This book investigates the "medicalisation" of England in the 17th century, "the pattern by which the English turned from praying for spiritual physic to paying for medicines when struggling with grave illnesses". It is a challenging topic.
Ian Mortimer bases his study on one class of evidence: the probate account. In early modern England, death was ideally marked by three types of document: the will, the chattels inventory and the account of administrative costs incurred.
About two million wills and one million inventories survive for the period, compared with a mere 43,000 probate accounts. That is a large number of documents for one person to master, to be sure, but in context, the number of accounts is tiny compared with the number of wills, let alone the hugely greater number of actual deaths. Nevertheless, probate accounts have the useful property of recording moneys disbursed for medical care, and it is the "interrogative" study of these that enables Mortimer to track how medical intervention changed over the course of the century.
The methodological difficulties facing him are daunting: only five counties generated accounts numerous and detailed enough for his purposes; in some cases, the local clerks simply totalled up the expenses generated, effacing for ever the possibility of extracting further information from the final bill.
However, Mortimer does a brilliant job of wringing interpretations from his accounts. He shows conclusively that England rapidly became medicalised in the 17th century, especially in the third quarter, and that medical services became available to all, not just people based in towns. In 1600, there were still some "medically remote" spots, but by about 1680 services were more or less evenly distributed.
Mortimer also distinguishes his subjects into various status groups, based on gross economic valuations of not only the worth of a deceased person's estate but also that person's creditworthiness: a large debt at death suggests the power to borrow in life. He then broadens his discussion to the nature of medical assistance and nursing care. If medical assistance was on the rise, then perhaps there were more medical practitioners? But this was not so, Mortimer shows, and he detects rather a change within the medical community's attitudes to care - a change probably driven by the rise of Paracelsian medicine, which advocated chemical cures.
By the end of the century, the sick English were very much more likely to seek medical, rather than just religious, aid. Is this then a "decline-of-religion" conclusion? Mortimer argues not. While the 17th century witnessed the medicalisation of England, the turn to medicine did not require a turn away from religion. He suggests rather a narrative of accommodation: the European spread of Paracelsian medicine around the turn of the 16th century preached medical intervention as a supplement to, not a replacement for, prayer.
By the later 17th century, the notion of medicine as supplementary to spiritual discipline had receded in England but not disappeared. Mortimer suspects, rather, that "the religious system might have given way naturally to a scientific one through a process of accommodating scientific changes within the existing religious framework". This is a conclusion that harmonises with current ideas about how early Enlightenment England renegotiated its religiosity in the face of both scientific and theological challenges.
Replete with tables, graphs and statistics, this is not a book for the general reader, nor does it pretend to be. But within its genre, it is a work of great clarity and elegance, and provides the bedrock on which social history must be based. It has long been conjectured that the view that only God could aid sufferers was breaking down in the 17th century. Now it is a fact.
The Dying and the Doctors: The Medical Revolution in Seventeenth-Century England
By Ian Mortimer.
Boydell Press, 246pp, £50.00.
Published 16 July 2009