Unsurprisingly, he finds many known currents flowing through small town health care, as well as large urban hospitals. Hickey highlights, too, important attitudinal shifts among elites. Town governments in Malestroit, Pontorson or Caudebec interfered regularly in the running of their hospitals, even after they had called in religious orders to run them, as at Pontorson in 1644. The seemingly incessant campaigns to abolish local hospitals and maladeries, or to confiscate their property for the benefit of urban general hospitals, or unilaterally to turn them into refuges for retired soldiers, receive a nuanced analysis that explains why some efforts failed and others succeeded. Louis XIV's effort to confiscate hospitals and maladeries from religious orders, for example, eventually foundered on the rock of property rights.
Hickey shows again and again the importance of local circumstances and of specific individuals.
Alas, the book's most fundamental defect lies precisely in the realm of the specific. His father's four siblings included three Carmelites and a knight of Malta. We know that the changes in Louis XIV's Council of State between the 1680s and mid 1690s led the king to change his views about treatment of some of the poor, such as prostitutes. Providing information about the actual royal councilors involved in the initiatives he examines would have greatly strengthened Hickey's arguments. More details about local matters would also have improved the text in a few cases.