The healthcare economy of Gloucester in the Age of Reform, c.1815 - c.1870

For the past thirty years, the early-modern healthcare economy in Britain through to the mid-1800s has been described as a ‘medical marketplace’; an unregulated commercial arena characterised by plurality, diversity, choice and competition. The demise of this medical marketplace is widely regarded as having been occasioned by the professionalisation of medicine and the regulatory reforms with which it is closely associated. In particular, the 1858 Medical Act has been seen as a watershed. This study challenges this chronology and makes the case for a new paradigm. Looking at Gloucester in the pivotal years between 1815, it comprises a detailed dissection of healthcare supply, drawing on familiar and previously neglected sources. First identifying gaps in the existing model through a wide-ranging literature review it then uses a combination of quantitative and qualitative analysis to map the supply of healthcare in the city in the years between 1815 and 1870; an era that can justifiably be termed the Age of Reform. Throughout, evidence of plurality, diversity, choice and competition is sought, beginning with an assessment of the role of institutional healthcare. This is followed by a quantitative analysis of commercial healthcare suppliers that raises questions around the degree and nature of competition. The discussion then moves to healthcare advertising; the most overtly commercialised sector of the healthcare economy, where through a sample survey of advertisements appearing in the local Gloucester press evidence of customer segmentation is revealed. Attention then turns to the dispensing activity of Gloucester’s chemists and druggists with an analysis of surviving prescription books; a source so far lightly handled in the historiography of the medical marketplace. Finally, the experiences of the sick themselves are examined, revealing the extent of structural constraints on the individual agency of the ‘healthcare consumer.’ Overall, the study shows that long before 1858, the supply of healthcare in Gloucester was dominated by regular doctors and chemists and druggists. In this environment institutions imposed structural constraints on the free market and competition in the commercial arena was noticeably less than described in other studies elsewhere. It becomes clear that people of all social classes preferred regular medical advice when they perceived it was warranted and that proprietary medicines and irregular healthcare suppliers were not necessarily simply the resort of the gullible poor. Instead, they served those who had purchasing power but were, for a variety of reasons, least well-served by the regular medical offering. In addition, chemists and druggists, far from being fringe suppliers, were, through their role in dispensing medical prescriptions, a respected and trusted community resource. Cumulatively, the findings suggest that well before 1858, what existed in Gloucester was not a medical marketplace but a stratified healthcare economy.