Medical Conflicts in Early Modern London: Patronage, Physicians, and Irregular Practitioners, 1550-1640 (review)

Margaret Pelling has written a book that will change the ways in which we think about early modern physicians. Ever since her 1987 "Trade or Profession" essay, she and a number of other scholars have been putting the nineteenth-century heroic account of the rise of the professions to rest. Physicians in the early modern period were not just like their later brethren but with fewer effective tools; rather, as Pelling shows, they had a difficult time persuading anyone (maybe even themselves?) that they were the ones to consult in times of sickness. Medical Conflicts is based upon the records of the College of Physicians from the years 1550–1640. The first few chapters lay out the structure and mechanisms of the College's activities, making the reader fully aware of the evidentiary base for Pelling's conclusions.

The central and brilliant insight that this book offers is a new understanding of the dynamics of the relationship between members of the College and those many London practitioners who were not members. Pelling shows, first, that these irregulars were not so easy to tell apart from members—in fact, a great deal of energy and anxiety was expended by members precisely because the irregulars were uncomfortably similar to themselves. She thus turns received wisdom on its head: it was not the distance between the College and the irregulars that was the problem, but rather, their proximity. One of the most telling details in this argument is Pelling's observation (p. 89) that three of the ten irregulars whom the College spent the most time discussing eventually became members of the College themselves! Second, the key activity that brought the members of the College together was the prosecution of irregulars: this was an odd group of men, who eschewed the usual manly civic activities that united members of other city companies and guilds. Finally, she overturns an older story about the College's effectiveness in controlling London medical practice. Because 76 percent of the irregulars mentioned in the College's records appear only once or twice, the "rise of the profession" story explained that the College was very successful in controlling practice: those who appeared once or twice then toed the line and stopped practice. On the contrary, says Pelling—London was too big, and many people practiced medicine opportunistically and intermittently, so that those who show up in the records once or twice probably slipped through the net many other times. Some of those practitioners were women, who treated both sexes and enjoyed successful practices.

"But wait," I hear you say. "What about those female practitioners? Surely they were nothing like male members of the College and everyone knew it. Surely the 'proximity' argument can't hold for them." Those familiar with Pelling's groundbreaking 1996 "Compromised by Gender" essay will already know otherwise. Physicians, she argues, were involved in tasks that were gendered female in early modern England: domestic health care was almost entirely the role of women, as was making medicines at home. Add to this feminine line of work the already-mentioned reluctance of physicians to take on the usual civic responsibilities pertaining to male heads of households—indeed, their reluctance to get married and take on the role of patriarch—and you can see how physicians might be troubled by insecurities of status and gender.

The book is full of captivating detail and rests upon a deep knowledge of London's complex civic structures. For example, it was evidently common to permit variously qualified travelers to practice medicine for up to a month while in London so that they could pay their bills while away from home! The College tried to resist this practice, but, as in so much else, they had to give way to custom and/or aristocratic patronage. As in Gianna Pomata's...