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  • Reply:What Historians of Medicine Can Learn from Historians of Capitalism
  • Christy Ford Chapin

I cannot adequately express what an honor it is to have scholars of such standing, veritable giants in the history of medicine—Patrick Wallis, Beatrix Hoffman, and Nancy Tomes—comment on my essay exploring the intersection of the history of capitalism and the history of medicine. I'm grateful for their astute observations, which have helped me think even more deeply about the history of capitalism as a scholarly project.1

This exchange about the New History of Capitalism and how it might inform the history of medicine highlights both the strengths and weaknesses of the nascent subfield. To that end, a primary theme of this essay is that while the history of capitalism offers a promising lens through which to explore history, the current lack of consensus about how to periodize and define "capitalism" could impede the bourgeoning subfield's robust development and its usefulness to historians of medicine. Since I discussed the matter in my original essay, I won't rehash the diverse ways one might define "capitalism." I will simply remind readers that scholars have provided myriad distinct definitions.

I found myself nodding in agreement throughout Patrick Wallis's insightful essay. Like me, Wallis forwards a broad conception of capitalism—one premised on responsive prices and private contracts enforced by third parties—while distinguishing modern capitalism by emphasizing the magnitude of capital accumulation and industry concentration.2 Wallis calls on scholars to combine the history of capitalism's concerns about power relations and neglected voices with themes that drive [End Page 388] economic history, namely "rigorous identification and exploration of causal relationships" (p. 387). I concur and will expand on these ideas below.

Hoffman (as does Tomes) perceptively highlights the importance of "how the economy functions and changes in relation to culture and society" (p. 369). With a nod to Marxism, she points out that scholars cannot separate the market from culture, politics, social arrangements, and intellectual currents. I'm delighted that she underscores this theme, with which I wholeheartedly agree. My only addendum to her point is that we cannot make the existence of capitalism a totalizing phenomenon that accounts for all variables in any given economy or society. If "capitalism" accounts for everything, then it accounts for nothing at all and, as a term, lacks explanatory power.3 For that reason, I believe it is important to define capitalism in a way that looks beyond contemporary Western countries. Studies premised on a more comprehensive classification would allow us to better understand the development of modern, industrial capitalism. For example, while Karl Marx viewed capitalism as deploying economic power to order culture and society, Max Weber and Werner Sombart inverted this contention by identifying culture—whether Protestant or Jewish—as the key to launching modern capitalism.4 More recently, Deirdre McCloskey has linked bourgeoisie culture and ideology to the rise of industrial capitalism.5 Scholars can more fully investigate the nature of this capitalism-culture interplay by researching pockets of competitive-market activity that have existed on the margins of society. At what point have such fringe endeavors begun challenging traditional political and economic orders by transforming how people thought about such issues as individuality, risk, and commodification? Do societies require certain cultural attributes to support the spread of capitalism? Within the history of medicine, we might consider how social medicine, though never disappearing, receded in importance as formally commodified health services increased in popularity. How did this economic evolution interact with and shape the identity of women healers—the neighbors, wives, and [End Page 389] sisters with birthing and medical experience—who became active market participants—that is, midwives who accepted money for their services?6

I offer one vignette from Hoffman's essay to illustrate how defining "capitalism" creates difficulties, even among scholars who have read many of the same primary sources and concur, to a large degree, about how to interpret them. Hoffman flips the narrative I tell in my original essay and in my book, Ensuring America's Health, to argue that early-twentieth-century U.S. doctors should be viewed not as resisting capitalism but as supporting...

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