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Medicine and Charity Before the Welfare State.

Has the rise of the modern state destroyed, complemented, or perhaps enhanced the traditional role of charity in society? Do economic booms or periods of depression provide the best stimulus to charitable activity? What do the poor need most, and who among them most deserves assistance? Has the emergence of modern medicine awakened or strengthened charitable interest in the poor, especially the sick poor? Have medical professionals generally supported or opposed medical charity? These important and timely questions formed the basis of a three-day conference sponsored by the Society for the Social History of Medicine at the University of Exeter in 1988; all but one of the essays collected here are reworkings of papers first given at this conference.

Two of the essays in this volume bolster the growing conviction among historians of medicine that Foucault got it wrong: long before the late eighteenth century, not just care but cure was an important institutional priority. In a sparkling analysis of hospitals and medical assistance in Renaissance Florence, Katharine Park demonstrates that Santa Maria Nuova and other charitable foundations "formed part of an extensive network of public and private institutions designed to provide professional medical care to the population of city and countryside, with special attention to the needs of the poor" (p. 27). Rich Italian cities, concerned in the wake of the Black Death about the health and productivity of workers, drew on Islamic and Byzantine models to create hospitals which people entered voluntarily, expecting that they would normally be cured of the acute illness from which they suffered. So much for the received picture of early hospitals as nothing but charnel houses for the old and terminally ill! Jonathan Andrews joins in this revisionist assault, arguing that the physicians of Bethlem Hospital for lunatics - long the standard example of a custodial institution mired in traditionalism - were "not always so far behind contemporary therapeutics as historians have been led to believe" (p. 73). If Andrews amplifies elsewhere what he hints at here, he will soon force a rethinking of the distance between Bethlem's regimen and the supposedly new moral treatment of Tuke and Pinel.

Two other contributions merit special mention. In her study of urban growth and medical charity in late eighteenth-century Hamburg, Mary Lindemann persuasively argues that urban growth forced a restructuring of charity in which "medical care for the labouring poor seemed an attractive quick fix for many of the seemingly intractable problems of urban impoverishment" (p. 199). Revealing an easy familiarity with the larger issues in the history of poor relief, Lindemann shows how the elite's new perception of urban poverty dovetailed with recent changes in medical education to produce clinics, dispensaries, and domicilliary assistance. In a different context, Anne Summers reminds us that the fascination with novelty can obscure as much as it reveals: the origins of mid-nineteenth century nursing reforms, she argues, lie not - as has commonly been supposed - in the needs of doctors, patients, or hospitals, but in the social imperatives of Victorian Christianity. Summers' fascinating and complex revelation of the spiritual forces behind nursing reform, and the conclusion she draws from it, are the intellectual equivalent of an explosion of dynamite. The history of the hospital will now have to be constructed anew.

Space precludes more than a brief mention of the other essays. The relationship between medicine, charity, and social power is analyzed by Sandra Cavallo, who studies benefactors in early modern Turin, and by David Cantor, who examines the Empire Rheumatism Council in interwar Britain. Mutual aid, solidarism, and the limits of state responsibility in nineteenth-century France and Germany are explored in the contributions of Allen Mitchell and Paul Weindling. In this reviewer's opinion, the least satisfactory essays are those which focus so narrowly that they lose their value as case studies: unfortunately, both of the essays on maternity - by Donna Andrew and Stuart Woolf - fall into this category, as does Bernard Harris's study of government responses to unemployment among Welsh and English miners in the late twenties.

It is difficult to agree with the editors' claim that the essays "range widely across western Europe" (p. 1). Only one is truly European in focus, and half of the remaining twelve are devoted to England. As a result, Scandinavia, the Hapsburg lands, Spain, even the Low Countries - where surely many charitable innovations were pioneered - are all ignored. This is a pity, but understandable given the origins of the volume. One hopes that other editors will take up the challenge of remedying these deficiencies, ideally with fewer, longer, and more synthetic, chapters rather than the tantalizingly brief case studies that make up this volume.
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Author:Hutchinson, John F.
Publication:Canadian Journal of History
Article Type:Book Review
Date:Apr 1, 1993
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