Medicine, Charity and Mutual Aid: The Consumption of Health and Welfare in Britain, c.1550-1950 (review)

Edited collections can be one of the most valuable forms of historical publishing and also one of the most problematic. At best, a set of carefully selected essays on a well-thought-out theme can stand as a singular entity that makes a substantial contribution to the historiography. At other times, however, they can read more like an assemblage of stand-alone chapters, which, though individually of great historical value, lack an essential coherence and unity of purpose. This collection, examining charitable health care and welfare in the urban context of early modern and modern Britain, falls somewhere between these two poles. While each of these essays constitutes an interesting and thoroughly researched addition to the historiography, the impact of the book as a whole is somewhat diminished by a lack of focus and an overestimation of novelty.

First, there is the comparatively minor issue of chronology. Although the timespan of the book stretches from the mid-sixteenth to the mid-twentieth centuries, the emphasis is on the later nineteenth and early twentieth centuries. Although those contributions that deal with the early modern period are among the most useful and illuminating, it might, for the sake of consistency, have been excusable to limit the book's historical focus in this regard.

More serious is the coherence of the subject matter. This book embraces the issues of medicine, charity, welfare, and mutual aid, but it is not always clear exactly how these issues relate to one another. Most of the essays are concerned with medicine, often in the form of institutions such as hospitals. Others, such as Anne Borsay's on charitable deaf education or Sheila Cooper's on kinship and reciprocal aid in early modern England, might also be included under the history of healthcare and the body. However, some, such as Sylvia Pinches's illuminating account of the contested concept of "charity" in relation to poor allotments, Peter Shapley's essay on the roles and functions of the Co-operative Men's Guild, and Pat Starkey's study of changing attitudes toward the perceived value of clients' narratives within late twentieth-century social work, feel less at home. Although each of these essays is, in itself, an excellent piece of historical scholarship, and although I would not want to posit too narrow a definition of the subject matter, given the overwhelmingly medical focus of the rest of the collection, I cannot help but feel that they might have sat better in another work on the politics of welfare.

The real basis on which to judge this collection, however, is the extent to which it lives up to its own claims to historical novelty. As the title suggests, it is ostensibly concerned not with the provision of charity but with its consumption. In this sense it follows in the social historical tradition of "history from below," which, in the history of medicine, has witnessed an increasing concern with recognizing the agency of sick poor people and of reconstructing patients' experiences of illness and of medicine: "Too many studies in the past have taken an institutional stance, concentrating on the benefactors and officials who were responsible for implementing policies . . . [this] book moves beyond the paternalistic approach to give due weight to the attitudes and feelings of those who were meant to benefit" (p. 1). As the editors recognize, this is as much a product of the archival record as it is a willful act of condescension or denial: "the nature of the source materials means that research continues to be largely from the perspective of institutions, donors, administrators and professionals" (p 3). How, then, can this book get around these problems to access the voices and experiences of the recipients of charity?

Unfortunately, the answer is that it cannot. Aside from Stuart Hogarth's excellent...