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

Published in Keith Thomas's Oxford Studies in Social History, one of the world's premier social history series, this study is much more than the story of a small group of medical monopolists. The focus of the book is, indeed, the College of Physicians of London, and its main source the college's carefully kept records, but the study's true contribution is the light it sheds on a much wider medical environment. As Pelling puts it, "Paradoxically, the Annals of the College, a small, homosocial, exclusive institution, provide perhaps the best single source of information on the rich variety of the medical occupations active in the fastest-growing western metropolis" (p. 4). Thus, this is a genuine multiple history: a detailed institutional analysis of a medical organization; a study of London's medical marketplace and the role there of what were called irregular healers; an account of the agency of early modern patients; and a valuable contribution to the history of women's work.

It is a long book, based on a prodigious amount of research by Pelling and her research predecessors and collaborators. It contains much quantitative material, the purpose of which was not always clear to this reviewer; do we really need to have a table indicating that November was the most active censorial month in the college calendar (p. 77)? The careful, explanatory, measured, even laborious tone will not appeal to every reader. (It forms quite a contrast to the academic exuberance of another leading medical historian, the late Roy Porter.) However, the reader should persevere, for it is an important work.

Indeed, it is almost an antihistory of the early modern physician, blurring the boundaries between college member and irregular, male and female practitioner. Pelling shows that an elite minority, less than forty men at a given moment, the ancestors of our modern-day medical establishment, who presented a self-image of hierarchy and superiority and whose own history has dominated the medical historiography for generations, was actually characterized by institutional anxiety and insecurity; "Anatomy of an Anxious Institution" is the title of an early chapter. Those who want a detailed history of an oligarchy in action will not be disappointed. But it is a history of those the college came into contact with just as much as it is of the narrow gerontocracy that ran the institution. Much as the Church Courts were responsible for the regulation and self-policing of social and sexual interaction in the early modern period, the College of Physicians offered a forum in which Londoners could work out their relationships in the medical sphere. It was a college of counsel as well as censorship. As Pelling describes it, an organization that was male-dominated, indeed male-exclusive, in terms of its composition and that "asserted that women were ignorant by definition" (p. 192) was faced with female interaction on a regular basis as sixteenth- and seventeenth-century female patients and healers appeared before it as accusers, accused, and witnesses. We encounter the female servant who healed sore eyes (p. 203), and the alewife who dispensed purgatives and claimed to be able to test for pregnancy by washing the woman's clothes with rose water and soap (p. 210). In a fascinating few pages, Pelling discusses a hidden category of female medical workers who acted in proxy for male practitioners (pp. 220-21).

Medical Conflicts in Early Modern London confirms the emerging picture of the early modern medical world as one of a wide-ranging marketplace populated with a diversity of healers. The medical elites could speak contemptuously about illiterate artisans who claimed to be able to heal eyes without even knowing what an eye was; yet their self-representations were challenged at every medical turn. In fact, Pelling shows that many of the so-called irregulars were university-educated and that some of the college were poachers turned...