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  • Introduction:The Growth of the Early Modern Medical Economy
  • Patrick Wallis

The papers in this section address a common question: how likely were sick people in early modern Europe to seek care from a medical practitioner? The evidence they present reveals a level of engagement with commercial medical provision that varied substantially across Europe but that, for the most part, shared one striking characteristic: growth. While the likelihood that someone would turn to a medical practitioner for help was markedly higher in the urban Mediterranean than in the countryside of North West Europe, in all three of the locations that these papers study we see the use of care rising over the sixteenth to nineteenth centuries. In short, people across Europe grew ever more reliant on commercial medical practitioners—individuals earning a living from their work in health care—in the early modern period. These findings substantially advance our understanding of developments in medical consumption over time. By shifting attention from goods to services, they provide a major complement to our understanding of consumption more generally. And they also present us with the challenge of explaining how these profound shifts in the medical economy connected with and contributed to wider economic, social, and cultural developments.

In turning to the task of identifying and measuring long run changes in the demand and supply of medical services, these papers move on from the essential work of uncovering the variety and abundance of medical care and medical practice that historians have undertaken in a series of studies over the last forty years. That important body of work excavated rich strata of medical practice in early modern England, France, Italy, Germany, and Spain, to note only a few of the best-known examples.1 It showed convincingly that what previous generations of historians had often assumed was a desert lightened by a few isolated oases of medical learning had instead been a rainforest, with a richly hued flock of medical practitioners filling the archives with their complaints, enticements, and conflicts.

However, where the grand narratives of professionalization and medicalization that were overthrown by these studies had been oriented longitudinally [End Page 477] (albeit teleologically), the florid abundance of the early modern medical marketplace lent itself instead to close readings and case studies. The problem of change over time was largely set aside. Historians’ attempts to impose order took the form of hierarchies or Venn diagrams that pointed out the blurred boundaries between clusters of fauna or plotted their relative positions in the biosphere.2 Inspired by the pioneering work of Pelling and Webster, historians revealed the abundance of medical practitioners relative to the population, but they did not resolve how to connect these observations over time.3 The new history of the patient that emerged in the same period shared these characteristics, concentrating on dynamics within patient-practitioner relationships, not the likelihood that they would exist.4 The alliances that physicians made with the state and the statute book to secure professional authority that had once supplied a convenient chronology to the history of medical practice were now refigured as part of ongoing dialogues over the recognition or reinforcement of the claims of specific tribes of practitioners. The few moments of identifiable change that survived tended to be rooted in the biological or scientific: the disappearance of plague in the late seventeenth and eighteenth centuries or the diffusion of bacteriological thinking in the nineteenth.

We can usefully identify some of the boundaries of our understanding of the nature of medical provision and resort by considering which aspects of these early modern “medical marketplaces” are least well defined.5 We know something of who came to sell, and the nature of their wares. But we know little of who turned to the market, how often they utilized practitioners, and who preferred other forms of recourse. We know almost nothing of how provision in one city or region compared to another or how they grew or dwindled over time. We know little, even, about which types of practice were more or less popular, though it is the varieties of practitioner that we have been most able to study. We are left unable to answer basic questions...

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