Charitable Knowledge: Hospital Pupils and Practitioners in Eighteenth-Century London by Susan C. Lawrence (review)

85 tice the reification that Bender and Miller would impose upon them. Mr. Gladfelder finely sees that Defoe’s ‘‘writing’s profusion and discord both stem from the intensity of his identification with the voices he invokes at the outset of each narrative.’’ In Defoe’s ‘‘edgy’’ presentation of Moll Flanders, ‘‘persistent Newgate immodesty threatens the value of her memoirs as an allegory of penitence.’’ Over forty years ago, Booth used Moll Flanders as an example of a first-person participant narrator who inevitablybuilds sympathy for herself, no matter her crimes. Starr in his Defoe and Casuistry and James Sutherland in his Critical Study anticipate Mr. Gladfelder. The figure standing between Mr. Gladfelder and these earlier critics is Bender, whom Mr. Gladfelder thanks warmly in his Preface. Imagining the Penitentiary has successfully inscribed its reductive and cynical reading of eighteenth-century fiction into the literary sensibilities of two generations of critics. Mr. Gladfelder forcefully pursues his version of the novel as a liberating , even subversive genre. Hebriefly and convincingly describes as ‘‘facile’’ James Thompson’s ludicrous claim, ‘‘The novelist’s investigation into individual motivation has the effect of legitimating surveillance.’’ Departing from the ‘‘bleak’’ arguments of Bender and Miller, Mr. Gladfelder sets up Richetti and Faller as his targets. While Mr. Gladfelder certainly is correct to say, ‘‘The ideological burden of most criminal biographies is, as both Richetti and Faller demonstrate, to reaffirm the legitimacyof legal authority,’’ he unfairly asserts, particularly in Richetti’s case, that these earlier critics were insensitive to the sympathy for criminals that these biographies encourage. This fine, useful book only sounds false when it misrepresents convenient critical targets and turns away from a more visible—if more dangerous —target close at hand. Brian McCrea University of Florida SUSAN C. LAWRENCE. Charitable Knowledge: Hospital Pupils and Practitioners in Eighteenth-Century London. Cambridge: Cambridge, 1996. Pp. xiv ⫹ 390. $95; $45 (paper). Ms. Lawrence delineates theimportant changes to charity hospitals between 1700 and 1820. In the absence of university medical education and training— the medical school at University College London did not begin operations until the late 1820s—the seven major voluntary hospitals in these years, she suggests, became central for a new medical authority. Here, one traces ‘‘the transformation of the traditional medical occupations— physician, surgeon, and apothecary— into themodernmedicalprofession’’;this took place ‘‘before the advent of organic chemistry, systematic microscopy, or anesthesia , indeed before all of the changes we now believe give medicine authority through correct science and efficacious practice.’’ At the beginning of the eighteenth century , there was an almost unregulated marketplace for medical services. Patients of allrankstreatedthemselves,consulted quacks, or used those who professed themselves licensed and trained. But urban medical culture, the nature of the clinical encounters, and patients’ attitudes and behaviors changed over the next hundred years or so. A gradual, cumulative process was led by a handful of elite practitioners, whose success depended on their hospital affiliations. Ms. Lawrence examines not only the ‘‘great men,’’but the host of obscure people who contributed to the formation of 86 a medical community on the apparently unpromising foundation of decentralized hospital teaching. An informal system of ad hoc private lectures and hospitalwardwalking , coupled with the growth of a prolific medical press, eventually created a newly articulate group of general practitioners who looked to the hospital physicians and surgeons to legitimate their claimsto authority andtraining.Itwasthe public world of the hospital rather than their private apprenticeships to which these men turned for substance. Charitable institutions became centers of social , intellectual, and pedagogical authority ; the hospitals’ status as public charities established and consolidatedthe elite status of hospital physicians and surgeons . Dignified, cautious, prudent, disinterested —institutional affiliations conferred these attributes to hospital doctors and, in more attenuated form, to those they instructed. Hospitals ‘‘promised a strong antidote to fraud, if not to error, with medical students and other practitioners subjecting patients to ‘public inspection.’’’ Where once practitioners might have been accompanied by a handful of apprentices or university men, they more and more drew crowds of short-term pupils who walked the wards with them, a pattern that ‘‘confirmed and strengthened hospital men’s prestige and influence as the arbiters of medical knowledge.’’Traditional distinctions were...