Medicine and the Workhouse ed. by Jonathan Reinarz, Leonard Schwarz (review)

Bringing together experienced and junior scholars, this collection of essays seeks to refocus attention on the significance of the workhouse in the provision of medical care. The book is split into two sections, dealing with the old and the new poor laws, respectively (though in practice, some chapters bridge both regimes). Under the former, Kevin Siena builds upon his interests in contagion and marginal metropolitan populations. Here, he argues that London’s workhouse infirmaries were medical safety nets for poor patients who were excluded from other institutions on a variety of grounds, not least a diagnosis of fever. Susannah Ottaway, an expert in the history of old age, outlines how demographic changes, the extension of life’s limits, and the medical needs of the elderly helped drive the growth of the work-house movement. This, she observes, requires fuller investigation given what we know about the care of the aged and shifting notions of individuality and freedom in the eighteenth century. The study of workhouse burials in the London parish of St Martin-in-the-Fields by Jeremy Boulton, Romola Davenport, and Leonard Schwartz quantifies the mortality outcomes for the sorts of patients discussed by Siena and Ottaway (that is, the gravely ill and the elderly). They demonstrate how the risk of death was at its highest soon after admission, particularly for males. They conclude, albeit speculatively, that the high death rate of the workhouse was more likely due to the profile of vulnerable and diseased inmates than to the environmental conditions of the workhouse itself.

Alannah Tomkins construes indoor medical relief through writings of life rather than documents of death. Mining working-class autobiographies, she addresses what might be an awkward finding in the light of the existing historiography: that is, these strategically written texts, when carefully corroborated and interpreted, are indicative of a form of care that was “deemed both materially and emotionally satisfactory” (p. 99) than we have thought so far. This, of course, was not uniformly the case; for although Leonard Smith’s chapter on mental illness does not include patient testimonies, it is clear that conditions in what he calls “workhouse asylums” were far from optimal. Straddling the Old and New Poor Law, and integrating Lunacy Commissioners’ reports with archival records from the English Midlands, Smith shows how workhouses became normalized as a locus of care for the mentally ill, and, as such, were accorded centralized inspectorial standards of care and management.

Surveys of poor law medical care in Ireland by Virginia Crossman and in Birmingham by Jonathan Reinarz and Alistair Ritch underline its increasing centrality to a mixed economy of both local and national “systems” of health care provision. Angela Negrine’s study of the Leicester workhouse infirmary complements these by highlighting the pedigree of the Poor Law Medical Officers and, despite the infirmary’s many deficiencies, she lauds the forms of care offered to paupers that otherwise would have been unavailable to them.

The depths and ramifications of “cruelty” might be said to form the basis of the two remaining substantive chapters. Samantha Shave analyzes the turning of national attention toward a series of pauper deaths and accounts of neglect in Somerset’s Bridgewater Union in 1836–37. This was no mere local wrangle, and Shave reveals how evidence from the scandal was instrumental in the shaping of the General Medical Order of 1842. Meanwhile, Rita Pemberton’s chapter on the British Caribbean provides a perspective that integrates workhouse and penal narratives very effectively. Pemberton judges, somewhat dismally, that even in a period of full and partial freedom from slavery, medical practices “buttressed, rather than relieved, the cruel impositions of prison and workhouse operations of the day on the inmates” (p. 225).

This volume leaves us with the impression that it is no longer enough to think of workhouse “medicine” in an undifferentiated way. Particular attention is paid here to the contagious, the elderly, and the mentally ill...