Competition and Cooperation in the Early Modern Medical Economy

Abstract

What was it like to work in the ‘medical marketplace’ of early modern London? How did medical practitioners interact with each other? How did they obtain, treat and cure patients? Studies of early modern medical marketplaces over the last three decades have shattered old accounts that emphasized the small scale of the medical sector, its dominance by an elite of learned physicians, and the importance of institutional, professional and theoretical boundaries between groups of medical practitioners. In their place, historians of English medicine have described a situation in which professional controls were either absent or contested, and where ‘occupational diversity’ was the norm. Above all, they have shown medical practitioners competing with each other in a‘market-place’ that was influenced but not defined by institutions, patronage and law.¹ Arguably, it is competition that most clearly distinguishes the medical marketplace from other systems of health care, such as domestic provision, socialized medicine, and, particularly, professionalized medicine — in which competition is normally constrained by entry controls and prohibitions on advertising, poaching patients and discounting. Where competition was limited, as in those parts of early modern Europe where occupational and regulatory institutions were stronger, historians have developed alternatives to the medical marketplace that reflect the more constrained form of practice they observe.²