Book Review

Gianna Pomata admits that "[w]hen I began this research, I was looking for something different from what I ultimately found." Her initial interest focused on the practice of popular medicine and she expected to see a "relationship between popular and learned medicine ... characterized by a pattern of conflict and repression from above (xi)." In the documents, however, she soon uncovered another story entirely in which cure-contracts and the cases presented to the Bolognese doctor's tribunal—the Protomedicato—played a major role in determining the rise of the modern medical profession.	1
The members of the Protomedicato were an elite among physicians who primarily endeavored "to uphold their role of control over the official medical system" (119). Their decisions did not always favor medical practitioners over patients nor did they wage an unrelenting battle against popular healers. Cases heard before the Protomedicato were of two kinds: the protests of patients about the failure of a practitioner to satisfy contractual obligations and malpractice suits. Not until the late eighteenth century did the tribunal attempt to check folk healers and eliminate their competition. Pomata's research reveals a different story, but one that bears, she insists, equal weight in stimulating the growth of professionalization in the early modern world. Throughout the sixteenth and seventeenth centuries, patients and healers commonly contracted for cures. The resulting understanding formed part of the "ancient horizontal model of healing" in which patients and practitioners agreed on the terms and length of a "cure." Only when the practitioner fulfilled the "promise of cure" was the fee due. By the end of the eighteenth century, however, the contractual agreement had disappeared as the concept ceded place to the newer position "that medical service should be remunerated irrespective of results (xvii)." This transposition, according to Pomata, shaped modern professional dominance as much as did the "medical technologies" sociologists view as decisive.	2
On the way to these conclusions, Pomata exposes and analyzes the worlds of the Protomedicato and the official medical hierarchy, as well as the vibrant diversity of wider beliefs about illness and health. In explicating the assumed fair relationship between healers and patients, she points out how: 1. Cure agreements existed as part of a medical practice still hovering "on the threshold between commercial trade and charitable works (37)"; 2. How the estate-ethos of the elite members of the Protomedicato functioned as a form of moral economy in medicine that paralleled E. P. Thompson's moral economy in the grain trade; 3. How elite practitioners were often seen as protectors rather than healers; and 4. How the Rabelaisian "joyously open body" (139) meant health to most. Pomata's deep reading of legal documents thus opens up new perspectives on a series of topics that have long occupied the attention of medical historians.	3
Pomata reevaluates, however, the reasons why the relationship between healers and patients changed by concentrating on the "constant decline" of the cure agreement. The evidence marshaled leaves little doubt about either the existence of the cure agreement or the timing of its eclipse. Some historians have cast the decline of popular medicine in terms of repressive policies cooked up between physicians laboring to eliminate competitors and a state eager to expand its own sphere of power. Other historians are less comfortable with a simple model of top-down subjugation and have sought answers in, for instance, a growing complexity of society that generated an increasing need for experts (i.e., professional medical men) to mediate choices. Pomata looks elsewhere for her explanations. She has little to say directly about the changing medical marketplace or about the rise of a consumer society (she indexes neither term). Her exacting investigation of incremental readjustments in the relationships among the Protomedicato, the various levels of the medical hierarchy, and patients rejects the idea of a conclusive turning point or a sole motivating cause in favor of a more subtle analysis based on many-sided negotiations and momentary realignments. For her, however, the "crucial factor in the process" was a "new opinion of jurists" (155).	4
Throughout the book, Pomata portrays cure agreements as embodying a "quasi-legal notion" (pp. xi-xii) of what constituted a evenhanded transaction. Patients thought in legal terms when dealing with all healers. Her evidence on this point is convincing, although one misses a certain willingness to critique the very documents upon which she relies so heavily. One wonders, for example, whether the action of drawing up a legally binding agreement did not make ideas seem more legalistic than they actually were. Pomata mentions the often formulaic ways in which patients composed their complaints as they "knew very well which accusations would be most telling in the court" (145), but does not otherwise suggest that the intent expressed in the cure agreement might be overdetermined by the nature of a legal document.	5
The major driving force in the change remains, nonetheless, the influence of juridical opinion. The professional ethics of lawyers and medical men dovetailed in the eighteenth century, producing a new relationship between professionals (whether lawyers or physicians) and their clients or patients. This new connection rested on the principle of fees for services rendered rather than for results obtained. Roman law, for instance, forbade lawyers from "striking a deal for a fee with their client during legal proceedings" (159). Jurists argued similarity of the medical and legal encounter in which clients and patients were equally vulnerable. Part of the reason for the decline in the cure agreement, therefore, derived from the older character of elites (whether lawyers or physicians) as protectors who should not exploit their clients' or patients' fears to obtain fees or fee-agreements. Thus, "[t]he illegality of the agreements between physician and patient was argued ... on the basis of a wider conceptualization of the sick's right to protection" (161). It was neither repression nor greed that wrought the change, for the decisions of the Protomedicato (as elite guardians of the poor and weak) eliminated the "promise of a cure" while purporting to safeguard the patient from the power of the practitioner. Here Pomata substitutes a subtle interpretation of how the interaction of various needs and ideals produced change without resorting to a sort of conspiracy theory of how the professions attained cultural and social authority. Contracting a Cure is, in the subtlety of its argument and in its impressive deployment of theory and explanation derived from archival materials (rather than the other way around), a persuasive and important work.	6
Mary Lindemann Carnegie Mellon University

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