Jennifer Evans and Sara Read’s Maladies and Medicine: Exploring Health and Healing, 1540–1740 (Pen & Sword, 2017) appears, at first glance, as a concise social history of illness in early modern England. However, when viewed within a wider context of social reproduction and class formation of that era, the book reveals more: it offers insights into how bodies were regulated, how suffering was accepted as natural, and how the rise of capitalism transformed the conditions in which ordinary people lived, worked, and died.
Evans and Read do not aim to write a comprehensive history
of class or the shift to capitalism. Instead, they use an empirical,
descriptive approach organised around specific ailments rather than overarching
arguments. The evidence they compile—such as casebooks, diaries, court records,
household remedies, and cheap almanacks—provides valuable insights into how
sickness operated within a society experiencing significant change. Their book
inadvertently but effectively captures the medical aspect of the gradual
decline of feudalism and the emergence of capitalist social relations.
The Humoral Body as a Social Body
The authors focus on the humoral body, viewed as a delicate
balance of hot, cold, wet, and dry forces, constantly threatened by diet,
weather, labour, and morality. This concept extends beyond medicine into a
social worldview, making sense in a setting where most people lived on the
brink of subsistence, faced endemic malnutrition, endured physically demanding
work, and where environmental factors were linked to social class. Evans and
Read interpret humoralism as a belief system, while a materialist perspective
considers it a form of ideology.
Humoralism reframed structural suffering as personal
imbalance, attributing disease to personal regimen, moral failure, or the
mysterious flow of fluids rather than factors like enclosure, dispossession, or
wage labour. This served an ideological purpose by naturalising the suffering
created by the rise of capitalism.
The Medical Hierarchy and the Restructuring of Social
Reproduction
The book’s strength lies in its detailed portrayal of the
layered medical economy. It highlights university-trained physicians at the
top, whose Latin education and guild privileges attracted wealthy clients.
Below them, apothecaries and surgeons handled manual, often bloody treatments.
Further down was a large informal sector of unlicensed healers—many women—whose
inherited household knowledge served most of the population. Evans and Read
describe this hierarchy, but within early modern social reproduction, it
indicates a deeper underlying process.
Women were excluded from formal medical authority not just
due to prejudice but as part of a broader process of knowledge enclosure. As
capitalist relations grew, household and community-based care—largely performed
by women—became subordinate to professional monopolies. This shift in the
medical field reflected similar changes in reproductive labour, such as
midwifery, childcare, food preparation, and sickness management, which became
battlegrounds between traditional communal practices and emerging market
influences. The 'informal economy” of healing was not merely an outdated relic;
it was the leftover of a pre-capitalist social reproduction system actively
being dismantled by the new economic order.
Disease, Poverty, and the Making of a Proletariat
Evans and Read briefly mention that factors like poverty,
overwork, and malnutrition influenced who became ill and who received
treatment. However, they do not link these issues to the class relations of
early modern England, which a materialist analysis would require. Between 1540
and 1740, England experienced significant social and economic changes,
including the enclosure of common land, the dispossession of peasants, the rise
of wage labour, increasing urban poverty, and the emergence of a landless
proletariat.
These processes not only created new economic relationships
but also established new physical conditions. “Bad diet” and “corrupt air” were
not simply random misfortunes; they reflected the lived reality of class
identity. The illnesses listed by Evans and Read—such as plague, smallpox,
gout, toothache, and madness—were unevenly distributed based on property
ownership and labour roles. The ailing body was inherently a body defined by
class. Later, Engels would describe this as "social murder”: the
deliberate, systemic creation of disease and early death through societal organisation.
Evans and Read’s era can be seen as the groundwork for this concept—the period
during which the foundations for social murder were established.
What the Book Offers—and What It Cannot Provide
As a compendium of lived experience, Maladies and
Medicine is invaluable. Its prose is clear, its sources rich, and its case
studies vivid. It allows the reader to encounter sickness in something close to
its own terms.
But as an explanation of why early modern medicine took the
form it did, the book is incomplete. It catalogues belief and practice but does
not analyse the social relations that produced them. It describes the medical
hierarchy but does not explain its connection to the restructuring of social
reproduction. It notes poverty but does not treat it as a structural
determinant of disease.
Where the book falls short is in its reluctance to press
this material toward a fuller social explanation. Poverty, overwork,
malnutrition, and environmental degradation appear in the narrative, but only
as background conditions rather than as structuring forces. The authors note
that “bad diet” and “corrupt air” shaped who fell ill and who could be treated.
Still, they do not connect these phenomena to the concrete class relations of
early modern England—the dispossession of the peasantry, the growth of wage
labour, and the emergence. The text discusses how a landless proletariat lives
on the brink of subsistence. It emphasises that the authors' limitations are
more about the academic division of labour than about their failure. The
history of medicine is often viewed separately from class struggle, ignoring
the interconnectedness of bodies and social structures. Maladies and Medicine
offers a solid empirical base for a Marxist perspective on early modern social
reproduction, illustrating how the shift to capitalism impacted not just work
and courts but also kitchens, sickrooms, and individual bodies. It successfully
recovers and documents these aspects but leaves broader explanatory questions
about societal forces open for others.
