Chapter 4 unpacks the conundrum faced by Restoration acting companies. Audiences wanted new works, spectacle, and theatrical innovation, but the unforeseen consequences of the duopoly hobbled the ability of the companies to respond nimbly to changing conditions. Strapped for money and shackled by the costs of maintaining their expensive, high-tech playhouses, the acting companies were hard pressed to keep up with rival entertainments and products now enticing Londoners. Coffeehouses, spas, pleasure gardens, dance recitals, and music concerts all offered convenience, variety, and value for money. Goods in expanded bourses also tempted consumers. The theatre largely responded to the new world of goods and pastimes through allusion and imitation, oftentimes to brilliant results. Intermedial exchange between the worlds of music and theatre resulted in the gorgeous dramatic operas still staged today. The new consumerism featured in the sparkling, witty comedies spoofing the London elite. Nonetheless, allusiveness could not rival actual experiences and commodities, which often could be had for less money and greater convenience than an afternoon at the playhouse.

While all mass gatherings create significant challenges for delivering optimal medical care, music concerts and festivals engender additional concerns ranging from a higher likelihood of toxicological, topographical, meteorological and sociological risks to additional threats from violence, injury and even food-borne illness. Locating patients can pose challenges among packed audiences in the dark and din of massive crowds and blaring entertainment. Multi-day music-related festivals, particularly those including on-site overnight camping, can pose additional and often escalating risks day-by-day.

Planning risk assessments can be multi-variate and dynamic in nature. Medical planners may first tailor plans based on historical experiences, evolving new intelligence or even developing external threats, but available tools for calculating risk for each type of threat can better quantify concerns and justify additional funding and resources for the best possible medical care and health security. Beyond basic considerations such as estimated crowd size and density, location of the venue, and event-specific medical considerations, mass gathering medicine clinicians and planners need to navigate some variable considerations including climate, weather, type of event, specific site structures, the organizers’ expectations and even typically unanticipated types of events such as terrorism, stampedes, contaminated food and some previously-unrecognized lethal drugs being passed around to attendees.