The Dying and the Doctors: The medical revolution in 17th-century England
By Erin Sullivan
The 17th century brought great changes in medicine and science, in England and abroad. Most famously, the formation of the Royal Society and the concomitant rise of empiricism led to a re-evaluation of the Renaissance belief in ancient knowledge as most authoritative. Increasingly, writers questioned classical precepts and suggested that the future, not the past, might hold the promise of enlightenment.
While intellectual historians have long emphasised the dynamism of this century – politically, philosophically, religiously, scientifically – social historians of medicine have found it more difficult to illustrate on a wide scale many of the shifts they suspect to have taken place. Ian Mortimer’s The Dying and the Doctors examines the changes in access to medical care among the gravely ill and dying. Drawing on nearly 200 000 probate records, official parish documents itemising a deceased person’s assets and debts to value his or her estate, Mortimer analyses the frequency with which medical care was enlisted at the deathbed over the long 17th century. He focuses on Kent, Berkshire, Sussex and Wiltshire, where these records are plenteous – and argues convincingly that the purchase of medical assistance increased dramatically.
Mortimer’s main thesis is that this was an era of marked ‘medicalisation’, in which orthodox medicine played a growing role in the understanding and treatment of serious illness. While, for instance, only 5 per cent of East Kent probate records in 1570–99 showed that medical aid had been sought for the dying person, by 1690–1719 a full 50 per cent did. Mortimer further shows how such increases can be found in multiple counties and among all sectors of the population, though the rates of growth vary. Mortimer finds that his counties show more idiosyncratic histories in terms of the influence that living in an urban versus a rural area might have on ability to receive medical treatment. In East Kent, “the medical disadvantage of living in a rural area had all but disappeared by 1690”, whereas in rural West Sussex and Wiltshire, country dwellers saw doctors markedly less than their city counterparts.
The study is highly empirical, breaking the language of probate records into more manageable datasets. Such studies inevitably lead to questions about how the written word is translated into numbers and percentages, and Mortimer does an admirable job of explaining his steps. In several cases he highlights how generalised figures can be misleading, obscuring important differences. He accordingly divides his data into several subsets, always carefully explaining his rationale. At times, this makes for ponderous writing, with paragraphs, tables and charts full of numbers. There is no doubt, however, that Mortimer’s work is rigorous and cautious, enabling readers to overview a truly vast section of 17th-century society.
One disadvantage is that it can feel under-theorised and under-referenced. The data does not always speak for itself, and in places it is up to the reader to link Mortimer’s work with that of others. A section on the ‘occupational identity’ of medical practitioners, for instance, omits reference to Hal Cook’s contrary thesis in The Decline of the Old Medical Regime in Stuart London. Though this is study is not London-based, as is Cook’s, one would still expect more active engagement with other research in the field. Similarly, Roger French and Andrew Wear’s The Medical Revolution of the Seventeenth Century receives little comment here, a puzzling omission given their shared emphasis on the ‘revolutionary’ nature of this period.
Instead, Mortimer maintains a firm focus on his datasets, and while they certainly are impressive, they at times lend the study a Whiggish feel. Particularly in discussing the role of religion and astrology in healing, he appears to esteem the growing reliance on medicine, the assumption being that this is more rational and effective. One can’t help remembering that all the individuals who form the basis of the datasets had indeed died, regardless of their use of medical services. Whether they found relief in such treatments, and whether increased medical provision was successful in preventing other deaths, remain unanswered.
Still, what Mortimer does do, he does well. This study involved a tremendous amount of research, and his calculations and conclusions will prove a valuable resource for early modern scholars and historians of medicalisation more generally. His thorough use of probate records, previously very under-utilised sources, reminds historians that our understanding of the past should emerge not just from books and treatises but from the wide variety of things people left behind.
Mortimer I. The Dying and the Doctors: The medical revolution in seventeenth-century England. London: Royal Historical Society; 2009.
Erin Sullivan is a doctoral candidate at the Wellcome Trust Centre for the History of Medicine at UCL.