SOURCE: “Honeyed Words: Bernard Mandeville and Medical Discourse,” in Medicine in the Enlightenment, edited by Roy Porter, Atlanta, GA: Rodopi, 1995, pp. 223-54.

[In the following essay, McKee discusses the language, discourse, and medical knowledge in Bernard Mandeville's 1711 work A Treatise of the Hypochondriack and Hysterick Passions.]

In 1711 Bernard Mandeville published the first edition of one of his best known works, A Treatise of the Hypochondriack and Hysterick Passions. The book aims to teach patients suffering from hypochondria how to question medical rhetoric and it is woven together from a combination of a wide variety of disparate texts—recipes, stories, quotations, diagnosis, case histories, articles, cited authorities etc. The cumulative effect of this mixture is a questioning of the origins of medical discourse and, indeed, the origin of an illness such as hypochondria or hysteria—pointing out how an illness may be no more than the sum of the texts describing it.

The question of origins is raised immediately in the Preface where Mandeville places the work in the context of the Fall of Man saying,

When the crafty Tempter of Mankind meditating their ruine, attacked our first Sire in his Pride, he shew'd himself profoundly skill'd in Humane Nature; from which the vice I named is so inseparable that it is impossible the latter should be ever entirely destroy'd, as long as the first remains. I have no design, Reader, to tire you, with the Catalogue of irretrievable Calamities, it has been the occasion of, both before and since the Creation; but shall only observe to you, that as it was destructive to unexperienced Adam, by bringing Sickness and Death upon him, so it has still continued to be no less pernicious to his forewarn'd Posterity, by principally obstructing the progress of the glorious Art that should teach the Recovery as well as Preservation of Health.¹

Here, the Fall is seen as the putative origin of all sickness and the source of the vice of pride. Before the curse of knowledge, Adam is ‘unexperienc'd’ and in a state of healthy grace. With ‘original’ sin he gains knowledge, pride and illness.

For the modern physician the Fall creates two problems. The first is the difficulty of curing an illness and restoring a patient to the state of grace. The second is overcoming the temptation of pride which persuades doctors to speculate and to propound theories as if they were derived from true knowledge:

Tis Pride that makes the Physician abandon the solid Observation of never erring Nature to take up with the loose conjectures of his own wandering Invention … and it is pride in the Patient, that makes him in love with the reasoning Physician, to have an opportunity of shewing the depth of his Penetration.²

Overcoming these temptations becomes even more difficult as medical discourse assumes the proportions of a crisis comparable to the Tower of Babel,

to advance this Doctrine is swimming against the Stream in our sprightly talkative Age, in which the silent Experience of Painstaking Practitioners is ridicul'd, and nothing cried up but the witty Speculations of Hypothetical Doctors.³

Mandeville's silent practitioner is immediately recognizable as a follower of Iapis, the physician alluded to in the motto on the title page,

Scire potestates herbarum, usumque medendi Maluit, & Mutas agitare inglorius artes⁴

The motto is taken from Book 12 of Virgil's Aeneid and refers to the doctor who comes forward to treat Aeneas when he is wounded in battle with Turnus. Iapis, like Mandeville, had artistic talents but chose instead to practice medicine.

The dialogue form, then, provides Mandeville with a mask which allows him to voice the personal, emotional elements that permeate his scientific outlook. It would be unwise, however, to assume that Mandeville has simply chosen to state his current views on hypochondria through the persona of Philopirio. Typically, his apparently innocent statement of intent raises the immediate suspicions of his readers. He claims that

In these Dialogues, I have done the same as Seneca did in his Octavia, and brought my self upon the Stage; with this difference, that he kept his own Name, and I changed mine for that of Philopirio, a Lover of Experience, which I shall always profess to be: Wherefore I desire my Reader to take whatever is spoke by the Person I named last, as said by myself; which I entreat him not to do with the Part of Misomedon …⁵

Such a statement would present the reader with no problems if Seneca was ratified as the author of Octavia. However, while Seneca's tragedies have been reluctantly accepted as ‘authentic’, Octavia has remained doubtful. Assessing the status of the tragedies, E. F. Watling concludes that

it is clear that the authenticity of Octavia is a matter of considerable doubt … The play could evidently not have appeared in its final form … before the death of Nero, three years after that of Seneca. One is strongly tempted to assume that Seneca knew more than nothing about it.⁶

Mandeville as Philopirio cannot be taken at face value. Nor can his assertion that Misomedon is free of Mandevillian opinion—the hypochondriacal patient often proves to be an even more effective mask to voice the unsayable against apothecaries and rival physicians. All origins are under scrutiny in the Treatise, whether they be the origins of Senecan drama, medical discourse, the author's father or Adam in the Garden of Eden.

The Preface, itself, underlines this subversion of origins in several ways. Derrida has pointed out the philosophical quandaries induced by the pretence that a preface introduces a ‘main’ text and yet must be written after that text:

From the viewpoint of the foreword, which recreates an intention-to-say after the fact, the text exists as something written—a past—which, under the false appearance of a present, a hidden omnipotent author (in full mastery of his product) is presenting to the reader as his future. Here is what I wrote, then read, and what I am writing that you are going to read. After which you will again be able to take possession of this preface which in sum you have not yet begun to read, even though, once having read it, you will already have anticipated everything that follows and thus you might just as well dispense with reading the rest.⁷

In the Treatise, Mandeville highlights this issue as his preface constantly apologizes for specific passages in the main text which implies that the whole work must be read before the preface can be understood. At the same time the preface masquerades as an introduction, preparing readers for an unknown text and warning them to slough off bad reading habits. Tackling nothing less than the consequences of the Fall and the works of the ‘Crafty Tempter of Mankind’, Mandeville demands that his readers approach the main text alert and critically.

The playfulness of the preface, for instance, not only sharpens the reader's wits for the following dialogues but demonstrates one of the possible therapies for hypochondria or ‘the hyp’. Humour was a well known palliative for sufferers of this disease and many new books of the day catered for this taste.

In the Treatise, however, Mandeville begins to extend his exploration of the dialogue form, testing its usefulness as a therapeutic tool in the doctor-patient relationship. In the preface he suggests that the dialogue may be ideally suited to the hypochondriac (Mandeville assumes a reader must be a hypochondriac). Conventional medical prose is ‘far from diverting’ and prone to ‘tedious Enumeration of Signs and Causes’. Such a text is more likely to induce hypochondria and at the least must be ‘tiresome and disagreeable to People that seek relief in a Distemper of which Impatience is one of the surest Symptoms’.

By using the dialogue, Mandeville draws the reader into a dramatic world focusing on the relationship between doctor and patient. The actual discussion of the illness reveals the tensions and desires which characterize this relationship, and the later scenes between the husband and wife illustrate the links between personal relationships and illnesses. By dramatizing the medical discourse, Mandeville attempts to produce a cathartic effect on the reader and patient. The dialogues ‘divert’ and ‘entertain’, thus combating hypochondria to some degree. More importantly, they dramatize the analysis of medical discourse, creating a polyphony of texts which finally persuade the reader to accept ignorance as a therapeutic state of grace, an aim implied early on in the preface,

The emphatical Truth is lost upon the Times, and he must not expect to be believed by our acute Philosophers, whose Pride won't allow that it is possible Nature should have recesses beyond the reach of their Sagacity, and reckons the injurious assertion an Affront to human Understanding.⁸

Logotherapy, in the Treatise, is designed to not only cure by words but to cure you of the disease of words, theories, tracts, medical journals, countless case histories and medical texts. Recalling his favourite metaphor of reading as a process of digestion, Mandeville claims that the Treatise will be a healthy meal,

I resolv'd to deviate from the usual method, and make what I had to say as palatable as I could to those I had in view for my Readers … I pitch'd upon the Physical Remarks, which you shall find interwoven with the main matter. Acriora orexim excitant enbammata.⁹

This meal is presented within the context of a society glutted on a surfeit of luxury. Mandeville's patients, revelling in the profits of the rising British Empire, are suffering from various forms of indigestion, having consumed too many texts, too many consumer goods and too many exotic foods that are new to the British diet. In The English Malady, a treatise on hypochondria, George Cheyne describes this society succinctly, saying

When I behold … such Scenes of Misery and Woe, and see them happen only to the Rich, the Lazy, the Luxurious, and the Unactive … those who are furnished with the rarest Delicacies, the richest Foods, and the most generous Wines … I … conclude, that it must be something received into the Body, that can produce such terrible Appearances in it, some flagrant and notable Difference in the Food … And that it is the miserable Man himself that creates his Miseries, and begets his Torture …¹⁰

In the first dialogue of the Treatise Mandeville outlines this society in more detail through the case history of Misomedon. In a speech that runs for 16 pages, Misomedon recalls the main events of a life divided equally between total idleness and a study of medicine and hypochondria. The speech incorporates portraits of two physicians who diagnose and treat Misomedon's illness. The patient's life itself is divided into two parts—his early life in which profligacy is his main occupation and his later years in which his only occupation is the study of his own illness.

Misomedon's early life is described in a style reminiscent of the hero of a restoration comedy,

I wanted but two Months of being One and Twenty, when my Father Died and left me Three Hundred a Year … upon this I left the University … I quickly became Extravagant … and minded nothing but my Pleasures; of which some were very Expensive … half of my Estate was hardly sufficient to Pay my Debts, and clear the remainder. At Five and Twenty I Married; my Wife's Fortune paid off some Scores … Love and Pastime was all our Employment, from Morning till Night … Neither of us could be call'd Extravagant, yet both desired to live handsomly; my Wife admired Cloaths, and I loved good Eating, and our necessary Expences, exceeded twice my Income. …¹¹

Misomedon is rescued from inevitable bankruptcy at this stage by an inheritance from a distant relation and he prudently trims his lifestyle to attain financial stability. Having inherited a library too, he turns to the study of classical literature though he remains ‘rei Uxoriae addictissimus’. This, his first lapse into Latin, marks the beginning of a constant series of classical allusions revealing an element of pretentiousness on the part of Misomedon. For Philopirio it is the sign of badly digested texts and he swaps classical banter with his patient only to humour him until he can be cured.

Having reached thirty-seven, Misomedon's body begins to suffer the consequences of his earlier lifestyle,

I began to be troubled with the Heart-burning, which in a little time became a constant Companion to me.¹²

He responds with some small remedies but finds that the problems are growing more serious,

Hitherto I had only Quack'd with my self … I perceived, that all the Remedies, I had taken, were only Palliatives, and none of them had touch'd the Cause, but to the contrary I grew daily worse, and the Heart-burning was no more the only Symptom that disturb'd me. After every Meal I had flushings in my Face; all Day long I was troubled with Wind and sowre Belches, and every Morning as long as I was Fasting, I had my Mouth continually fill'd with a clear insipid Water, which without any straining came off my Stomach. …¹³

The narrative of the Restoration rake has disappeared, to be replaced by the eighteenth-century hypochondriac in this account of Misomedon's sufferings. This new discourse is replaced as quickly, however, by the arrival of an ‘Eminent Physician’ who gives his account of the patient's illness in true Galenist jargon,

I was inform'd that the heat and burning all along the Oesophagus, from which the Distemper seem'd to have deriv'd the Name of Heart-burning, as well as the Flushings in my Face after Meals, were certo certius, occasion'd by an Interperies hepatis calide, which in my Case happen'd to be accompanied with an Intemperies Stomachi frigida, as was manifest from the cold Pituita, which I voided every Morning, as well as the Wind, sowre Belches, and other signs of Indigestion.¹⁴

The suggested cure reinforces this smokescreen of medical verbiage,

As to the Cure … repeated bleeding from the left Salvatella would satisfie both Indications, and to use his own terms, utramque fere paginam absolveret; for that by this means the Fountain of heat, the Blood of which my Liver had too much, would by way of Antipasis or revulsion be drawn from the Right side.¹⁵

The physician continues in this style for several more pages, outlining a course of bleeding and purging to be followed by a visit to Epsom Spa. Misomedon follows the prescription and finds himself drained and exhausted by the time he reaches Epsom. There he is saved by an ‘honest Gentleman’ staying in the same lodgings. He dismisses all suggestions of purging and instead applies traditional common sense:

he … call'd for a Bottle of French Claret, which he order'd to be burnt with good store of Cinnamon, Cloves and Mace, and a pretty deal of Orange-Peel; whilst this was a-boiling he sent for some Syrup of Quinces to sweeten it, and when it was ready, made me take half a Pint of it, with a very brown Toast well rubb'd with Nutmeg, and sup it off as hot as I was able to bear it.¹⁶

Having abandoned the rhetoric of a Galenist for that of a cookery book Misomedon finds his strength beginning to return. He is, in fact, sufficiently healthy to avoid doctors for nearly two years. When he finally succumbs to medicine again in the shape of a physician ‘of the Modern Opinion’. This doctor bears a striking resemblance to the young Mandeville of De Chylosi Vitiata and his account of Misomedon's illness is a neat précis of that Latin treatise,

He told me, that the part affected was indeed the Stomach; but that it was a vulgar Error, to think, that there was a great heat required for the Concoction of our Food, since in some Creatures it was altogether perform'd without, as was evident in Fishes, in whom there was not so much as any perceptible warmth; yet, said he, be feeding on their own Species, and swallowing one another, it is plain, that, Bones and all, they digest whole Bodies, sometimes half as big as themselves, without the help of chewing, and consequently are endued with a stronger Concoction than other Animals: He made me sensible; first, that the Aliment in every Creature was digested, and dissolv'd by means of a certain adapted Menstruum, that by insinuating it self into the Pores was able to break the contexture of it: Secondly, that this Menstruum did not act by any Muscular or other Organick Force, but an Intestine motion not unlike that of Yest, or Leaven in Dough, from which Analogy in the Operation it had received the same name in Latin, and was call'd a Ferment: Thirdly, that on the various faults of this Ferment all manner of Indigestion depended …

The first I was to do, was to take an Emetick Potion or two, to discharge the Viscid Saburra, that oppress'd my Stomach; then with Chalybeats and other powerful Alcalicks to subdue the fix'd Acid Salts, and with Carminatives and Specifick Stomachicks mix'd with Volatile Salts, endeavour to Meliorate, and if possible restore the Ferment to its Pristine State.¹⁷

Thus young Mandeville succeeds in easing Misomedon's suffering and remains in favour. Even after he has gone his recipes continue to provide ease and are the only successful remedy before the appearance of Philopirio. The recipes, however, only ease pain and even then Misomedon becomes immune to their palliative effects. Mandeville is admitting, through this, that his earlier work on chylification was not effective enough, though it had sure foundations. Later in the Treatise he will argue that the true cure must go far beyond the simple fact of prescribing drugs. Misomedon's recitation of his case history is already an example of this belief. His long speech is essentially a history of textual digestion as he imitates and absorbs the styles of restoration rake, Galenist physician, classical authors etc. What Philopirio perceives in this case history is that Misomedon has not yet learned to select texts judiciously and maintain a spare and healthy diet.

This is confirmed by Misomedon as he completes his case history. From the Epsom incident onwards he became interested in medical theory and begins to study it in earnest:

For above two Years together I read Hippocrates, Celius Aurelianus, Aretaeus, Galen, Celsus and several other Volumes of Greek and Roman Authors without any great advancement as to Knowledge, till being acquainted with the Physician, I lately mention'd, I was put in a better way, went first thro' two of three Modern Anatomists, and slipt no opportunity of seeing publick Dissections, not forgetting in the mean time Harvaeus de Generatione and Borellus de motu Animalium … Having laid this foundation, I read with great avidity the inventive Sylvius de la Boe, and faithful Etmuller, and of our own Nation the speculative Willis, and practical Sydenham.¹⁸

Not content with a study of medical systems, Misomedon then decides to explore medical theories of hypochondria,

Having gone through the Practical Authors, with which as I told you, I began, I went over to Fernelius, Sennertus, Jacotius, Salius, Varandaeus, Zecchius, Thomas a Veiga, Riverius, Forestus, and several others of the first rank among the Learned: After them I consulted … Cardan, Sanctorius, the Voluminous Mercatus, Ferrerius, &c. not forgetting the excellent Cautions of Ballonius, or … Septalius … Claudinus Agricola, Martini, Wedelius, Hartmannus, Matthiolus, Doringius, Rhodius, Petraeus, Fisherus, and both those lower shelves.¹⁹

Having gorged on physicians Misomedon ends by consuming their words on the basis of quantity alone, making room for a short but ‘voluminous’ list of pharmacopoeias. At this point, the reader begins to suffer from the same indigestion that afflicts Philopirio's patient.

Mandeville has deliberately constructed a medical Tower of Babel where theories of digestion jostle for attention. It is within this context that he turns the dialogue towards an analysis of medical training and the propagation of medical theories. Beginning with the notion of a young medical student graduating from university he argues that

such a one is no more capable of discharging the weighty Office of Physician, than a Man, that should Study Opticks, Proportions, and read of Painting and mixing of Colours for as many Years, would without having ever touch'd a Pencil, be able to perform the part of a good History Painter.²⁰

Despite this, a young doctor can quickly earn himself a reputation by contributing to the babble of medical discourse,

Physicians … have found more Compendious ways to Renown and Riches … writing of, or performing something with accuracy in any one of the shallow auxiliary Arts, that all together Compose the Theory of Physick, they … insinuate themselves into the publick Favour … The witty Philosopher … Cures all Diseases by Hypothesis, frightens away the Gout with a fine Simile, but oftener reasons a trifling Distemper into a Consumption.²¹

Through language and the dramatizing of a disease by metaphor a physician can quickly gain recognition. Philopirio is attempting to make Misomedon aware of the dangers inherent in the application of language and metaphor to the human body and illness. If the rhetoric of medical discourse is dominated by self-interest then the gap between the actuality of bodily illness and its verbal definition will inevitably increase. In the case of hypochondria the disease eventually exists more as a linguistic construction than as a verifiable physical phenomenon. But, paradoxically, the power of language and metaphor can have a tangible influence on the body. Reading, therefore, is a physical act and a reader can read himself into hypochondria.

Philopirio recommends instead that doctors should follow a more silent course based on the quiet observation of patient and their illness:

The Tedious, the Difficult, but the only useful, in regard of others, the Practical part which is not attempted by many, is only attain'd by an almost everlasting attendance on the Sick, unwearied Patience, and Judicious as well as Diligent Observation.²²

The model and precedent for such a course of study is Hippocrates who is linked by Philopirio to the claim that

Tis Observation, plain Observation without discanting or reasoning upon it that makes the Art, and all, that neglecting this main point have strove to imbellish it with the Fruits of their Brain, have but crampt and confounded it.²³

Philopirio goes on to argue that this long course of observation should be linked to a system of specialized research at universities, a scheme he has adapted from Giorgio Baglivi. This championing of Hippocrates is part of Mandeville's broader strategy in which he aims to question the authority of medical discourse and to analyse the motives behind medical writing. Hippocrates provides him with a useful tool in this analysis. Within the official ‘canon’ of medical writers Hippocrates is one of the greatest figures, one of the ‘origins’ of medical discourse. At the same time, the authorship of the Hippocratic texts is more difficult to ascertain. Hippocrates is a shadowy figure, his authorship cannot be definitely proven for any of the texts and if he did exist he probably inspired a school of physicians who contributed many of the works now under his name.²⁴ Mandeville reads these works as a clear exhortation to practise observation and to reduce medical discourse to a simple record of these observations. This paradoxical figure is then set in opposition to that of Galen, another ‘originator’ who betrays all the unsavoury motives of the modern physicians who have followed him:

Galen himself a Man of very great Sense, and no less Pride, having entertain'd the Ambition of raising himself above any of his Contemporaries, foresaw, that to exceed the most skillful of them in real Knowledge, would be a very difficult task, if not impossible, and at best a tedious work of endless labour: He was well acquainted with the state of Physick and the Palate of his Garrulous Age, and found, that nothing would sooner establish his Reputation, than his Wit: Accordingly he left the Observation to them that liked them, and fell a writing, as fast as a Bird could fly … This was the beginning of People's reasoning about Physick, and that the cause of it all the Hypotheses we have had since, the best of which will be always defective and full of Error.²⁵

Medical discourse is revealed to be just another branch of rhetoric, here liable to the same need to be properly ‘cooked’ to suit the ‘Palate of his Garrulous Age’. Galen's motives for constructing medical hypotheses are also seen to be self-serving in contradiction to the traditional image of the ‘noble physician’. Mandeville succeeds in undermining both the authority and the scientific objectivity of medical discourse in this discussion of Hippocrates and Galen. Having done so, he then goes on to examine some medical hypotheses in detail in the second Dialogue.

Having begun this section with brief discussions of some of the main issues in digestion theory of that time, Mandeville allows Misomedon to quote a lengthy passage from Thomas Willis's Of Fermentation. In this quotation Willis outlines the commonly used metaphor of the brain as an alembic, saying

the Brain with Skull over it, and the appending Nerves, represent the little Head of Glass Alembick with a Spunge laid upon it, as we use to do for the highly rectifying of the Spirit of Wine: For truly the Blood when rarified by heat is carried from the Chimney of the Heart to the Head, even as the Spirit of Wine boiling in the Cucurbit, and being resolved into Vapours, elevated into the Alembick; where the Spunge covering all the openings of the hole, only transmits the more penetrating and very subtile Spirits, and carries them to the Snout of the Alembick.²⁶

This metaphor is developed by Willis for a further two pages and Philopirio patiently listens as Misomedon quotes it in full. His immediate comment on the passage, however, is cutting:

The admirable Willis is here as he is every where full of wit; his Speculations are as Sublime, as imagination can carry them, and the contrivance of all he supposes are most Ingenious. These Similes I confess are very diverting for People that have nothing else to do: In some of our Modern Hypotheses there is as much Wit to be discover'd as in a tollerable Play, and the contrivance of them costs as much labour; what pity it is they won't cure Sick People.²⁷

The evident frustration and anger in Philopirio's final comment is indicative of a constant problem in medicine as new generations still face the obstacles of metaphor. Susan Sontag, analysing the dangerous acculturation of metaphors for the AIDS virus, recalls how she first became aware of this danger after she was diagnosed as having cancer,

It was my doleful observation, repeated again and again, that the metaphoric trappings that deform the experience of having cancer have very real consequences: they inhibit people from seeking treatment early enough, or from making a greater effort to get competent treatment. The metaphors and myths, I was convinced, kill. (For instance, they make people irrationally fearful of effective measures such as chemotherapy, and foster credence in thoroughly useless remedies such as diets and psychotherapy.) I wanted to offer other people who were ill and those who care for them an instrument to dissolve these metaphors, these inhibitions … to regard cancer as if it were just a disease … Without ‘meaning’. Illness as Metaphor is not just a polemic, it is an exhortation. I was saying: Get the doctors to tell you the truth; be an informed, active patient; find yourself good treatment, because good treatment does exist.²⁸

Mandeville, like Sontag, wants to offer his readers and patients ‘an instrument to dissolve these metaphors’. His second dialogue between Philopirio and Misomedon attempts just that, as the physician dissects the rhetoric of Willis's metaphor, teaching his patient how to read prudently. At the end of the lesson his pupil will have been taught how to choose critically from the wealth of images and texts available to him. Philopirio's lesson runs as follows:

Phil.: Let us once examine the Simile, and take the Still to Pieces. First, What Comparison is there between the Function of the Heart, the great Treasury of Blood and Life, and the vile Office of a Chimney?

Misom.: But you are Captious, Won't you allow of either Trope or Figure? By Chimney he means the Furnace that gives the Heat, the Fire place of the Still.

Phil.: No, Misomedon, there is more Artifice in this than ye are aware of: The word Chimney is made use of designedly, to hide, as much as possible, the deformity of the Still: For the Caput Mortuum being in the Spleen, if he had call'd the Heart the Furnace, as he ought to have done, it would have been too plain, that he had made the Fire between the Head and bottom of the Still.²⁹

Misomedon's misreading of Willis's metaphor reveals the dangers of using tropes to convey medical information. As a rhetorical device the metaphor will convey a striking image to the reader which will reinforce the theory being put forward. If the metaphor is accepted uncritically, the medical ideas behind it will also be unquestioned and, worse, they may be misrepresented by the metaphor. The dangers of rhetorical seduction are clearly presented to Misomedon.

If, however, metaphor is a localized danger in medical discourse, Philopirio argues that there is a much greater evil—the medical hypothesis. The case for any hypothesis in medicine rests on a claim to knowledge of the body claims Philopirio, and he goes on to demonstrate that it is this original sin of pride which is the flaw of all hypotheses:

Misom.: You say the Hypothesis is ingeniously contriv'd, and may be easily defended; but yet you seem to dislike something in it … what have you to object against it?

Phil.: Nothing, but what I have against all Hypotheses in general; I can't endure a Man should make a formal Description with so many Circumstances to make you believe it is true, and write a whole Book upon a thing which he is sure in his Conscience he knows nothing of. We are altogether in the Dark, as to the real use the Liver, the Milt, and Pancreas are of to our Bodies; nay, wholly ignorant of their several Offices otherwise than that they are Organa Colatoria … and all that has been said of them besides, by the most Sagacious Man has been nothing but Conjectures, in which the best Anatomists could yet never agree.³⁰

Philopirio's cure for this rash of conjectures is yet again, observation. This time he refers Misomedon to Baglivi's advice for physicians to model their hypothesizing on that of astronomers who

ascend into Theories exactly delineated after a Geometrical manner; and when they have Learnedly examin'd, and are thoroughly vers'd in these things, they are able to foretel, and define all the Motions, Sites, Conjunctions &c. of those Bodies with all the certainty imaginable: So that first they take care of having a vast Train of Observations, and then they compose a Theory.³¹

Philopirio goes on to note that the theory devised by such an astronomer will be almost bound to be wrong but that at least a body of accurate observations has been compiled. Comparing a lifetime's study of medicine and astronomy he concludes that

an exquisite Genius, vers'd in Arithmetick, and every thing else, but the two Arts I named, would not believe the Knowledge, that could be got by observing the different motions of the Celestial Bodies more capable of ever being reduced to an Art of Rules and Certainty, than that which might be acquired by likewise observing the various courses of Distempers incident in our Terrestrial ones.³²

It is our pride then which blinds us to our true ignorance. Man abuses science by declaring each new system to be infallible, the product of knowledge (the product of the Fall). Instead, Philopirio advocates the acceptance of a shifting, uncertain world filled with contradictions and relative values. The path to any real certainty is deferred for centuries perhaps,

It is as yet inconceivable, to what prodigious pitch human Knowledge in all things, that fall under the Senses, tho' never so changeable, remote or irregular, may be carried by diligent Observations, when they are faithfully transmitted from one to another, and without intermission continued for several Ages.³³

For Mandeville this is a particularly important passage as it marks one of the earliest statements of his theory of evolution, to be worked out in much greater detail in his later works. He posits, here, a slow accumulation of observations, facts and information that may one day, far in the future, lead to a moment of certainty. This implies a present-day world of uncertainty and it is the physician's role, therefore, to master the art of uncertainty. Having done so, he can then lead his patients to an understanding of this condition.

For the hypochondriac, it means the learning of a new way of reading and a re-examination of the self. Patients must learn to see themselves surrounded by a network of texts, images, metaphors and theories which attempt to define an illness. The authority centred in medical discourse and the medical establishment tries to present this patient as a passive receiver on which the network is imposed.

Through the dialogues in the Treatise, Mandeville hopes to reinvigorate the reader and the patient. Through the dialogic technique of splitting the self, he forces the reader to interrogate medical discourse and to experience, through the patchwork of literary styles, the relative and uncertain nature of medical discourse. By assigning an active role to the patient, he is implying that the dialogue between doctor and patient is a vital part of the therapy. This is underlined by Mandeville's presentation of his own theory of chylification. In his original thesis, his theory was laid out clearly, point by point, beginning with the etymology of terms used in digestion theory and ending with a series of recipes to alleviate patient's distress.

In the second dialogue of the Treatise, Philopirio presents Mandeville's thesis to Misomedon. Now, however, the work is placed in a much subtler context. Philopirio introduces the thesis to his patient in the following manner:

Phil.: It is the custom in all our Foreign Universities for Students in all Faculties … to compose and defend against all that will oppose a Thesis or Disputation … Mine was de Chylosi vitiata, which I defended at Leyden in the Year 1691, Dr William Senguerdus, Professor of the Aristotelian Philosophy, being then Rector Magnificus.³⁴

Philopirio then goes on to outline many of the points raised in the 1691 thesis. This is not, however, a simple insertion of an earlier work by Mandeville and the reworking of his thesis can only be appreciated fully by an examination of the structure of the entire second dialogue of the Treatise.

The dialogue is based on the structure of Mandeville's original thesis on chylification but with one major change. Rather than beginning with the ancients, Philopirio opens the dialogue with a statement of the contemporary theory of fermentation and its role in digestion. He then runs through a brief examination of the physicians who contributed to the formation of this theory—Sylvius de la Boe, Van Helmont and Thomas Willis. His discussion of Willis's metaphors leads to his criticism of the authority invested in medical hypotheses and this creates the context in which he presents the main arguments of his thesis. Having just stressed the relativity of hypotheses he launches his own with typical Mandevillian humour—the contents page for this section states unequivocally that this section outlines ‘The Chief Cause of the Hypochondriack and Hysterick Passions.’ He continues to toy with the reader in his presentation of the thesis as he combines it with ideas from his earlier work, Disputatio Philosophica de Brutorum Operationibus.³⁵

The most radical change to his thesis is found, however, in Mandeville's use of the dialogue format to expand various points and to interrogate his earlier theories. The looseness and informality of dialogue style permits him to heighten descriptions of medical ‘facts’ dramatically. In his thesis, for example, he refers to an observation of Platerus on perverted appetites,

Platerus, in an observation, refers to a girl who ate an onion which had previously been applied to a plague swelling, also without any harm: although it can't be doubted that the onion was plainly infected with poison.³⁶

In the Treatise, this description has been digested and absorbed into a livelier text where it reads as follows,

Platerus … relates, that a Girl of about Seventeen, had so depraved and perverse an Appetite, as not only to fancy but likewise to eat an Onion, that in the time of a raging Plague, having been applied to a Pestilential Boil, and being blacken'd and putrified by the Poisonous exhalations was thrown down by the Fire-side. The Girl, says he, received no hurt, and remain'd free from a Disease otherwise so Contagious.³⁷

Philopirio continues by recalling his use of a quotation by Hippocrates and here uses it to introduce the notion that the stomach's ferment is composed partly of chyle and partly of animal spirits from the brain. However, the role of these animal spirits has now become much more central to the whole process of digestion and to the disorders of hypochondria:

Next to Experience, I shall make use of what is the result of it, the Testimony of Hippocrates, who in one of his Aphorisms tells us, the Aliments, which our Appetite stands enclined to, are far better digested, than those we don't fansie. From these Anatomical and Practical Observations I conclude first, that if the Animal Spirits, which continually trickle down into the Stomach through the innumerable little Nerves, that discharge themselves there, do not wholly compose … the Stomachick ferment, Menstruum … by virtue of which our Aliments are digested, they at least make a considerable, and the most essential part of it. Secondly that some of the Spirits, that help to Constitute the Ferment are of a greater subtilty, and more refin'd than the rest that serve only for Muscularly motions, and other actions of force.³⁸

These spirits of ‘greater subtilty’ create the stomach's ferment and are also ‘the Spirits, which are immediately employ'd in the act of thinking’. With this statement, Mandeville links the brain and the stomach in an intimate dialogue. Food can, he implies, influence the brain and hence the mind's thoughts. Likewise, the mind can influence the stomach and, by implication, the rest of the physical functions. The Cartesian problems of the mind's relationship to the body have resurfaced in this discussion of chylification, and Mandeville's earlier thesis on the operation of animals is being revisited.

In 1689 he rejected the strict Cartesian division of body and the soul which gave man the power of self-reflexive thought. However, he found nothing more substantial to replace it and admitted his conclusions were highly subjective,

I preferred to persuade myself that ‘Animals are endowed with no thought and all their actions are automatic’. And after I adapted this idea I noticed that many functions of their lives could be explained by mechanics, which previously I thought must be controlled by thought. That many, however, remain which I cannot explain from their structure, I freely confess.³⁹

Now Mandeville feels that the concept of subtle animal spirits can provide a new image of the relationship between the mind and the body which is more satisfactory than that of Descartes. He admits that ‘The Metaphysical Principle of Monsieur Des Cartes, Cogito ergo sum’ is ‘the first truth’ and furthermore that ‘matter it self can never think’. Beyond this, however, the relationship between soul and body is ‘Mysterious to us’.⁴⁰

Certain things can be asserted, however, such as the claim that ‘there must be an immediate Commerce between the Body and the Soul’. As the soul is immaterial there must be a link between the two (a subject of intense philosophical debate after Descartes). For Mandeville, the link is the subtler animal spirits—‘exquisitely small Particles, that are the Internuncii … the intermediate Officers between the Soul and the grosser parts of the Body’. This is a vital image in the Treatise. The description of the animal spirits as ‘intermediate officers’ conjures up the metaphor of the body as a commonwealth, with the soul as ruler and the stomach as the mass of the population. Mandeville plays on this allusion but complicates it further by going on to refer to the soul as ‘an Artificer, whilst the Organs of the Body are her tools’.⁴¹ To accuse the soul of artifice immediately raises interesting questions about thought and the ‘true’ nature of the soul. In an exchange between Philopirio and Misomedon, Mandeville outlines the implications of his claims on the issue of thought. It is worth quoting this passage in full as it is not only central to an understanding of Mandeville's views on the body and hypochondria but also a key element in his aesthetics. Discussing the ‘mixture’ of the body and soul Philopirio concludes,

For tho' our thoughts be never so elevated or Metaphysical, we cannot form them without Idea's of Words, Things, or joint Notions and Thinking only consists in a various disposition of Images received before.

Misom.: Then you would have this variously disposing of the Images to be the work of the Spirits, that act under the Soul as so many Labourers under some great Architect.

Phil.: I would so: And reflecting on what is transacted within us, it seems to me a very diverting Scene to think, when we strive to recollect something that does not then occur; how nimbly those volatil Messengers of ours will beat through all the Paths, and hunt every Enclosure of the Organ set aside for thinking, in quest of the Images we want, and when we have forgot a word or Sentence, which yet we are sure the great Treasury of Images received our Memory has once been charged with, we may almost feel how some of the Spirits flying through all the Mazes and Meanders rommage the whole substance of the Brain; whilst others ferret themselves into the inmost recesses of it with so much eagerness and labour, that the difficulty they meet with some times makes us uneasie, and they often bewilder themselves in their search, till at last they light by chance on the Image that contains what they look'd for, or else dragging it, as it were, by piece-meals from the dark Caverns of oblivion, represent what they can find of it to our Imagination.⁴²

Mandeville is arguing here against the Platonic, benevolent vision of the soul. He is at pains to stress that thoughts depend on the arrangement of observations and images from the material world, even if they are ‘elevated or Metaphysical’. Furthermore, thought relies on the images presented to the retina and is shaped by the disposition of those images. The soul, the ruler, has now become the ‘great Architect’, which arranges these images. The brain, as centre of the commonwealth of the body has a ‘Treasury of Images’ and Mandeville continues by describing the animal spirits as ‘airy velocious Agents … Ministers of Thought’ working in ‘this Volatile Oeconomy of the Brain’. At the same time, there are darker notes in the description as the soul, once the ‘Artificer’, now becomes the ‘great Architect’. Echoes of the Daedalus myth are multiplied as the animal spirits ‘quest … through all the Mazes and Meanders of the Brain’. The image they seek finally begins to reasemble the Minotaur as they drag it ‘by piecemeals from the dark Caverns of oblivion’. This confounding of the soul with artifice and the image of a beast argues violently against any Platonic, idealized image of the soul.

Mandeville has mixed motives for creating this image of the human brain and the process of thought. Within the immediate context of A Treatise of the Hypochondriack and Hysterick Passions, he is advocating a new awareness of the importance of observation in medicine and encouraging both doctors and patients to examine the relationship between the mind, the body and health. On a wider level, Mandeville is developing the view of human nature he first propounded in his earlier works such as The Grumbling Hive and The Virgin Unmask'd in which he attempted to explain the ways in which we can reveal or mask images of ourselves.⁴³ Having highlighted the need for sharp observation in a social context, he is now attempting to examine the nature of representation and perception.

The Dutch tradition of portraiture provides a valuable model for Mandeville in his description of physicians who must compose a case history of each patient based on observations of the symptoms. Philopirio, as an active example of Mandeville's therapy, has attempted to build up a series of observations on Misomedon's illness in order to compose a case history, or portrait, of his patient. Central to this portrait is the issue of Misomedon's identity. His greedy, untrammelled absorption of so many medical texts and theories has had a weakening effect on his health. His equally unregulated consumption of worldly goods and the joys of venery have contributed to this steady deterioration in health. For Mandeville, such a life is the consequence of a poor understanding of digestion. The consuming and digesting of ideas, goods, or sexual acts should be judicious. Every digestion should be made in the awareness that it is simultaneously a process of imitation and absorption. Misomedon has to be made aware that his identity is ultimately composed of the materials he has digested and synthesized in the creation of his own self. ‘Tell me what you eat: I will tell you what you are’, as Brillat-Savarin phrased it a century later.⁴⁴

As the culmination of this argument, Mandeville has Philopirio retell the life of Misomedon in the context of all the discussions that have occurred between them. The patient, having absorbed the doctor's well-regulated diet of advice is now ready to accept such a portrait and sets the mood for it when he thanks Philopirio for leading him ‘to a noble Prospect of Miracles in the composure of our Frame’.⁴⁵ Philopirio's portrait recalls every aspect of his patient's life and at every opportunity he stresses Misomedon's lack of moderation in consumption. Each detail of excess is examined in a portrait which runs to several pages. Finally, Philopirio concludes that it was luxury which permitted the onset of his patient's disease:

Immoderate Grief, Cares, Troubles, and Disappointments are likewise often Concomitant Causes of this Disease; but most commonly in such, as either by Estate, Benefices, or Employments have a sufficient Revenue to make themselves easie: Men that are already provided for, or else have a livelyhood by their Callings amply secured, are never exempt from Sollicitudes, and the keeping not only of Riches, but even moderate Possessions is always attended with Care. Those that enjoy em are more at leisure to reflect, besides that their Wishes and Desires being larger, themselves are more likely to be offended at a great many passages of Life, than People of lower Fortune, who have seldom higher Ends, than what they are continually employ'd about, the getting of their Daily Bread.⁴⁶

In this passage Mandeville broadens the portrait of Misomedon to view him in his social context. The intense focus of the first two dialogues on the personal life and identity of the patient gives way to a wider world view. Through money, Misomedon had access to the consumer world of the fast-expanding British empire, and the leisure to consume constantly. It was Misomedon's imprudent and excessive consumerism which led to the onset of his hypochondria. It was the luxury of leisure time which then allowed this disease to thrive.

By drawing such a portrait of Misomedon, Mandeville prepares the reader for the third and final dialogue which is more outward looking. Polytheca, the wife of Misomedon, is introduced and there are detailed portraits of their daughter and of Pharmenio, an apothecary. The allusions in the earlier dialogues to the plays of Terence and Plautus now find an echo in the family and social life portrayed here. As the dialogue in which Philopirio presents his cures for hypochondria, it is dominated by recipes, nostrums and apothecaries bills. Related to this is the underlying theme of wine and fermentation which pervades every aspect of the discussion.

The third dialogue begins after the physician and patient have both dined and the reader is aware that all the participants are digesting their dinner as they speak. The conversation opens with a further discussion of the animal spirits in which Philopirio defines wit:

Thinking consists in a various Disposition of the Images received; so what we call Wit is nothing but an aptitude of the Spirits by which they nimbly turn to, and dexterously dispose the Images that may serve our purpose.⁴⁷

He goes on to argue that if witty men study too much and ignore exercise, they will also become victims of hypochondria by exhausting the animal spirits. This explanation only raises more questions for Misomedon, however, as it seems to exclude women:

what equivalent.. wasts the spirits in Women, and is likewise able to make them subject to the Hysterick Passion: for studying and intense thinking are not to be alledged as a cause in Women.. and yet the number of Hysterick Women for exceeds that of Hypochondriack Men.⁴⁸

Philopirio replies that in young girls, at least, a poor diet caused by ‘Agues, Green-Sickness, or other Cachexies’ produces weakened animal spirits. As he digests his own dinner, the doctor proceeds to outline his view of the digestive process and its centrality to the ‘Oeconomy’ of the human body,

We can ask no more of the Stomachick Ferment, than that insinuating it self into the Pores of our Aliments it dissolves the Contexture of them, and makes them into such a Pulp, as being afterwards mix'd with the Gall and Pancreatick Juice, shall suffer its finest parts by the Peristaltick motion to be transcolated through the Glandules of the Intestines into the Lacteal Vessels: This is all what belongs to a good Chylification, which may be done, and yet the Chyle be unfit to make good Blood, if the Aliments are improper; the Stomach is only to be consider'd as a good Cook who may dress every thing to the best advantage, but cannot make the Flesh of a Starv'd Old Cow so Nutritious, as that of a Young well fed Heifer. If the Food when we Eat it, is not endued with a great many Balsamick, Spirituous, or what we call nourishing Parts, the Blood cannot receive them from it, how well soever it may be assimilated with its Mass.⁴⁹

This ecstatic celebration of the digestion process is at the core of Mandeville's thought. The stomach—‘a good Cook’—is dependent on the materials given to it to work with. In the case of young girls this means that eating ‘Trash’ will give the stomach poor material and the resulting animal spirits will therefore be weakened.⁵⁰ In the wider context, where Mandeville imagines life in a complex consumer society, it means that the wrong choice of consumer goods or an excess of goods, theories, acts of lust etc. will destroy personal identity. Prudent choice of goods, food or models to imitate is imperative to retain a stable sense of the self. As Philopirio moves on to a discussion of children he stresses the value of imitation in providing the animal spirits with suitable images to arrange in the act of thinking:

the aptitude of the Spirits … is no more so, than the aptitude of the Organs of Speech, and that both are only to be attain'd by Imitation and Practice, of this we see Thousand instances every Day in Infants … that striving to imitate the actions of others by degrees they model their manner of Thinking … by what their Senses communicate to them of the Thoughts and Words of those they converse with.⁵¹

Having restated his belief in imitation Mandeville has set the scene for the examination of Misomedon's family and the society they live in. The world he depicts is one of unfit people tyrannized by fashions, jargons and authoritative con-men. Lacking any understanding of the body and health in this society, most people appear to succumb to the wine-laden drugs of apothecaries and doctors.

This section opens with more than ten pages of Misomedon's recipes and prescriptions, transcribed in the abbreviated Latin that requires a pharmacopoeia for elucidation. The prescriptions are typical of the physician of the ‘Modern Opinion’ mentioned in the first dialogue and several of them are reminiscent of the recipes found in Mandeville's De Chylosi Vitiata. However, their presentation by a patient undermines their medical authority. The obsessive interest and enthusiasm which Misomedon displays while showing off these recipes reveals a life lived by stumbling from one drug to another:

I never found any thing of greater Efficacy against the Sour, and Wind in my Stomach than what I read to you last, and I would never have left it off, but that I imagin'd it bound me up; after that I remember I made use of this Absorbent Electuary. …

M. & C. S Q Conserv. flor. genist. f. Elect. cuius dos. bis indies.⁵²

Misomedon is a connoisseur of drugs, proud of his knowledge and ever alert to the effects of every dose, whether imagined or real. In an orthodox medical text the transcription of these recipes would be read as a serious passage of advice. Delivered by Misomedon they become the deadly arsenal of a medical bore. Just as Philopirio seems about to criticize this performance, however, Misomedon's wife arrives.

Polytheca, a name that literally means ‘many drugs’, is a suitable culmination of this series of prescriptions. She is plagued not only by hysteria but the pressures of suffering from the ‘Vapours’ when ‘the very name is become a Joke’.⁵³ Her life revolves around the advice and medication provided by her apothecary, Pharmenio, who has pronounced her to be incurable but enamoured himself to her by his constant ability to listen to her when she describes her problems. After introducing herself she quickly begins to describe her case history to Philopirio and then recounts the history of her daughter who suffers equally from the vapours. Their lives are strikingly summarized by Misomedon when he tries to recall his daughter's medicines:

I know that she has had several Decoctions of Mugwort, Feverfew, Calaminth, Rue, Peony, Peony (sic), Pennyroyal, and such like, with Baths of the same, sometimes she has taken for a considerable time Testaceous Powders, and others, with Crabs-eyes, Red-Coral, Volatil Salt of Tartar, Diaphoretick Antimony, Bole-Armenick; at other times Uterine and Stomachick Electuaries, with Savin, Nutmeg, Myrrhe, Saffron, Volatile Salts, Foetid Oils, &c. several sorts of Hysterick Pills … I remember she had a Bolus prescrib'd her … This she took twice a Day in Six Ounces of a Decoction of Black-Hellebore and Briony-Roots, Pennyroyal, Rue and Mugwort; and at the same time in Regione Umbilici, she wore a Plaister of Galbanum Caracanna, asa foetida and Oil of Tacamahaca.⁵⁴

Mandeville goes on to make it clear that most of these decoctions are mixed with various wines, creating an image of both Polytheca and her daughter as women living in a constant state of dulled inebriation. As with Misomedon, Philopirio constructs a portrait of Polytheca which places her in a social context and takes every aspect of her life into account. This is, in effect, an holistic view of the patient's illness in which Mandeville is arguing both that such a view of the illness is necessary if it is to be treated properly and that the patient's lifestyle is the main cause of the illness.

The reasons why Polytheca has drifted into this condition are never stated explicitly but Mandeville makes it apparent that it derives from the poor relationship between her and her husband. Her speeches are constantly interrupted by Misomedon who mocks her views, dismisses her illness as a figment of her imagination and derides her apothecary. Any point Polytheca makes about her condition is immediately taken up by her husband and methodically criticized, every argument being reinforced by a battery of medical information. Misomedon is systematically brutalizing his wife with his knowledge as Mandeville demonstrates in their final exchange. Having again attacked apothecaries, Misomedon concludes with this advice to Polytheca:

Misom.: But if you think I don't do them Justice, pray, my Dear, give your self the trouble of reading this little Book, where the Mystery of Compound Medicines as to their intrinsick Value, is very handsomely unfolded: It is the work of an Eminent Physician, Dr Pit, who for the good of the Publick has shewn the vast difference between the prime Cost, that Simples are bought at from the Druggists, and Herb-Women, and the extravagant rates, they are sold at by the Apothecaries, when they have disguis'd them in mixtures of specious Titles. It is very diverting …

Polyth.: It may be so, but I have other things to mind.—Oh the Tormenting and Throbbing Pain I feel in my Head! This Minute my Brains are a boiling, and if there was half a Dozen Trunkmakers at work under my Skull, I don't think I could be sensible of more Noise and Beating than I am. I can stay no longer … I am forc'd to withdraw. Oh! the misery of. …⁵⁵

The lack of communication between the couple is obvious. Misomedon only seeks an opportunity to broadcast his views of medical issues while Polytheca's vivid complaints and her withdrawal are symptoms of an ailing relationship. When she has departed Misomedon reveals just how little sympathy is left in the marriage when he declares ‘she nothing but thwarts and contradicts me’. Convincing himself of her deliberate malevolence he reacts with equal spite—‘I did expect it would put her in the Vapours, if I spoke more against the Apothecaries than she could answer’.⁵⁶ Philopirio gently tries to highlight the problem in their marriage by directing Misomedon to a satire by Horace which argues that man should look for the fault in himself rather than criticize others.⁵⁷ He has carefully couched his advice in the classics to humour his patient before adding a more direct comment on the exchanges between husband and wife:

it could not be to please her, that with so much eagerness you snatch'd at every opportunity of speaking against the Apothecaries; and indeed, in my Opinion, you have been too severe upon them.⁵⁸

This comment not only serves as a criticism of Misomedon's marriage but forces the reader to reassess the harsh attacks on apothecaries in the previous pages. While the attacks give a thorough airing to the contemporary debate on the role of the apothecary they go beyond the feud between doctor and pharmacist. Clearly, Pharmenio, the apothecary to Polytheca, has a role in her life which derives from the difficulties of her marriage.

Misomedon remains wrapped in contemplation of his own self and devotes his time to a minute analysis of his own physical condition. He resents the competition for attention provided by Polytheca's vapours and suspects it is a deliberate attempt to annoy him rather than seeing it as a visible sign of the crisis in their relationship. Pharmenio, however, both listens to Polytheca and acknowledges the suffering involved in her illness:

Polyth.: Pharmenio, whom you are pleas'd to call Judicious in Jest, is a Skilful-Man of great Experience, the understands my Constitution thoroughly; he is of Opinion that I am incurable, I have heard the same of Eminent Physicians; yet he has the Patience to weigh my Complaints, or at least the good manners to hear them, and seldom fails of giving me ease, even when I am at the worst, which is what others that boasted of greater learning either could or would not do; so that I should think myself unwise to leave him.⁵⁹

The reason, then, that Polytheca (and perhaps most women at that time) preferred the services of Pharmenio was that he acknowledged her as a person, taking her problems seriously. A doctor would have paid more attention to the illness without acknowledging the broader context of the patient's life. The danger of Pharmenio, however, is that he is essentially a businessman and his remedies often are designed only to offer a state of inebriation which will lessen the pain of a failed marriage.

In Mandeville's burgeoning consumer society the apothecary appears as an ambivalent figure typical of the new society. As a businessman, he persuades his customers to buy his products and thus understands the market forces of the consumer world. He then persuades the customer to swallow the consumer product, often sweetening the pill with sugar and wine. He achieves both of these objectives by feeding his clients with palatable rhetoric. In a memorable portrait Misomedon reveals the apothecary at work,

I have known an Apothecary in an idle Afternoon go to a Person of Quality's, where they made use of him: There happen'd to be no body at home but Children and Servants, that from the highest to the lowest were all in perfect Health: If here he came for Business (you'll say) he was disappointed; but you are mistaken, the Courteous Gentleman with an engaging familiarity accosts every Servant in the House, and puts off a Purge to the Cook, a Vomit to the Butler, a Box of Pills to one of the Footmen, and a Pot of Lucatellus Balsam to old Nurse. The Children absolutely refusing to take any Physick at least inwardly, he Coaxes the little Master into the use of a charming Dentifrice, and a sweet-scented Collyrium to rinse his Mouth with after it, that shall preserve his Teeth and make them look like Ivory, tho' he was to eat nothing but Sugar and Sweet-Meats all Day long; to pretty Miss he'll send a Lotion for her Hair, and a Paste for her Hands, that shall render the one so bright as Silver, and the other whiter than Snow, with a Beauty-wash for their Maid, that assisted in the perswading of them. The affable Gentleman has every Bodies good word: The Children are pleas'd, the Servants commend him, my Lady is obliged to him; and Ten to One but the first opportunity of driving that way her Coach stops at his Door, and she thanks him for the care he took of her Family in her absence.⁶⁰

This is the rhetoric of consumerism at its best. The apothecary, understanding the true nature of consumerism knows exactly how to arouse the desires needed to offload various products, accurately sizing up the articles that will ‘sell’ to each customer. He is skilled at reading people and situations, just as Pharmenio is skilled at reading the needs of Polytheca and her daughter. Mandeville stresses the rhetorical nature of the apothecary and his art throughout this section of the Treatise. Not only can the apothecary read the world but he can easily deconstruct a prescription:

Polyth.: How then come they to understand the Physicians Bill so readily, that are all writ in Latin?

Misom.: The Body of a Bill is only compos'd of Medicines, they have in their Shops, and contains nothing but the Names of what they can Sell.⁶¹

The doctor's bill is an intersecting series of ingredients, each of which represents a consumer item. The bill is no more than a customized consumer item. Just as hypochondria is an illness constructed from a series of intersecting texts and Misomedon's body is the compound of various foods, remedies and digested readings, so the ‘Body of a Bill’ has ingested various ingredients. Moreover, medical receipts, like culinary recipes, are of indeterminate origin as they are usually the product of a long series of imitations of other receipts.

The apothecary is the embodiment of the ‘sprightly talkative Age’ which Mandeville warns us of in his preface. Through the seduction of his rhetoric consumer goods are transmitted from retailer to customer with the same promiscuity as the pox passed through London society. Mandeville's portrait of the apothecary is not particularly distasteful however. The tone of the description is comic and there is a definite sense of admiration for the apothecary's ability to match people and products. Mandeville's warnings to Misomedon and to the reader of the Treatise, then, are not directed at the new consumer culture in Britain but at those who participate in that culture without understanding how it is constructed.

At the heart of this network of ideas lies Mandeville's theories on ways of seeing and the interpretation of an image. His attention to the lengthy quotation of Thomas Willis's metaphor of the brain as an alembic, his championing of the microscope and the Dutch tradition of portraiture and his notion of the animal spirits arranging images received in the brain all relate to this issue. The ‘witty Speculations of Hypothetical Doctors’ were multiplying as quickly as the range of choices, commodities and temptations available in the British Empire. To deal with such a constant barrage of images, goods and medical theories Mandeville suggests that it is necessary to have reliable interpretative tools with which to examine the usefulness of each consumer choice. By linking the brain and the stomach through the work of the animal spirits Mandeville makes the reader aware of the effect society can have on the physical constitution. Every image is, in effect, digested by the eye, the stomach and the brain. The case histories of Misomedon, Polytheca and their daughter all attest to the dangerous effects of indiscriminate digestion of images, rhetoric, medical theories, food and drugs. Both doctors and patients must therefore learn to assess every morsel and to moderate their consumption accordingly.

When Mandeville republished the Treatise in 1730, he elaborated on this theory of medical aesthetics by allowing Philopirio and Misomedon to discuss the two lines of Virgil's Aeneid which appear on the title-page of the book itself. Misomedon begins by relating a story of Michelangelo making a new head for a broken statue of a ‘Faunus’ by means of educated guesswork. Philopirio replies

Michael Angelo knew his Task; and tho' perhaps no body besides himself could have made a Head answerable to such a Body; yet it was no Secret, which Part of the Statue it was that was wanting: but in the latent Causes of Diseases we can form no Idea of what we are ignorant of; that is, we don't know the Figures nor the Properties of the things that are hid from us, and we are obliged to make Sounds for, and adapt Words to things that are inexpressible.⁶²

Through experience gained by years of observation, Michelangelo can skilfully complete a work of art. Philopirio argues that doctors must approach disease and illness in the same way. Observation will lead to an educated guess at the cause for an illness but there is a gap between reality and language. Misomedon quotes Virgil's lines on the silent arts of Iapis, acknowledging their authority, but admitting that he still desires more:

There is a Gap between the Observations made on the Symptoms of a disease, and the Cure of it: I want to have that Gap fill'd up; and the most airy Speculations are more satisfactory, than a Man's saying that he knows nothing of it. To consider the Nerves as the Snouts of an alembick, and make the Brain serve for a Spunge, requires at least as much Capacity, as to be altogether silent concerning the Operations of either.⁶³

Misomedon has acknowledged the uncertainty of medical theory and the flaws in Willis's metaphor—Philopirio's lesson in the second dialogue. He now agrees with his physician that medical discourse has a strong fictional dimension and has pointed out the exploratory nature of Willis's metaphor. When it is recognized as a possible fiction it can then have an experimental value, probing the gap between observation and language.

As Philopirio presents his cures for Misomedon and his family, relativity becomes the dominating feature of the dialogue. Medical and literary origins again become uncertain as Mandeville cites sources such as Thomas Sydenham, Thomas Fuller, Mercurialis, Suetonius, Terence, Herodicus, Plato and Hippocrates. Many of these figures appear are distanced by appearing indirectly in anecdotes related by other writers cited by Mandeville and Daniel Le Clerc's Histoire de la Médicine is a constant secondary source.⁶⁴ The other dominant voice is that of Horace the Roman poet, who himself imitated Greek poetic styles. As this ferment of writers is absorbed into the text and digested by Misomedon and the reader, Philopirio outlines a dietary cure for his patients' illness. Diet supplemented by plenty of exercise is recommended for all three patients. Wine is also discussed through the medium of Horace's poetry, allowing Mandeville to create a ferment of literary images around a discussion of wine's influence on the vapours.

Mandeville's recommendation of diet attempts to present itself with as few traces of medical jargon as possible. His introduction of the cure states that

Diet, says Le Clerc, was the first, the principal, and sometimes the only remedy that Hippocrates made use of. And shall we lay no more stress upon it, as if it did not belong to the Art of Physick?⁶⁵

Even this simple statement mediates the authority of Hippocrates through the prose translation of Le Clerc and reduces medicine to the simple basics transmitted through the centuries. More emphasis is placed on knowledge of the dietary worth of various foods and the art of cooking than any technical skill in medicine. Philopirio's advice is as follows:

Let your Diet be Nutritious and inoffensive, and your Cookery be simple, natural, and I won't say unartful, but not operose. As for Example, Let your Fish be neither stew'd or fried, or your Flesh be otherwise than Broil'd or roasted; and neither of them previously Salted … make use of no manner of Sauces (Salt and Pepper only excepted) but plain Butter for the first, and the natural Gravy for the latter.⁶⁶

The austerity of this cookery is reminiscent of the Dutch desire to control what they termed ‘overvloed’—conspicuous over-consumption in the kitchen. In The Embarrassment of Riches Simon Schama describes the general context of such an approach to diet in Holland:

The control of overvloed through a dam of pious manners became a standard refrain of Dutch family manuals as it already had been in Renaissance Italy and humanist Flanders. The prolific and immensely popular physician-author, Jan van Beverwijck, in his Schat de Gezontheyt (Treasure of Health) followed moralists all the way back to Seneca in urging moderation in diet as the best way of avoiding plague, flux, pox, rheum, ague, and insomnia. The standard cookery book designed for households of the middling sort, De Verstandige Kok of Zorgvuldige Huyshouder (The Wise Cook or the Painstaking Householder) similarly connected an orderly, regular and balanced dietary regime … with a morally wholesome and thriving family life.⁶⁷

Schama goes on to show that the best example of the Dutch idea of a balanced diet could be found in the galleys of the navy where meals were regulated by a republican bureaucracy.

Mandeville appears to have agreed with such a reading of the naval diet as Philopirio recommends it as the basis of his own cure for Misomedon:

I can advise you to a Dish, which tho' cheap, and in England unregarded, is for goodness of inestimable value: What I mean is stockfish, a kind of Cod that is dried without being Salted … the Fish I speak of, and Grout or Burgoe, make up almost the whole Diet of the Dutch Sailers, who are fully as Robust, and for the generality more Healthy at sea, than those of other Nations that are fed at dearer rates.⁶⁸

Misomedon's objections that there are far more nutritious fish are countered by the argument that his constitution is not able to cope with richer food. Behind this excuse, however, there is a desire on Mandeville's part to recommend a fish which will deliberately remind Misomedon of the need for austerity and a sense of balance in diet. The crude simplicity of the meal will be a therapy in itself as it removes the patient from the seductions of over-specialized medical or culinary vocabulary.

Philopirio's reluctant use of drugs is also couched in the same austerity, emphasizing their simplicity and demystifying their use by prescribing in English:

I have no Opinion of Syrups, or Simple Waters; the Medicines I give are either always taken in Coffee, Tea, Wine, Fair-water, or other Liquors that are familiar to the Patients, and generally to be had at their Houses or near hand; or if any particular Vehicle be required, I prescribe a Decoction, or Infusion of a few Simples, in plain English, which every body may make at home, or have done where he pleases.⁶⁹

In the 1730 edition of the Treatise Mandeville adds one other suggestion as to the necessary skills of the physician claiming that ‘all physicians should be good Cooks, at least in Theory’. The deliberate simplicity of his description of the physician's role is reinforced in the closing pages of the Treatise where Mandeville focuses on one of the oldest medicinal cures—wine. Philopirio calls it ‘the Greatest Remedy in the World’ and stresses how its use must be regulated by the relative needs of each drinker. All his comments are mediated by the poetry of Horace which Mandeville has carefully selected to suggest the complex social nature of eating and drinking. His choice of Horace for this task is significant in itself. While Virgil was seen as a more pastoral figure who represented a highly moral stance, Horace was seen as more worldly. His association with Augustus and his constant mixture of love and politics in an urban setting seemed to compromise the purity of his moral position. Because he frequently wrote of food he was often used as a touchstone in debates on taste—both culinary and aesthetic.⁷⁰ By choosing Horace, Mandeville places his discussion on wine and food in a social context and uses this to point out the way in which everyone creates their own fiction of society and their place in it. Philopirio quotes Horace, Epistle V, Book 1:

                                                                                                    —operta recludit,
Spes jubet esse ratas, in prælia trudit
inermem
          Sollicitis animis onus eximit;
addocet artes:
          Fæcundi calices quem
non fecere disertum?
Contracta quem non in paupertate solutum?

[It opens secrets, / gives heart to our hopes, pushes the cowardly into battle, / lifts the load from anxious minds, and evokes talents. / Thanks to the bottle's prompting no one is lost for words, / no one who's cramped by poverty fails to find release.]⁷¹

Here Horace is stressing the transformative powers of wine, its ability to change man's vision of the world. Philopirio pushes this further with his own description of wine's effect, speaking as if the discussion of wine itself has inspired a ferment of images in his brain:

it is not only in the power of this Vegetable to make the Slave fancy himself to be free, the Poor to be Rich, the Old Young, and the Miserable Happy; but it likewise actually mends visible Imperfections; renders the Infirm Strong, the Decrepit Nimble, and the Stammerer Eloquent; and what neither Circe's nor Medea's Art could ever perform; turns Vices into Virtues, and by the Charm of it, the Coward, the Covetous, the Proud, and the Morose become Valiant, Generous, Affable, and good Humour'd.⁷²

Wine and its power to ferment images in the mind stands as a summary of the main lesson of the Treatise that fictions pervade medical discourse, our personal lives and our image of ourselves in society. Mandeville celebrates these fictions but argues that we must understand that we are living among fictions before we benefit from them. The role of the physician is essentially to help his patient understand the nature of these fictions and digest them in a balanced, nutritious manner. As early as the first dialogue Philopirio states that

every Physician, that would discharge his Conscience, ought as much, as he can in his private Capacity, to supply the neglect of the Publick, and wholly apply himself to the study of one Distemper only.⁷³

The physician must make each patient aware of the importance of personal health for the benefit of the commonwealth and each physician must himself be aware of the social responsibility involved in the treatment of patient's private problems. The discourse of public and private will be the subject of Mandeville's next major work, The Fable of the Bees, in which he will investigate the relationships between the physical body and the operations of society in much more detail.

Notes

1. Bernard Mandeville, A Treatise of the Hypochondriack and Hysterick Passions (London: 1711), iii.

2. Ibid., iii-iv.

3. Ibid., iv.

4. Ibid., title-page.

5. Ibid., xi.

6. Seneca, Four Tragedies and Octavia, trans. E. F. Watling (Harmondsworth: Penguin, 1966), 38-9.

7. Jacques Derrida, Dissemination, trans. Barbara Johnson. (London: The Athlone Press, 1981), 7.

8. Mandeville, op. cit. (note 1), iv.

9. Ibid., viii.

10. Ibid., 20.

11. Ibid., 3-4.

12. Ibid., 6-7.

13. Ibid., 7.

14. Ibid., 8.

15. Ibid., 8.

16. Ibid., 12-13.

17. Ibid., 15-17. Mandeville's medical treatise was published as Disputatio Medica Inauguralis de Chylosi Vitiata (Leiden: Elzevier, 1691).

18. Mandeville, op. cit. (note 1), 20.

19. Ibid., 27-8.

20. Ibid., 32.

21. Ibid., 33.

22. Ibid., 32.

23. Ibid., 35.

24. G. E. R. Lloyd, introduction, Hippocratic Writings, trans. J. Chadwick and W. N. Mann (Harmondsworth: Penguin, 1978), 9-12.

25. Mandeville, op. cit. (note 1), 55-6.

26. Ibid., 83-4.

27. Ibid., 86.

28. Susan Sontag, AIDS and its Metaphors (London: Allen Lane, 1989), 14-15.

29. Mandeville, op. cit. (note 1), 87-8.

30. Ibid., 103-4.

31. Ibid., 109.

32. Ibid., 111.

33. Ibid., 111.

34. Ibid., 120-1.

35. Bernard Mandeville, Disputatio Philosophica De Brutorum Operationibus (Leiden: Elzevier, 1689).

36. Mandeville, De Chylosi Vitiata (note 17), A4r. ‘Platerus in observat … coepam veneno plane fuisse infectam’.

37. Mandeville, op. cit. (note 1), 123.

38. Ibid., 123-4.

39. Mandeville, op. cit. (note 35), A5r. ‘Et postquam hanc fovi sententiam … libenter confiteor’.

40. Mandeville, op. cit. (note 1), 124-5.

41. Ibid., 125-6.

42. Ibid., 129-30.

43. Bernard Mandeville, The Grumbling Hive; or, Knaves Turn'd Honest (London: 1705) and The Virgin Unmask'd; or, Female Dialogues betwixt an Elderly Maiden Lady and her Niece (London: 1709).

44. Jean-Anthelme Brillat-Savarin, The Philosopher in the Kitchen, (Harmondsworth: Penguin, 1970), 13.

45. Mandeville, op. cit. (note), 142.

46. Ibid., 150-1.

47. Ibid., 164.

48. Ibid., 165-6.

49. Ibid., 170-1.

50. Ibid., 166-9.

51. Ibid., 170-1.

52. Ibid., 192-3.

53. Ibid., 199.

54. Ibid., 207-8.

55. Ibid., 232-3.

56. Ibid., 234.

57. Horace, Satires and Epistles, trans. Niall Rudd, (ed.) Betty Radice (Harmondsworth: Penguin, 1973), 50. The passage Philopirio alludes to is in Satires I, iii, 25-8, ‘Before examining your own faults you smear ointment / on your bloodshot eyes, but when it comes to your friends' foibles / your sight is as sharp as an eagle's or the Epidaurian snake's. / Unfortunately they in their turn scrutinize your deficiencies.’ Mandeville first quotes this passage in his De Medicina Oratio Scholastica, 13.

58. Mandeville, op. cit. (note 1), 234.

59. Ibid., 200.

60. Ibid., 216-17.

61. Ibid., 229.

62. Bernard Mandeville, A Treatise of the Hypochondriack and Hysterick Passions (London, 1730), 228.

63. Ibid., 230.

64. Daniel LeClerc, Histoire de la Médecine (Amsterdam, 1696).

65. Mandeville, Treatise, 254.

66. Mandeville, Treatise, 245.

67. Simon Schama, The Embarrassment of Riches: An Interpretation of Dutch Culture in the Golden Age (London: Collins, 1987), 158-9.

68. Mandeville, Treatise, 246.

69. Mandeville, Treatise, 263.

70. In 1705 Dr William King published The Art of Cookery, a riposte to Martin Lister's translation of Apicius' De Re Coquinaria published in the same year. King's attack on Lister was modelled on the structure of Horace's Art of Poetry.

71. Mandeville, Treatise, 272. The English translation is taken from Horace, Satires and Epistles, trans. Niall Rudd (ed.), Betty Radice (Harmondsworth: Penguin, 1973), 139.

72. Mandeville, Treatise, 272.

73. Mandeville, Treatise, 40.