Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

Bernard de Mandeville (1670 – 1733) was a Dutch doctor who studied at Leiden but practised in England, whither he emigrated when some of his poems incited a riot in Rotterdam. He became a master of English prose and one of the most important political philosophers of his age.

Among his lesser works were a defence of brothels – A Modest Defence of the Public Stews: or, an Essay Upon Whoring, as it Is now practis’d in these Kingdoms – and a proposal for making public executions more efficacious in the deterrence of crime, An Enquiry Into the Causes of the Frequent Public Executions at Tyburn. He is most famous, however, for his Fable of the Bees, in which he presents arguments that private vices become public virtues, and that no country can thrive on the basis of behaviour deemed moral.

One is never quite sure how literally to take what Mandeville writes, but there is little doubt about the contempt in which he hold his medical colleagues in his A Treatise of the Hypochondriack and Hysterick Passions. This is written in the form of a dialogue, mainly between Philopirio (lover of experience) and Misomedon (hater of physic), the former a doctor who is to be taken as Mandeville himself, the latter a depressed patient. Much of the bile poured on the medical profession is from Mesomedon, but since Philopirio does not contradict him, and when he speaks holds to essentially the same view, it can be assumed that it represents Mandeville’s opinion.

Philopirio describes how to be a successful physician:

If you can Chat, or be a Good Companion, you may drink your self into Practice; but if you are too dull for what I have hitherto named, you must say little and be Civil to all the World, observe your certain Hours, and take care you are often sent for were you are, and as’d for where you are not; but tho’ in Coffee-houses you are forc’d to sit idle and loiter away your Time all day long, yet when our of ’em always Counterfeit a Man that is in haste, and wanted in a great many Places… contradict no body, never open your Lips without a Smile, and give no Peace to your Hat.

In other words, it is all a question of acting and not of curing, even if the latter were possible. But, even more scandalously, Mesomedon says that doctors do not want to save their patients:

But among the Crafty and Polite [physicians], that in reality mind nothing but themselves and getting Money, there is no Appearance of [wanting to cure their patients]… Shall I Hazard my Reputation, say they, on the possibility of saving a Patient, when I may be sure of preserving it as well when he dies as when he lives? Nay it is certain, that should a Patient miscarry after a daring Medicine, a great Clamour would be rais’d against the Physician by his Enemies. No wise Man ought knowingly to lay himself open to the Censures of a malicious World, and therefore to prescribe otherwise, than in the safe common Road, is what a Man cannot answer to his family.

It has been suggested that Mandeville was motivated by envy and his own lack of financial success as a physician. But he was an early believer in the work-life balance. Philopirio dislikes working too hard, seeing too many patients, or hurrying.

Not that I love to be idle; but I want to be employed to my own liking.