psychology and the treatment of mental illness at this time?
A: There was lots of change occurring in the early 19th-century around how to treat individuals who were deemed to be ‘insane’. The idea of so-called ‘moral treatment’ is developing, favouring more humane and possibly paternalistic attitudes towards patients. Certain people began to think that patients may be able to recover from conditions, so there’s a move away from the older attitudes of locking or hiding away those who are deemed to be insane.
Professionals also started thinking about moving mental hospitals out of the cities and into big houses in the country air, so that a more humane way of treating people could be undertaken. There was a sense that patients in these kinds of asylums should be treated as members of a well-run household, and would be expected to dine at group dinner tables and make conversation over tea. There were ideas that the gardens around such houses would be helpful too, and that sanity could be ‘restored’ through self-discipline and fresh air.
These new attitudes were a world away from the older attitudes of locking or chaining up people who may have been different or may have had mental health issues.
Quacks. (BBC/Lucky Giant)
Q: There’s also a female character in the series who wants to become a doctor. What was the situation for women who wanted to practise medicine at this time?
A: It was a very problematic journey. We didn’t see the first qualified female doctor in England, Elizabeth Garrett Anderson, until 1865 – she received a qualification from the society of apothecaries at that time. So, one of the routes for us was to think about healthcare and women through what was happening within nursing at the time as well.
We considered what was happening in the 1850s with Florence Nightingale, who famously helped to transform the nursing profession. Before this time, the job was something that a ‘lady of refined character’ would not have been involved with.
This prejudice was possibly even a creation of the doctors of the time, to play down the knowledge that some women had of medicine. In the beginning of the 18th century, there’s the creation of the so-called ‘man midwife’, which was the professionalization of a midwife’s responsibilities. They made midwifery seem like a job only a man could do, as opposed to the traditional and, in their eyes, amateurish knowledge that female midwives of previous centuries.
Q: How does the Wellcome Collection go about advising on a show such as this? Do you choose certain stories or instances from history that might be good fodder? Did you allow access to any artefacts in the collection?
A: We advised on literature to read or earlier sources to consider, and we also provided visual resources for inspiration, too. In 19th-century medicine, you don’t have to go too far before you find hair-raising incidents from that time. It was a case of guiding James [Woods, the writer of the series] through the vast collections to give him a broad overview and also selecting a few characters to think about and be inspired by.
We also tried to use the objects that we have on display in the Medicine Man gallery at the Wellcome Collection in London. We have a great arrangement of saws and amputation tools which give a sense of the kind of tools that would have been used to perform surgery at the time. The show is shot like a costume drama and we tried to provide objects that would help producers be accurate and also get the look they wanted for the programme.
Quacks. (BBC/Lucky Giant)
Q: The term ‘quack’ today can be used to mean someone that’s amateurish or fraudulent in their profession. In the programme, it seems as though every doctor would have been a bit experimental and trying out new things – was this the case?
A: There’s certainly some doctors who embraced the tactic of self-experimentation. James Young Simpson, a Scottish physician, took chloroform in his house with some friends. They realised the anaesthetic properties after they woke up the next morning. If the doses had been a little bit different, there’s a high chance that may not have survived such efforts! But as it stood, Simpson realised the potential it could have to alleviate pain in situations such as childbirth. Not long after that, Queen Victoria was administered chloroform to assist when giving birth to two of her children.
At the time that the series is set in the early to mid-1800s, you’re seeing medicine really professionalise itself. Even the creation of the journal The Lancet in 1823 fits in with this. The Lancet was created to root out fraudulent thinking, a lancet to cut that ‘boil’ out of medical thinking. There were real attempts to show that it was a professional, respectable and honourable profession to go into. Surgery is starting to transform itself as well; in previous centuries, it was seen as something that was barbaric, very much a manual practice and something for the less refined, less clever men of medicine to be doing.
While there are so many moments that are great for comedy, it’s also a look at a really remarkable time in medicine. One of the great things about the series is that it situates what’s happening in the wider developments of the 19th-century and Victorian thought; James Woods touches on ideas of empire, of who the public is at this time. You cannot separate medical history out of wider history.
Ross Macfarlane is the research engagement officer at the Wellcome Collection, which provides insight and information to anyone seeking to understand medicine and its role in society, past and present.