The 'Marriage à la Mode' series was Hogarth's first to satirize the upper classes. In particular he was attacking arranged marriages for economic convenience. The series tells of the disastrous marriage of the Earl of Squanderfield's son, Viscount Squanderfield, to the daughter of a wealthy Alderman of the City of London.
In this scene, the third in the series, the Viscount is visiting Doctor Misaubin. Hogarth uses a black spot on the Viscount's neck to represent the venereal disease that he has passed on to his young mistress whose predicament seems to be of little concern to the young man. The older woman in the scene could be the doctor's assistant or wife but is perhaps the girl's bawd. She waves a knife, possibly unwilling to be examined or perhaps unhappy at the Viscount's criticism of her husband's medicine.
In the eighteenth century patronage of the sciences was seen as being a sign of a civilised society so in contrasting the scientific instruments in the doctor's office with images and animals traditionally associated with Africa, a continent viewed by the upper classes as savage and uncivilised, Hogarth comments on the ignorance of this society and highlights the uncivilised and savage nature of the Viscount's lifestyle.