Medicine, Disease and the State in Ireland, 1650-1940 (review)

Greta Jones and Elizabeth Malcolm, eds. Medicine, Disease and the State in Ireland, 1650-1940. Cork, Ireland: Cork University Press, 1999. x + 278 pp. Tables. £40.00 (cloth), £15.95 (paperbound).

Many people associate Irish medical history with the Great Famine of the mid-nineteenth century that depopulated the countryside and brought a wave of immigrants to the shores of the United States. It is not surprising that images of this shattering event should be deeply etched on our historical consciousness--but there is much more to the history of health and medicine in Ireland, and little of that larger history has yet been explored. Medicine, Disease and the State in Ireland is a collaborative effort to provide a sampling of work in progress. These essays deal with medical practices and institutions, diseases and public health, state intervention and poor relief, hospitals, asylums, and the regulation of sexuality. The editors nicely describe the papers as "a collection of spotlights illuminating a small number of points in a vast sea of darkness" (p. 9). This charmingly modest description is also quite accurate: the thirteen individual studies do not connect in any clear manner to map a new social history of medicine in Ireland. Rather, each provides a glimpse of the work of its individual author. Presumably some of them will publish more extended studies in the years ahead.

These historians of things Irish have a divided gaze. Professionally, their main reference is to English medical history and to the works of Roy Porter, Christopher Lawrence, John Pickstone, and the other leading lights who are liberally cited. Another important reference point is the Wellcome Trust, which funded the conference from which these papers were drawn. The first is key to the methodological and conceptual sophistication of the new Irish history; the second is essential for nurturing its production. But equally important is Ireland itself and the peculiarities of its history and politics. Irish medical history is not merely a variant of English patterns, and the most successful of these essays draw upon the social and cultural context of Ireland in showing how different the Irish experience has been at many points.

Many of the papers illuminate the uneven struggles between Protestant and Catholic and the various permutations of this religious, ethnic, and class division. Lawrence Geary, for example, provides a well-crafted, if brief, study of several miraculous cures in the 1820s, and suggests ways in which these fueled the apocalyptic hopes and fears of the period. Maria Luddy describes how nuns essentially took over workhouse care in the late nineteenth century, asserting a strong managerial and moral presence that was not always welcomed by Poor Law commissioners. Sandra McAvoy discusses the effort to impose Catholic morality in the early twentieth century through such measures as the prohibition of birth control and the wonderfully named Evil Literature committee.

Another theme is the complicated nexus between Irish families, land ownership patterns, and emigration. Elizabeth Malcolm provides a rather frighteningly convincing suggestion that Irish families used asylums to warehouse those disaffected members, particularly middle-aged male laborers, who had failed either to emigrate or to find economic independence at home. A number of authors make at least passing reference to the relationship between land ownership patterns, diet, and poverty, although none deals with these issues in depth. Specific essays discuss typhus, tuberculosis, and smallpox vaccination, and there is an extended exploration of asylum architecture. No single collection of papers can possibly do justice to all realms of health and medicine, but this reviewer would have liked some analysis of traditional and folk medicine, alcohol consumption and diet, and childbirth and infant mortality to complement the emphasis on medical and health institutions.

This collection of essays will serve as an essential contribution to the history of Irish health and medicine. Although it does not yet constitute the coming of age of Irish history of medicine, it...