The Dying and the Doctors. The Medical Revolution in Seventeenth-century England.
This book tries to show when "society became medicalized"--that is, when people "sought professional medical solutions to serious illnesses and ailments rather than spiritual or amateur nursing help." To do so, Mortimer quantifies and analyzes the medical services noted in patients' probate accounts--registers created by executors in the course of administering a deceased person's estate. He concludes that "after 1675 the great majority of non-destitute people who required medical assistance of some variety not only sought it but obtained it, in some degree at least." As far as the probate accounts indicate, this is a major shift from a century earlier, when medical expenditures had been used primarily for attendant or palliative care. The increase in purchased medical services was not due to an increase in practitioners, which Mortimer considers highly unlikely, but because the "fate of a severely ill patient was increasing seen to be a matter for human--not divine--intervention."
In the introduction, Mortimer explicitly addresses the general limitations of probate accounts, namely their inconsistencies, incompleteness, and non-representativeness. To mitigate some of these deficiencies, he focuses on the accounts from central southern England and East Kent, which are generally mote complete and more often enumerate medical costs. However, because these limitations always persist to some extent, Mortimer must constantly qualify possible interpretations. Such a Sisyphean task can seem particularly tedious when the data's statistical significance remains uncertain to the reader. Mindful of the data's limitations, Mortimer clearly articulates the dangers that arise from an effort to quantify the ambiguous descriptions of medical services recorded in the accounts. Yet some methodological practices remain too opaque, like how descriptions of medical services (like 'medical' vs. 'nursing', or whether 'physic' meant medicine or consultation) got mapped from the accounts themselves to the fixed categories used in the unpublished electronic database that Mortimer used for his analysis. Although not entirely neglected, explanations of these mappings could stand considerable elaboration. Far too much hinges on these translations for them not to be foregrounded in the way that the numbers themselves are. The tension between Mortimer's rigid numerical analysis and the slippery descriptive language of the accounts permeates the book.
Despite the difficulties inherent in the dataset, Mortimer convincingly uses the accounts to make some excellent broader points that contradict some prevailing assumptions about medical care in southern England in the seventeenth century. Mortimer argues that geographic proximity was in fact not the principal concern of patients when choosing a physician to treat a serious illness. Nor was social class a primary factor: Mortimer concludes that lower status groups sought professional medical care about as much as higher status groups. His provocative analysis of the geographic range of physicians in urban and rural areas shows how physicians increasingly traveled to rural areas to provide medical expertise, and that 'qualified' practitioners themselves were more frequently living in rural areas. He also demonstrates that women, too, were specifically sought out for medical expertise and were not called upon merely for geographical convenience. Mortimer nicely illustrates the myriad ways in which the accounts described medical practice and practitioners, especially the wide range of activities (and descriptions of them) that comprised 'nursing' duties.
Because the text often spells out its demographic analysis (and qualifications) in detail, it can make for rather slow and technical reading. The text is aided by numerous charts, but unfortunately they are almost all uninspired numerical tables. This is especially frustrating when the analysis is primarily geographic, though a few rough qualitative maps aid in this regard. When the discussion moves away from numerical analysis, it becomes immanently more readable and the probate accounts themselves come to life. Despite usual restraint against overly broad claims, a few seem to come out of nowhere. For example, Mortimer mentions that the increasing reliance on physicians was a likely result of the increasing use of chemical remedies. Yet he does not present any clear evidence that such strong medicines were available to or used by the physicians and apothecaries named in the probate accounts, many of whom he has meticulously tracked down. Even with the occasional over-enthusiastic conclusion, however, Mortimer is usually successful in explaining how the social and demographic details he presents shed new light on the broader medical culture.
Mortimer has clearly identified an intriguing phenomenon that, as he mentions in the conclusion, requires additional research. His analysis of language from the probate accounts, for example, would be well complemented by more attention to language used in other medical literature. Such a comparison might help answer questions about medical professional boundaries and the relationship between physicians and patients. Without broader social (as opposed to demographic) context, however, and with such vague descriptions in the accounts, the deeper meanings of his quantitative findings remain elusive. Thus it seems premature to label the increase of references to medical care in probate accounts as indicative of a "medical revolution." Yet even if his claims based on quantitative analysis are not on the firmest ground, Mortimer's descriptions and conclusions must inform our understanding of seventeenth-century medical practice.
George Mason University
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|Publication:||Journal of Social History|
|Article Type:||Book review|
|Date:||Jun 22, 2011|
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