By Mark S. R. Jenner and Patrick Wallis
Medicine and the Market in England and its Colonies, c.1450- c.1850, edited by Mark S.R. Jenner and Patrick Wallis (Palgrave Macmillan, 2007)
Introduction: In the mid-1980s, a number of Anglophone historians began to describe health care in early modern England as a ‘medical marketplace’ or ‘medical market’. These terms were foregrounded by several scholars more or less simultaneously. The opening chapter of Lucinda Beier’s 1984 Ph.D. thesis (published in 1987) was entitled ‘The Medical Marketplace’. In 1985, Roy Porter wrote of the premodern ‘medical market place’ ‘where physicians, surgeons, and apothecaries … melted into each other along a spectrum that included thousands who dispensed medicine full- or parttime’, and Irvine Loudon observed that one of the most important unresolved areas of eighteenth-century medicine was ‘the extent of the market for medical care and how that market was satisfied’. The following year Harold Cook’s Decline of the Old Medical Regime began with a chapter entitled ‘The Medical Marketplace’. This terminology was not confined to scholars working on the United Kingdom. Katherine Park’s Doctors and Medicine in Early Modern Florence (1985) contained an identically entitled chapter.
Most earlier accounts of early modern medical practice had either focused on the notional three-part occupational hierarchy of physicians who advised, surgeons who operated and apothecaries who prepared drugs, or else were simply dominated by a concern with learned, ‘professional’ practitioners. Other healers were either denigrated as ‘quackish’ or simply ignored. Developing pioneering work on the diversity of medical practitioners in early modern England, the medical marketplace literature was in the vanguard of a wave of scholarship that overturned all these assumptions and began to set out the characteristics of an emergent diverse, plural and commercial pre-professional system of health care. These studies stressed that the boundaries between physicians, surgeons and apothecaries were blurred to the point of irrelevance: regulation had limited force, professionalization was anachronistic. Early modern practitioners, they argued, competed for custom in an open ‘medical marketplace where services were advertised and sold to those sufferers who cared to shop’. Patients had ‘relative freedom to choose the medical practitioners they liked’; they were ‘medically promiscuous’, selecting therapies and therapists according to their estimation of the practitioner’s effectiveness or manners, not to mention cost. For all their intellectual pretensions, learned physicians did not command any real degree of cultural authority until the nineteenth century. As the medical marketplace literature revealed, in any year a sick person might visit a wart-charmer, get a remedy from a neighbour or bookseller, pay for a surgeon and hire a horse leech.