In the last two chapters the rise of the medical profession has been traced from its comparatively unimportant status in Tudor and Stuart times. In the eighteenth century, it shared in the general expansion of a market economy. In the nineteenth century it achieved formal public blessing as a liberal profession and benefited from the state's growing involvement in public health with the progress of industrialization and urbanization. But if medicine grew strong, did it actually promote health in others? After all, in The Doctor's Dilemma (1906), George Bernard Shaw could still present on the stage a bevy of top doctors shamelessly admitting to themselves (though not to their patients) that their medicine was bogus through and through. Lawrence Muggleton could opine in the seventeenth century: ‘if there were never a doctor of physick in the world, people would live longer and live better in health’. Was such a view still tenable during the reign of Victoria [126]? And if so, how then do we explain its persistence?

The widest context against which to evaluate these questions is to ask whether medicine (of all sorts, from self-help to Harley Street, with public health thrown in as well) kept people alive. Did it have any significant effect upon the aggregate population? The death rate was strikingly high through most of the seventeenth century, peaking again in the 1720s and 30s, declining somewhat from the 1740s, rising again during the early nineteenth-century decades of rapid industrialisation. It began a slow but sustained decline from around 1830, and plummeted only in this century.