The Dying and the Doctors: The Medical Revolution in Seventeenth-Century England (review)

Ian Mortimer has found proof of profound change in English medicine between 1570 and 1719 in the probate accounts of the period. Examining more than eighteen thousand accounts set up to administer deceased persons' estates in five counties, Mortimer has discerned a measurable shift in the treatment of the dying from palliative nursing and spiritual help to paying for medicines and doctors. Society became "medicalized" as medical men extended their care beyond the larger towns to serve the sick in rural areas; Mortimer's evidence makes clear that by 1700, most of England was no longer medically remote.

Provincial doctors, a term that included physicians, surgeons, and apothecaries, often had episcopal authorization to practice; indeed, Mortimer calculates that 40 percent of those doctors tending the dying were diocesan licentiates, a much higher proportion than previous historians have estimated. The nomenclature of their different occupations meant little in terms of responsibilities, although men described as doctor or physician may have gotten higher fees. They treated the rich and the poor, men and women. Though Mortimer finds no significant increase in the number of doctors, they served a larger clientele, giving physic and advice across the countryside. Medicines, including ointments and internal remedies, cost more as the decades passed, undergoing a significant upward trend until the restoration. Average prices for medical substances rose from fourteen shillings in the first years of Mortimer's study to forty-three shillings in the thirty years after Charles II resumed the Stuart reign.

Self-help medical books proliferated and popularized remedies for certain diseases, enabling housewives and other readers to procure or make their own recipes. Neighbors could be called upon for nursing help. Men usually had female family members to nurse them for free, but men without female relatives and sick women usually had to resort to outside nurses. When children fell ill, local women frequently provided advice rather than medical practitioners. Mortimer spends considerable space defining what nursing meant in the seventeenth century. Words such as attending, tending, and looking after were used in the accounts. The specific assignment of watching, a task performed on a nightly basis, fell to men, while women handled subsidiary services like feeding and cleaning the patient, as well as laying out the body after death. Nurses also purchased medicines prescribed by a doctor, more frequently as men directed case strategies. Mortimer observes that the word nurse came to connote female at about the same time that the exclusively male term doctor stood for men practitioners. However, paid female healers found their roles more formalized, occupational, and reduced in scope as the decades rolled by and males came to dominate medical treatment for the sick and dying. Exceptions to this general trend emerged when examining care for plague victims; two-thirds of sufferers paid for nursing care alone throughout the period under study. And while smallpox cases initially followed the pattern of nursing care, by the end of the seventeenth century, nearly 80% of accounts attest to practitioner-directed strategies for treating that disease.

Mortimer concludes that the rise of medical strategies in health crises coincided with a decline in relying on spiritual answers. More medicines, many newly arrived from abroad, encouraged sufferers to try medical means in dealing with their illnesses to the diminution of the exclusive use of prayer. He argues that Keith Thomas's theory in Religion and the Decline of Magic needs a little refinement: religion might have given way naturally to science "through a process of accommodating scientific changes within the existing religious framework" (209).

Tables galore festoon the text, but Mortimer should have been as particular about his writing style as he was in charting these changes. He uses far too many copulative verbs and falls into the passive voice pit all too common in histories. While his book depends on primary sources, his bibliography, especially the secondary sources, seems dated...