INTRODUCTION

From the Renaissance well into the nineteenth century, no ethics particular to medicine governed the patient–practitioner relationship in Europe and North America (see also Chapters 1 and 28). Although elite university-trained practitioners wrote treatises on topics that we now consider under the rubric of medical ethics, the day-to-day relationships between healers and the sick were shaped by two sets of more general social norms. First, the structure of early modern health care provision has been likened to a medical marketplace. In such a marketplace, medicine was a commodity like any other, and so medical interactions were largely structured by the rules of commercial interchange. Second, as in other social relations of the period, both patients and practitioners appreciated the mutual obligations of patronage and deference between people of different social groups. At times, the patient was the patron, and the practitioner a client, whereas at others these roles were reversed. From the seventeenth century, patients were sometimes understood as a group deserving of special protection due to their temporary or permanent disability.

THE MEDICAL MARKETPLACE

Over the past two decades, historians have become interested in the rank-and-file of medical practitioners and in the experiences of patients rather than just the elite of medicine. As a result of this broader canvas, they have come to describe health care provision in early modern Europe and North America as a medical marketplace (see also Chapter 27). Three key features characterize this model.