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There was something about Europe that qualified it for what happened next. No hegemon dominated Europe, a gallimaufry of 500 kingdoms, city states and republics locked in ferocious competition that stimulated independence and ingenuity, propelled by rival civic and economic power centres, cults of aspiration, Enlightened culture – and nuclear families who, like the Wedgwoods and Krupps, intermarried with each other, sharing values and passing on wealth. The idea of a Protestant work ethic has been overdone – Catholic France was also sophisticated – but these northern nations had developed the spirit of self-starting motivation, creating a singular European psychology that favoured individualism, self-improvement and a society of trust. ‘Wherever manners are gentle there is commerce,’ a philosophe, the baron de Montesquieu, reflected in 1749, ‘and wherever there is commerce, manners are gentle.’ Not just manners but standards. ‘Whenever commerce is introduced,’ wrote a Scottish philosophe, Adam Smith, in 1766, ‘probity and punctuality always accompany it – the principal virtues of a commercial nation.’

It was financial capitalism in its widest sense that funded the revolution. The international esprit of Britain, Holland, France and the new US republic stimulated manufacturing and trade. The economic life of the world was shot through with slavery, thanks to sugar, tobacco and cotton. Its profits were embedded in the wealth of those powers, ready to invest in new businesses; it touched everything. Yet there was plenty of wealth that was not linked to slavery, from Bridgewater’s coal and canals to Wilkinson’s iron and Wedgwood’s china – and then there were the German Krupps and other entrepreneurs of the German kingdoms, which had minimal slavery and empire. Slavery was a significant source of capital but far from the only one.

A sudden spurt in the British population – fuelled by rising food production, which doubled between 1600 and 1800 – provided a market of workers and consumers. People poured into cities: between 1790 and 1850, the city dwellers more than doubled from 9.7 per cent to 22.6. By 1800, there were a million Londoners. In thirty years, that doubled; by the 1870s, it had doubled again. The surge was nourished by better food and conditions, but certainly not by medical advances. An eminent case was now to demonstrate how doctors remained an iatrogenic menace – even to the most privileged.

On 16 October 1788, the fifty-year-old George III went mad – at least partly poisoned by his own doctors.

SALLY HEMINGS AND MARIE ANTOINETTE: THE DIAMOND NECKLACE AND THE LOVE CABBAGE

‘I wish to God I may die,’ cried George, ‘for I’m going mad.’ Suffering stomach pains and fever, he started to jabber incessantly, deteriorating until he was demented and in the full grip of psychosis. Sometimes he was violent, oftentimes he ran away from his courtiers and had to be pursued. His appalling doctors treated him with an array of lethal medicines and damaging treatments, including scarification (cutting the skin), blistering (creating pustules on the skin), cupping (applying heated glass cups to the skin), venesection (bloodletting), the application of leeches and dosages of laudanum, purgatives and emetic tartar laced with arsenic.

The king’s madness was later diagnosed as hereditary porphyria, but modern doctors now believe he suffered from bipolar disorder, possibly sparked or exacerbated by chemical poisoning.* In 1788, doctors had no understanding of mental illness or the properties of their own medicines. Finally a ‘mad-doctor’, Francis Willis, a sixty-year-old vicar and physician who treated ‘wrongheads’ not just with the traditional coercion but also with the ‘health and cheerfulness’ of serene rustic exercise, arrived at Windsor. But although he reduced the poisonous tonic, he deployed his trademark kindness with the use of gags and straitjackets that if anything increased the stress on the patient.

Pitt was forced to pass a Regency Act that allowed for the prince of Wales to become prince regent. Prinny was thrilled at the thought of power – dismissing Pitt and promoting his Whig allies – and more spending. But George recovered, allowing Pitt to avoid dismissal. For now, Pitt increased the prime minister’s authority, partly thanks to the madness, partly thanks to America – where the new republic, chaotic and indebted, was governed by a confusion of committees and states. As Washington tried to restore his declining estates and recapture fugitive slaves, Rochambeau and Fersen returned in triumph to Paris, where Antoinette welcomed the Swede for the most intense period of their relationship. A new American minister soon followed them: Jefferson.

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