Medics, Monarchs and Mortality, 1600-1800: Origins of the Knowledge-Driven Health Transition in Europe

Abstract

Medical knowledge – defined broadly to include both its private and public forms – has been the driving force behind the historical transitions that have raised life expectancy in modern Europe. Advances in knowledge, rather than better nutrition (particularly the escape from caloric insufficiency) deserve greater emphasis because the very first groups to undergo anything recognizable as a secular rise in longevity were the rich and well fed, rather than the poor and chronically malnourished. At the beginning of the 16th century Europe’s ruling elites lacked virtually any reliable information about how best to use their ample material resources to prevent, manage and cure the ill-health that caused so many premature deaths among them.

The advance of medical knowledge and practice accelerated in Western Europe after c. 1500, with a succession of discoveries that were quite useful (as judged by modern standards) in preventing disease, reducing “life-style” risks, managing illness and providing cures for a few debilitating and deadly diseases – severe dysentery, syphilis, malaria, scurvy and, finally, smallpox, being the principal diseases affected. Yet, access to most of the available innovative medical care remained closely restricted. Medical expertise was limited and highly priced, and many of the measures prescribed were unaffordable even to town-dwelling middling-income families in environments that exposed them to endemic and epidemic disease. Along with the poor, they therefore were left at a grave health disadvantage vis-à-vis adult members of the wealthy urban families to whose conditions the doctors were attending. The London-based ruling family of England in this epoch benefited to an exceptional degree among the European elites from the contemporary progress of medicine: their improved chances of survival in adulthood was the major factor raising royal life expectancy at birth (males and females, combined) from 24.7 years for the cohort born during the 1600s to 49.4 years for those born during the 1700s.

Keywords: demographic history, mortality transition, European elite populations, medical knowledge, healthcare access

JEL Classification: I12, J11, N33