Notebook: The faint whiff of snake oil: Harley Street's ornate facade oozes professional substance. But, as the exposure of Dr Courtney this week proved, appearances can deceive

A DOCTOR exposed for raping and otherwise sexually assaulting women inevitably brings discredit not only on his profession but on his workplace. In the case of Dr Thomas Courtney, the consulting rooms were in Harley Street, famous sanctum of the medical elite. Harley Street conjures up the silk hats and silver canes of royalty's bedside baronets, efficacious remedies for the affluent, and endless subdivisions of medical knowledge into -ologists,

icians, -ists and -itioners.

I loitered there last week soon after Dr Courtney was sentenced to seven years' imprisonment. Harley Street's reputation betrayed few outward signs of distress following the scandal, which featured the Irish doctor's unusual seduction techniques (drugged wine, vibrators, soapy showers, job promises), and gullibility on the part of those to whom he commended himself (journalists, hospitals, drugs companies, other doctors and charities).

The street, running north from Cavendish Square to Marylebone Road, exudes tradition and self-confidence through its red brick, terracotta and stone styles, ranging from eclectic Gothic to Queen Anne, from Georgian symmetry to Beaux-Arts. From Coutts Bank on the south corner to the National Westminster Bank on the north corner, it also exudes money.

I found myself admiring shaped gables, shallow bow windows and oriels; the Roman Doric columns on the first floor of No 2, built in 1724-26 as part of Lord Chandos's house, the restrained classical stone face of No 35, the corner oriel of No 37 with figures in low relief and a caryatid higher up; brass, lion-paw knockers on great double doors, Venetian windows and vermiculated entrances. Chauffeur-driven Rolls-Royces, Bentleys, BMWs and the odd Jaguar purred at the pavements. Outside one house, a tiny Arab woman in a chador was hunched in a wheelchair, waiting for her limousine: reassuring symbols of economic well-being and professional substance.

But it's not always easy to tell. Dr Courtney seemed well-heeled, yet he was a charlatan - a bluffer. He set up a string of charities that yielded nothing after donations totalling pounds 400,000. He rubbed shoulders with Cabinet ministers, Downing Street advisers and media people, while robbing his patients (charging one woman pounds 1,500 for tests offered free by the NHS). At No 12 (late 18th century), he tricked the distraught and the well-meaning with a phoney scheme to 'help the women and innocent babies dying of Aids'. He claimed to have treated 666 women who were HIV-positive, yet the police found his filing cabinets and appointments books almost empty when they raided his office. In other words, he made money from what he wasn't (a gynaecologist) and couldn't (relieve terminal disease).

He was not the first Harley Street doctor to achieve such a miracle. According to Harley Street, a history by Reginald Pound published in 1967, the first Harley Street fortune was made in the 1830s by 'an Irish quack' named John St John Long of what is now No 84. In time, others followed. Transplant rackets, slimming rackets, cocaine busts, suicides have crowded into Harley Street's history like invading bacilli. I inhaled the solemn air. A faint whiff of snake oil perhaps?

What is Harley Street? Nowadays, there are about 2,000 practices with Harley Street name-plates, but 'Harley Street doctors' are also to be found in rich veins running off it: Bentinck St, Welbeck St, New Cavendish St, Devonshire St, Portland Place, Hallam St and Wimpole St. In Harley Street itself, there are also chartered accountants, surveyors, property consultants, solicitors, architects, computer companies, and the offices of the British Water Industries Group. Sketchley is handily headquartered there, should your doctor wish to take you to the cleaners.

Brian Pattinson, the osteopathic physician who mended my back a few years ago is in Wimpole Street, having moved from Harley Street in 1984. Still referred to as a Harley Street man, he relieved my vertebrae for a fairly painless fee. Conscious of his integrity, I called on him again for a chat.

Dr Pattinson is tall, charming, friendly; the sort of man I expected would have known most of his neighbours past and present. 'There is very little feeling of togetherness,' he said. 'In five years in one house there were two doctors I never even met. It was the same in another Harley Street house where I spent six years. We were all doing different things, you see.'

He did know something of Harley Street's medical past. 'Originally, doctors moved to Harley Street because the property was cheaper than in Mayfair. They would live and practise in the same houses; servants and kitchens in the basement, practice on the first floor, living rooms on the second, bedrooms on the third and servants' bedrooms on the fourth. As property values rose, they split the houses into practices and went to live elsewhere, the suburbs perhaps, and beyond.'

Some Harley Street consulting rooms are in large suites, with reception areas panelled in honey-coloured oak, antique furniture, impressive paintings and copies of Country Life on coffee tables, though one doctor has opted for a different opulence - a waiting-room resembling a Bedouin chief's tent - to make his Middle Eastern patients feel at home. Others are subdivided till quite tiny, ill-furnished, with worn carpets, and sometimes used on a time-share basis. Dr Pattinson reckons the average rent for a modest suite is pounds 10,000 a year.

This may help explain why a Harley Street hysterectomy can cost pounds 900, compared with pounds 160 in Ontario, pounds 600 in New York and pounds 400 in Sydney. Many consultants, taking pounds 50,000 a year from their NHS work, can top this twice over from their private Harley Street practices. So for 2,000-odd doctors, a few of whom are said to have little more than a nodding acquaintance with human organs, Harley Street is a nice little earner.

In the early part of this century, when psychiatrists started to move into Harley Street, Sir Heneage Ogilvie, a surgeon, noted disapprovingly that they needed only a room, a couch and a notebook and not much in the way of diplomas. 'Psychiatry,' he wrote, 'offers a wonderful opening to the hyenas of Harley Street, the confidence men of medicine . . . who gamble on the magic of an address . . .'

But he was unfair in singling out psychiatrists. Surgeons, too, have been guilty of over-zealous incisions on the wallet. In a letter to the Times at the turn of the century, when Harley Street had only 157 medics, a doctor advised: 'A surgeon should give as little pain as possible while he is treating the patient, and no pain at all when he charges his fee.' Twenty years later, Lord Northcliffe, co-proprietor of the Times, wrote and circulated a parody of a Lancet news item. Headlined A Profitable Cough, it said: 'Considerable interest continues to be manifested in the well-known and profitable cough of Lord Northcliffe. Discovered in February 1918 by a general practitioner, it has from time to time been a source of much augmentation of income, not only to local medical men but also the consultants of Harley and Wimpole Streets.'

A wide variety of famous patients have been to Harley Street: among them Thackeray (apoplexy), Dickens (gout), John Merrick, the 'Elephant Man' (pachydermatocele and papilloma of the skin), Edward VII (inflammation of the bowels) and George VI (a stutter), H G Wells (sore leg), Augustus John (ditto). The more that eminent patients turned to Harley Street, the more seductive its reputation became. In The Doctor's Dilemma, Shaw included a line, 'Ours is not a profession but a conspiracy,' startling Edwardian first-nighters, but applauded in later years by audiences who shared his derision for aspects of private practice.

Today, there are reminders of occupiers who have enhanced the street's 'cred' since its first mention in the Marylebone rate books in 1752: Gladstone, who lived there in the latter part of last century; Florence Nightingale, who set off from Harley Street to tend the Crimean sick; Dean Swift, who pined there for his Stella; Lady Nelson, who nursed bitter feelings there about Horatio's mistress Lady Hamilton.

But Harley Street has a new dilemma. Two years ago, it was the focus of illegal transactions in the organs of Turkish peasants. In 1989, a guide to the specialists referred to treatment that was 'inadequate or even deceitful'. Earlier, a doctor was accused of turning patients into drug addicts through his slimming techniques, while a police raid on another practice unearthed 100lbs of cocaine. All this before Thomas Courtney was exposed.

I came across a number of empty buildings there. Others seemed only partly occupied (it's impossible to be certain, because the chief ground landlords, Howard De Walden Estates, have an aesthetic objection to 'To Let' boards - though not to plaques warning against the chaining of bicyles to railings). Dr Pattinson suggests there are consultants who find it more convenient - and quite as profitable - to practise privately at outlying hospitals. 'A lot of doctors have moved out. The floor below me has been empty for a year. Some houses were bought by property developers and were then hit by the recession. They remain empty.'

But, by and large, he maintained, Harley Street still 'represents the cream of the medical profession'.

(Photograph omitted)