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Bulletin of the History of Medicine 75.1 (2001) 133-134



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Book Reviews

Medicine and Charity in Georgian Bath: A Social History of the General Infirmary, c. 1739-1830


Anne Borsay. Medicine and Charity in Georgian Bath: A Social History of the General Infirmary, c. 1739-1830. The History of Medicine in Context. Aldershot, U.K.: Ashgate, 1999. xii + 484 pp. Ill. $96.95.

The goal of this book is clearly set out in its title and subtitle: Anne Borsay's intention is to present the Bath General Infirmary "as an integral part of its host society, national and local" (p. 11), in order to elucidate the many contexts in which medicine and charity interacted in Georgian Britain. The result is a densely written, fact-filled book that will repay the demands it makes on scholars with a greater understanding of eighteenth-century urban charity institutions.

Medicine and Charity begins with a brief introduction to eighteenth-century Britain, and to Bath. Part 2 of the book, "The Commercial Economy," looks at the tensions that arose from the new mercantile and commercial outlook that pervaded the city. Bath residents were acutely aware that, according to current political and economic theories, new wealth should breed corruption. They resolved this tension, Borsay argues, by supporting charitable institutions, carefully administered to guard against financial mismanagement and maintain solvency. In this way, wealth was transformed from a potential source of corruption to an agent of civic virtue. Part 3, "The Medical Profession," argues that, paradoxically, the General Infirmary provided less of an outlet for progressive ideas among its physicians and surgeons than for their administrative colleagues: "with balneology [spa therapy] translated to the margins of orthodox medicine, [End Page 133] voluntary service brought fewer clinical returns. Therefore, doctors took up complementary posts at other charities in the city that were keeping pace with new developments in medical knowledge" (p. 129). Their increasing autonomy over their own workspace and clinical materials--that is, the wards and patients--did, however, lead to increasing confidence and professional identity.

Having examined the world of those who ran the institution, Borsay, in part 4, "The Moral Economy," looks at the interaction between the Infirmary authorities and the population that the institution was intended to serve, the local sick poor. She draws on secondary literature on moral economy and on philanthropy as a form of social control to conclude that paternalistic structures of charity were declining, as laissez-faire economic theories emerged at the beginning of the nineteenth century. Part 5, "Status, Politics, and Power," looks at a different kind of insider-outsider interaction, to examine the relationships between Infirmary governors and medical men and city and county elites. The Infirmary, Borsay concludes, "fostered the development of an integrated political elite" (p. 344). This conclusion is echoed in part 6, in which she identifies Bath medical charity in general, and the General Infirmary in particular, as a window onto the emerging middle class that comprised that elite.

Medicine and Charity is not easy to read, but the detailed picture that emerges from Borsay's close attention to archival sources is very valuable. Using numerous tables, she has surely quantified all aspects of Infirmary life that can be usefully quantified. Whether her evidence, drawn from a single institution in a single city, can really support her larger claims about Georgian Britain is a question scholars may wish to ponder. This work will be useful to historians of medicine and of eighteenth-century Britain.

Lisa Rosner
Richard Stockton College

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