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Response to Review no. 386

I am grateful to Professor Furdell for devoting the major part of her review to giving some account of the contents of my book. This performs a useful service for readers. In this part of the review, Furdell makes it clear that Medical Conflicts deals with both collegiate physicians and irregular practitioners, but that the main purpose of the book is to gain access to the latter, while taking full account of the fact that we are seeing the irregulars through the eyes of their opponents.

The rest of the review is more attention-seeking than useful or revealing. It projects its own over-simplifications – and its own techniques of description (‘lambast’, ‘upbraid’, ‘condemn’, and so on) – onto its subject matter. Some readers may even be disappointed, on consulting Medical Conflicts, to find it lacking in the violent partisanship that Furdell’s epithets suggest. Similarly, my comments on the work of other authors are not as she represents them. For example, criticizing Cook for coining ‘the medical marketplace’ is precisely what I do not do.(Pelling, p. 342) Rather, I suggest that the concept is now in need of reassessment because it has been too automatically applied within the history of medicine without reference to economic content or geographical location. A candid reader might conclude that my style cannot be as Furdell represents it either, given her account of the book in the first part of the review. Overall, Furdell is presenting herself as an uncritical champion of the Royal College of Physicians (and some London historians of medicine), which she views without reference to historical context. The aim of Medical Conflicts with respect to the College was to redress the balance of historical comment, by assessing the strength of the College’s position in relation to the established structures of male authority.

In her own fashion, Furdell does raise the issue of seriousness. As its practitioners know only too well, the history of medicine can be done in two different ways. It can be light entertainment along predictable lines, or it can be more challenging. I chose to attempt the latter, and to accept the standards set for history as a whole – in this case, social and cultural history, defined in the most inclusive sense. It is for other readers to decide whether these standards have been met.

As this suggests, Furdell is unwilling or unable to engage with the substance of the book at the level either of its main arguments, or of the sources. Her summary aside, her own focus on the College leaves little room for the irregular practitioners. She accuses Medical Conflicts of lack of balance, but this is a fault on her side. Since she does not tackle the main issues, there are only a few matters of content in what she says which should perhaps be clarified.

First, she is likely to confuse the reader on the issue of stranger practitioners (and possibly also on the purpose of an index). My point here is that the College’s disproportionate pursuit of stranger irregulars, which was more or less constant, underlines both its isolation in London, and its focus on its own concerns. It did not follow the fluctuations in hostility and tolerance that have been noted for London as a whole, and which can be correlated with economic and political conditions.

I did not ‘label the Fellows inept in their “perversely” intermittent exercise of authority’. The sentence on p. 42 to which Furdell presumably refers is: ‘for the College, as a group of medical practitioners, the summer recess presents the apparent perversity of absence just when need among the general population was likely to be greatest’. One of the aims of this chapter was to prove, as directly and concretely as possible, that collegiate physicians did indeed flee the city during plague periods – a familiar contention, but one previously resting on anecdotal evidence or contemporary polemic. One of the concerns of the book is to balance the College against the needs of the population, and to estimate the irregular practitioners according to the value (negative as well as positive) likely to have been placed on them by Londoners as a whole, rather than by the College. As Furdell realises, it is the irregular practitioners who are the main focus of the book’s attention, but most of them are accessible only via the College’s account of them. Hence the need for analysis of the College’s forms of authority, and of the College’s Annals as a text. I was also concerned in this chapter to develop the concept of `monitoring’ of disease, that is, the service performed by physicians for their elite clients in deciding when it was safe for them to stay in the capital. Physicians themselves were inevitably caught up in this restless ebb and flow between London and the country, which helped to create the pattern of `seasonal’ living long familiar to those interested in the elite.

In her point about Star Chamber, Furdell again becomes simplistic. There are long-standing debates over the effectiveness of Star Chamber, and about the reasons for its abolition in terms of the bulk of its activities. Furdell also seems unaware of the literature that has established that the College, rather than merely bumbling, adapted itself quite dramatically to the changes of the civil war period.

With respect to what she calls ‘the quacks’, it is not clear what Furdell wants most: to imply that I think today’s GPs are descended from quacks, or to convict me once more of disrespect towards collegiate physicians. Either way, she seems unable to break free of the physicians-versus-quacks story that has persisted for so long. What the College’s Annals reveal is not only the overlap between the College and some of the irregulars, but also the ‘excluded middle’ of apothecaries, barber-surgeons, and other practitioners at the artisan level, with whom the College was so unwilling to identify, and whom it tried so hard to suppress. Medical Conflicts tries to provide a reconstruction of ‘citizen’ or contractual medicine, in which patient and practitioner arrived at a bargain (often conditional) based on an assessment by each side of the patient’s condition and of the likelihood of a cure. Such contracts were verbal, but forms of redress were available just as they were in cases of debt. It is this widespread, long-lived, and flexible urban system, rather than the patronage links dominating the College’s own affairs, which was the staple of early modern patient-practitioner relationships.

Similarly, Furdell misreads what I say about the literature on venereal disease. She brings forward Siena’s study, to be published by the same press as Furdell’s own work. I am sure this will be a valuable addition to the literature. However, my point (p. 341) was to deplore the fact that the contemporary preoccupation with this disease is still so routinely ignored, not by historians of medicine, but by generalists whose primary focus is on such subjects as poverty, manners, or gender relations.

Lastly, Furdell falls prey to the common vice of castigating a book for not doing what it explicitly states (for good reasons) it does not intend to do. I did not set out to provide an institutional history, not least because I regarded Furdell’s desideratum of ‘a complete and balanced institutional history’ as having been admirably fulfilled by Cook (I am surprised that Furdell apparently does not agree with me about this). Equally, I am fully aware of the importance of what she calls theoretical splits among the College Fellows. So important is the subject of the pluralistic medical philosophies of the period that it has already been handled by scholars over an extended period, primarily with reference to the published writings of the main protagonists. Partly for this reason, Medical Conflicts took a different approach.(See the Introduction, and especially p. 3) That said, the reader will find in the book a good deal of information about the educational, social and religious allegiances of College members, which is linked to the issue of how this might have affected their selective approach to irregular practice. Sources of intellectual authority are also dealt with as part of the content of confrontations between College and irregulars. At this point Furdell digs deep to find two early articles on Paracelsianism not mentioned in my bibliography; she seems unaware that these contributions, albeit pioneering, have been superseded, notably by Charles Webster. It is curious that she highlights Paracelsianism, given that the doctrines of Paracelsus constituted a reforming critique of established religious and medical institutions, which in the earlier part of the review she seems so concerned to defend.

The energy devoted by Furdell to issues of presentation is somewhat misplaced. The shape of the bibliography was determined by my decision to use only short titles in the footnotes, a decision which had disadvantages as well as advantages. However, Furdell’s contention about the footnotes is obviously absurd. As she admits, the bibliography is extensive (including multiple references to various authors). Because some of the themes of the book are complex or contentious, I wished to refer the reader to as wide a range of sources as possible, and also to further discussions where certain arguments, or information, were set out at greater length.(see p. viii) In accordance with normal scholarly practice, the preface to the book sets out what part of it has appeared in print before – in this case, different versions of sections of two of the nine chapters, one of them in Dutch.

No bibliography, however extensive, is without its oversights. Although the book does not set out to be comparative, I should like to take this opportunity of regretting that I made no reference to the work of Katherine Park, which I certainly should have done. I knew of Brian Nance’s work, but it was not available to me before my own book went to press. My comment about Mayerne referred rather to the project undertaken by Hugh Trevor-Roper, who died before he could complete it. There is some prospect that this work may be published posthumously.

I am naturally sorry that Furdell’s strenuous efforts to enjoy my book ended in such abject failure. Her own work is very different in its aims and techniques from my own, but all authors wish their work to reach as wide an audience as possible. Possibly she was over-hasty, both in her reading and in the writing of her review. She may also have underestimated the abilities of her students; certainly I can say that the book has been adopted for teaching in other universities. In any case, I would urge her students to retain an open mind, and to make their own comparisons between the works available to them.