Medicine and the Workhouse edited by Jonathan Reinarz and Leonard Schwarz (review)

This book seeks to bridge a gap that the editors identify between welfare history and medical history. They argue that welfare historians have tended to focus on the “relieving” functions of the Poor Law, whereas medical historians have directed their attention to the history of voluntary hospitals and neglected the role of workhouse infirmaries. Although this description may be unfair to earlier historians of the Poor Law medical service, such as Hodgkinson and Flinn, it is certainly doubtful that the histories of sickness and poverty should be separated in this way.¹ Even if we leave aside the question of the extent to which poverty was a direct cause of sickness, sickness was certainly a frequent cause of poverty and the Poor Law authorities had an obligation to provide not only for the “able-bodied poor” but also for “the lame, impotent, old, blind and such others among them being poor and not able to work.”²

The contributors employ a range of strategies to address this gap. The majority of the chapters tend to rely on traditional forms of documentary analysis using a variety of institutional and official records, such as the Minute Books of the Birmingham Board of Guardians and the Parliamentary Papers. Methodologically, the most innovative chapters are those by Jeremy Boulton, Romola Davenport, and Leonard Schwarz about the mortality of inmates at the workhouse of St Martin’s-in-the-Fields, and by Alannah Tomkins, who consults working-class autobiographies to reconstruct the “patient’s view” of workhouse care. The book’s other chapters also address a wide range of health-related issues, including such topics as infectious disease, maternity care, various forms of mental affliction, the infirmities of old age, and medical innovation.

One of the central themes of the book concerns the distinction between the Old and New Poor Laws. Of the nine chapters that deal mainly with England and Wales, four are largely concerned with the Old Poor Law and two with the New Poor Law. Three of the chapters span both epochs. The overall conclusions tend to reinforce Flinn’s view that the advent of the New Poor Law led to improvements in the quality of medical provision in some areas and a decline in others. Parts of the service likely deteriorated in the face of demands for “economy” and “less eligibility.” However, as Samantha Shave demonstrates, the establishment of a central authority also created the opportunity for new forms of accountability, in which the exposure of local “scandals” could increase the pressure for centrally induced reforms.

The book also includes two chapters about the relationship between medicine and workhouse provision in the different settings of Ireland and the Caribbean, together with a reflective afterword by Steven King. One of the most important points to emerge from the book is the need to place the workhouse in what King describes as the “mixed economy of health care for the poor” (230). Although it can sometimes be tempting to think of “the poor” and “paupers” as relatively static groups, they should be discussed more dynamically. We still need to know more about the routes that took people into (and, less often) out of pauperism, the ways in which they utilized different forms of health care throughout their lives, and the role that sickness played in precipitating periods of hardship and destitution.