This is a slim publication at 43 pages but this should not diminish its interest to academics and scholars. The Dugdale Society ‘Occasional Papers’ series offers space to explore research in local (Warwickshire) archives and Stuart Wildman’s book pays dividends in this regard. The first quarter of the book provides context for the history of managing and receiving medical relief under the new poor law. Situating this research within a range of key texts is essential, but the contextualisation of themes in relation to other historians perhaps could have been more nuanced and more effectively threaded among the subsequent discussions of local unions. Nonetheless, a close reading of the ties and tears between national policy and local practice is without doubt the strength of Wildman’s approach in the remainder of the book. Situated within a broad Warwickshire poor law jurisdiction (poor law districts consistently do not follow county lines), this study uses that narrow ambit to go into exquisite detail. It is clear that practice bedevilled policy. As Wildman guides us through different unions within this one region, there are nevertheless wide disparities in the ways that sick paupers were treated and in the standards of care they might receive from the poor law medical services (such as they were). The Longley Strategy (broadly pushed forward between 1869 and the early 1890s) was one of the only policies from the centre that was enthusiastically taken up by many (but by no means all) local unions. Known as the ‘crusade’ against outdoor relief, because it sought to diminish reliance on welfare outside of the workhouse, the Strategy was an ideologically-motivated attempt to bring deep cutbacks in welfare expenditure across the nation. Historians dispute the effect of this, though, because it was only encouraged and not enforced by legislative action. The impact of this central policy has been difficult to measure ‘on the ground’. Wildman’s research is therefore important because it reveals the extent to which the district inspector was vehemently pushing unions to adopt crusade measures in Warwickshire. For the most part, cutbacks in welfare translated in practice to cuts in medical welfare. This was hazardous for workhouses already deluged with a sick and aged populace. In 1848, one Nuneaton parish gave out-door relief to 365 paupers—80 per cent were sick or infirm (p.15). Between the 1850s and 1880s, almost all outdoor relief in Moreton Morrell was to the ‘old, infirm or ill’ (p.15). In the mid-1880s, only 4 per cent of the Warwick workhouse inmates were able-bodied; the rest were sick, infirm, disabled and aged. Medical officers working in any of those unions would have struggled to maintain even the most basic regime of care during the crusade years. Between 1879 and 1889, the numbers of paupers in Coventry workhouse prescribed sick diets rose from 5 to 27 per cent, as Wildman observes, ‘probably as a result of the crusade’ (p.18). In many infirmaries, medical officers were hopelessly outnumbered by patient numbers, such as Birmingham with 917 sick paupers (p.18). The majority of district and workhouse medical officers were employed part time by the poor law and torn between those onerous duties and the more lucrative needs of their own private practice. In 1857, the medical officer for Warwick echoed a common complaint of many nineteenth-century medical officers: ‘420 [pauper] patients on the books many requiring surgical treatment and visiting daily. I find to attend properly to the poor I must sacrifice all my private practice’ (p.28). Notably, he resigned rather than face ruin. Not much changed in this regard until the twentieth century and medical officers frequently shouldered the blame for neglectful care (pp.24–5). It is clear that within Warwickshire’s medical services—reflecting most parts of the country—improved nursing was the turning point in providing decent medical care to the poor for many unions (pp.34–41). The simple attentions of humane care, cleanliness, regular attendance (replenishing medicaments and dressings) or help with feeding and ablutions intrinsically altered the course of medical practice (and standards of care) for the poor. Although cementing other work at the vanguard of historical welfare studies, Wildman does not bring new ideas to light. What this book does accomplish, however, is to narrow-down on one poor law region to provide invaluable (and much-needed) evidence of the crusade’s devastating effect. Wildman’s case studies inadvertently put in mind our own times. The impact of the current British government’s austerity policies mirrors the crusade years in some revealing ways. At a time of continuing government budget cuts to local government, health and social care, the severe and harmful impact of the crusade is both unnervingly familiar and prescient. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Social History of Medicine – Oxford University Press
Published: Aug 1, 2018
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