Medics, Monarchs and
Mortality, 1600-1800: Origins of the Knowledge-driven health transition in
Europe

S. Ryan Johansson

Cambridge Group for the History
of Population and Social Structure

University of Cambridge

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 families 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 were 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.