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Chapter 3 Profiling Patients and Patterns of Practice 28 WHO WERE THE CUSTOMERS? PATIENTS’ SOCIOECONOMIC AND DEMOGRAPHIC PROFILES Possibly the most interesting details provided in Monro’s case book are those that give us clues about the identity of the customers of the maddoctor , an aspect of the mad-business that historians, thus far, barely have begun to investigate.1 On the one hand, Monro’s case book reveals, as one might expect, that a significant number of his clients came from the “respectable,” moneyed classes, including merchants, lawyers, journalists , and established tradesmen. Monro was called to attend, for example, on prominent city politicians and tradesmen, including Alderman Richard Peers and the wife of Alderman Barlow Trecothick (both men were also prominent governors of Bethlem).2 At still higher levels of the social hierarchy, his services were sought by members of the aristocracy . Besides being consulted in the cases of Earls Orford and Ferrers, for instance (interventions we have discussed in our first volume, Undertaker of the Mind),3 the case book records that he was also called in to deal with the case of Sir Francis Chester by the latter’s relation through marriage , Sir George Robinson, baronet.4 Such cases indicate the substantial reliance of eighteenth-century medical practitioners on familial links between their clients in order to spread the word and market their services, patterns of practice also discernible in other early modern case books.5 Not surprisingly, there is no evidence that Monro ever felt the need to advertise his services, something that was disdained as the method of quacks, itinerants, and tradesmen . Such overtly mercenary behavior unquestionably would have compromised the appeal of elite physicians to the types of social circles they primarily sought to cultivate and with whom they sought to associate themselves. However, to assume that the aristocracy and the merchant elite were Monro’s primary clientele would be mistaken. The case book suggests, on the contrary, that the majority of Monro’s clients were from either the middling and lower ranks of society—the shopkeepers, smaller tradesmen , and craftsmen who comprised the city’s modestly heeled bourgeoisie —or else from the ranks of the nouveaux riches. Patients such as a Shoreditch distiller; the cooper to the brewer, Samuel Whitbread; a Fleet Market grocer; and bakers’ wives and sisters from Wood Street, Turnstile, Cow Cross, and Crown Court were hardly the elite of London life, but were far more typical of Monro’s customers than were baronets, knights of the realm, aldermen, and their ladies. As for patients drawn from the ranks of the major professions, it was captains, not admirals (but also not common sailors!), whom Monro saw, and country parsons and city clergy, not bishops and deacons. Monro’s attendance on eminent lawyers such as Dr. William Macham of Doctors Commons, on merchants’ families, and on various individuals styled “ladies,” “maiden ladies,” or “gentlemen” suggests that the higher-ranking professionals, wealthier tradesmen, and the gentry constituted a significant portion of his clientele. Among city tradesmen, he attended the Swiss merchant Mr. Rosat, but only after the latter’s trading fortunes and mental health had declined and forced his return from Turkey to England, while he also attended Mr. Bevan, a well-traveled clerk to the established and reputable London merchant company Messrs. Drake and Long. Some of his customers, though, were from distinctly humble backgrounds, including servants and even slaves. Among the sizable number referred to as “poor,” at least some must have been in the service of relatively well-off families who presumably paid for their treatment, while a number of others in distressed circumstances appear to have suffered rather dramatic reversals in their fortunes, either precipitated by or precipitating their mental troubles. One can identify similar cases in other surviving contemporary sources, such as a patient Monro attended in consort with William Pargeter: a “Mr Wood, who formerly kept the Assembly-House at Kentish-Town, was tried at the Old Bailey for a highway-robbery, and was acquitted,” but who was allegedly so badly affected by these circumstances “that he became epileptic mad, and died.”6 All in all, Monro’s socially heterogeneous patient population seems to suggest that, however lucrative and successful his practice became, he was never (or not, at least by 1766) able to attain the kind of social status enjoyed by fashionable physicians from superior family backProfiling Patients and Patterns of Practice 29 [18.222.163.31] Project MUSE (2024-04-19 22:23 GMT...

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