‘No cure no money’: Reverend William Vickers’ account of the perils of private medicine in eighteenth century London (1711)

Abstract

Dear editor

Modern general practitioners face competing demands on their clinical, administrative, educational and personal time. This has implications for healthcare service resources alongside doctor wellbeing and resilience. GP work is increasingly high-pressure due to operating in:

the ‘squeezed middle’, caught between hospital services and a public frustrated with healthcare provision. This contested space lies in the eye of a storm of political mandates, persuasive media messages and a resurgent private healthcare industry. To survive in the tempest, new GPs require careful upstream training in community-based clinical generalism.^1,2

We believe that a way to help medical students prepare for these challenges lies in lessons and stories from the history of medicine.³ Here we consider one such account, which may be the earliest to highlight the allure and perils of private medicine in London. This comes not from a physician or surgeon (for whom some form of private practice was routine) but from the pen of the vicar William Vickers of Sherburne Lane, London.^4,5

Vickers’ biography is of note by having received treatment for ‘the King's evil’ (tuberculosis) in the traditional manner of his day: ‘I was stroaked [sic] twice by King Charles II. and thrice by King James II’.⁴ Vickers also describes a host of other treatments he endured and how he claims to have discovered his own cure:

It's incredible, to tell the great Quantities of Purges, Vomits, Diet-drinks, Lime-Waters, Millipedes, Rue-Whitlow-grass, and many other Things, not excepting Mercurial and Antimonial Remedies, which I have taken in my time; but nothing availed until it pleased God, by a wonderful Providence, to direct me to the knowledge of this Specifick [sic, his own medicinal product], which exceeded all my Hopes and Expectations.⁴

It is also of historical note that he astutely found no merit in heavy metals:

And because some may have very high Thoughts of … Mercurial and Antimonial [medicines], it may not be improper to acquaint you that I made several Tryals thereof, but never reaped the least Benefit or Advantage … I never found their Efficacy one Jot beyond what choice Rhubarb and Sene [i.e. senna] skilfully exhibited would perform.⁴

Like Gideon Harvey (senior, 1639–1702) before him,⁶ Vickers never reveals the content of his ‘new and uncommon’ ‘specifick remedy’.⁴ He presents, however, multiple case reports as evidence of the efficacy of this ‘liquor’ (which was taken ‘three half Pints at three Times every Day’ or as a ‘constant drink’). Among these, one overlooked⁵ account is notable as an early voice on the dangers to patients of private medicine. This sad story begins:

Mr. Burry, of Cirencester [in the South West of England], came up to London, with his only Son, to get him cured of the Kings-Evil and among some others he sent for me to advise withal. So soon as I saw the Child, I told him if he could give me the Wealth of the Indies, I could not cure him. He told me that a famous Man, not far from Lincolns-Inn [Holborn], would engage to Cure his Child in six Weeks, no Cure no Money. If he doth, quoth I, I'll pay for that Cure, let it cost what it will.⁴

Unsurprisingly, the despairing father sought succour elsewhere – but all to no avail:

Two Months afterwards I met the Gentleman in Fleet street, who, with Tears in his Eyes, told me that his famous Practitioner had not fulfill'd his Promise, his Son every Day waxing worse and worse, he resolv'd (as he said by good Advice) to put his Child under some particular Manual Operations [presumably cupping, bleeding, blistering etc]; which were, as I understand, perform'd on the Monday, and the following Wednesday Night, about 6, the poor Child died convulsive.⁴

Vickers reflects upon his own previous judgement and counsel. He then proceeds to decry how doctors’ clinical judgment is determined by whether patients are paying for their care:

In my former Discourses with this Child's Father, I had shewed him the ill Consequences of such Methods, that his Child was too weak and feeble to suffer the least Severity, that nothing in Nature could retrieve his Son's Life, and therefore it would be in vain to attempt any thing; but no Perswasives [sic] nor Examples [presumably stories of other patients] are sufficient to restrain some People from doing themselves and others Hurt, where great Names and great Authorities interpose. I have been inform'd its [sic] a standing Order in both our Hospitals [presumably St Bartholomew's and St Thomas’ hospital in London], That no Person afflicted with the Kings-Evil shall be admitted into those Houses; which, if procur'd [i.e. endorsed] by the Professors of Physick and Surgery, it looks as if they thought this Distemper incurable, and if so, it seems a little incongruous they should meddle with it in their private Practice.⁴

This story reflects challenges today: frustrated patients heeding persuasive adverts for ‘self-pay’ solutions offered up by the ‘great names and great authorities’ of market-based healthcare services. Negotiating patient assumptions that private care is ‘better’ remains a daily dilemma for many doctors, especially GPs. Likewise, in our GP consultation role plays, medical students sometimes swiftly assert the very same assumption. This typically takes the form of leaping to ‘look inside the body’ through private imaging (e.g. MRI) services, even in low-risk populations. In response, we promote the concept of ‘VOMIT’⁷ in our teaching: patients can easily become Victims of Medical Imaging Technology, for example through incidental findings. We also discuss divergent ‘narratives’ presented by doctors in common presentations like headache or mechanical back pain: NHS GPs typically articulate the value of clinical restraint, reassurance and incremental management whilst private doctors are likely to advocate imaging on grounds of ‘reassurance’, ‘just in case’ or ‘to get a baseline (i.e. for future comparison)’. This contrast helps students to recognise narratives behind ‘corporate strategies’ at play in medicine.

Wherever possible, we use stories from our own experience as doctors (and sometimes as patients) to support students’ understanding of these challenges. The UK's General Medical Council does not include storytelling among learning outcomes in its national exit examination for medical students. Despite that, we believe that storytelling is fundamental to being a doctor. Storytelling is particularly powerful where modern and historical accounts are explored side by side. These ‘parallel stories’ help students to understand enduring aspects of medical practice – in particular, the important place of palliative care and general practice in strong healthcare systems, pressures from healthcare rationing and, particularly in the private sector, the risk of overtreatment.

Many reasons for seeking private medicine remain the same as three hundred years ago. Conversely, reflecting upon ‘parallel stories’ in the way above can also help underscore challenges particular to modern consultations: litigation, defensive medicine and risk-averse artificial intelligence. This highlights to students the abiding value of building rapport with patients, delicate communication skills and thorough record-keeping. Ultimately, Mr Burry's sad story reveals that time with a doctor is an enduring commodity in all times and in all types of healthcare. In our teaching, we seek to highlight the ‘therapeutic value of time with a doctor’ which is an art that starts by helping patients to understand their situation and options – rather than leaping to tests and treatment. Many doctors are passionate storytellers and their clinical anecdotes can support patients in weighing up positive and negative risks from interventions.

We believe that stories like Mr Burry's can support learners in understanding enduring challenges, tensions and mirages in medicine. Foremost amongst these is recognising confounding factors acting upon patient decision-making and, especially, the impact of personal financial interests of doctors. Vickers’ narrative offers a way of raising this important issue with learners and so to introduce the famous dictum of Nye Bevan (1897–1960) on the same subject:

The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health.⁸

Footnotes

ORCID iD

Max Cooper

Author contributions

MC identified the source, drafted and submitted the paper. SC and JH read and commented upon drafts.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author biographies

Max Cooper is an Associate Professor in General Practice. He began his academic career as a ‘Higher Professional Fellow in General Practice' at Glasgow University (2002-2004). He is fascinated by the history of medicine and of London. As a boy he lived in Harrow and his Cooper family reach back to a birth certificate from 7 Little Woodstock Street, Marylebone (14th June 1858).

Jason Heath has been a GP in Lewes and Brighton for thirty years, a Program Director on the Brighton GP training scheme, and has contributed to undergraduate teaching at BSMS since it opened in 2003. He graduated from St Bartholomew's Medical School, the third of four generations to qualify from Barts. He was awarded a First Class BSc (intercalated) in Physiology and went on to work in Winchester and Brighton before joining his partnership in Lewes. A GP trainer at Foundry Healthcare Lewes, he is an enthusiast for the variety that careers in General Practice offer having been an appraiser, endoscopist, and GP with a specialist interest in substance misuse. He also enjoys cinema, motorsport and cricket.

Sarah Cooper is a Consultant Neurologist at Brighton. She studied at Southampton University, the London School of Hygiene and Tropical Medicine and Edinburgh University. She is a Fellow of the Royal College of Physicians (London) and teaches neurology to year four students at BSMS.

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An Easie and Safe Method for Curing the King's Evil. Fifth edition. S. Manship, London. 1711. https://www.google.co.uk/books/edition/An_easie_method_for_curing_the_King_s_Ev/JOMOpO2UsV0C?hl=en (accessed 7 February 2026)

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. The Rev. William Vickers, the “Evil Doctor”. Annals of Medical History 1940; 2: 404–421.

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Gideon Harvey’s 1683 proposal for a cluster-controlled trial of medical treatments. Notes and Records of the Royal Society of London 2026; 20240051. Epub ahead of print. 10.1098/rsnr.2024.0051

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. VOMIT—victim of medical investigative technology. BMJ 2008; 336: 8.

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. In place of fear. London: William Heinemann Ltd, 1952.